OOCYTE DONATION

WHAT IS OOCYTE DONATION?

Oocyte Donation (OD) is the procedure whereby an oocyte from a donor is fertilized by sperm from a recipient man and the subsequent embryo is inserted into his wife's uterus with the intention of her becoming pregnant. The treatment has been used for many years and has a high success rate of up to 15% per month and 60% over a six month course of treatment.

WHO CONSIDERS OOCYTE DONATION?

Approximately one in 35 women are unable to produce their own eggs. Indications for this include those women:

1. entering menopause (prematurely);
2. having no ovaries;
3. having hereditary disorders;
4. having inaccessible ovaries (unable to collect her oocytes);

Once it has been diagnosed that the female partner is unlikely to be able to produce her own oocytes , the couple have three choices. One is not to have children and to concentrate on developing their own lives and interests. Secondly, the couple can aim to adopt a child. Unfortunately this is difficult as there are few children for adoption and waiting lists are very long. If a couple does adopt, they have a ready made child, without the risk of complications of pregnancy and childbirth. However, they do not have the shared experience of pregnancy and labour, nor do they make any contribution to the genetic make-up of the child. The third choice is using donated oocytes.

OD has the advantage that a pregnancy can be shared by the couple and half the genetic make-up comes from the father. The shared experience starts with the excitement of the misse d period, the diagnosis of pregnancy and continues throughout the pregnancy, climaxing with the delivery of the child.

Unfortunately, OD cannot protect the expectant mother from the complications of pregnancy and childbirth. Women who have children by OD have exactly the same risk of an abnormality in their children as those who conceive naturally. There is no decrease or increase in the risk of congenital abnormality.

WHO ARE THE DONORS?

The selection of women who apply to become oocyte donors is complex. In order to be considered as a possible donor, a women must be aged between 18 and 35 years.

Prospective donors must provide a full personal and family medical history and answer questions specifically about activities associated with risk of AIDS infec tion.

The donor will be seen by her clinician who will discuss medical issues, and she may attend a counselling session to ensure complete understanding about what is involved and the legal issues associated with becoming a donor.

Many people are intereste d to know what kind of women become donors. Studies indicate the most common characteristic donors possess is a desire to help others. Oocyte Donors are often blood donors and many report having friends or family who have had a fertility problem.

OOCYTE COLLECTION

If the donor meets the clinic requirements, the donor has blood taken. This blood is tested for HIV (AIDS virus), Hepatitis B and C and Blood Group. If all these tests are clear the donor is examined by a clinic doctor who can review the family medical history and ensure that the donor is in good health.

The donor then undergoes a stimulation programme using natural hormones to produce a number of oocytes (refer IVF or GIFT literature).

DONOR SELECTION FOR COUPLES

Couples are given the non-identifying information about the donor. This information includes race, ethnic origin, height, build, hair and eye colour and blood group.

Couples are provided with oocytes from a donor whose physical characteristics most closely resemble those of the wife, although other factors such as ethnic origin and blood group may influence the decision. The availability of oocytes often makes close matching very difficult.

WHAT IS INVOLVED IN OOCYTE DONATION

The donor oocytes must be fertilized at the time of collection, which occurs in the middle of the donor's menstrual cycle. Once fertilized the embryos may then be implanted into the wife or frozen for storage. The procedure used depends upon whether the wife's hormone and monthly cycle coincides with the donor or not. Ovulation is monitored by blood or urine tests which must be undertaken daily to predict the exact timing of OD.

The embryo transfer is a simple procedure rather like having a Pap Smear Test. It is done in the clinic and does not take long. Afterwards the wife is required to lie quietly for some hours before being free to resume her normal activities.

If a pregnanc y does not occur the treatment may be repeated during subsequent menstrual cycles if further oocytes are available.

DECISION MAKING

In our society today there are many different ways to form a family. Oocyte Donation is one way many couples have chosen to produce their families. However, the decision may not always be straightforward, nor will each partner be certain that this method of family formation is for them.

In some cultures, eg Islamic societies, OD may not be acceptable.

All couples approaching the Oocyte Donation service should discuss their plans with the centre counsellor. This session does not consist of any assessment as to a couple's suitability to become parents. The decision to start on an Oocyte Donation programme is one made by the couple in consultation with their doctor. It is, however, a decision which we consider to be a serious one and it may not be the right choice for all couples. Even for those couples who proceed to Oocyte Donation, there can be social and emotional hurdles to be overcome.

The clinic counselling service offers the opportunity to discuss the issues that might arise if a couple proceed with oocyte donation. The counsellor may also be in a position to discuss the issues which have arisen for other couples who have children from the programme. The legal aspects and issues such as telling the family, friends and the children about oocyte donation will be discussed with you in the counselling session.

COMMON PROBLEMS

1.  To tell or not to tell friends and family?
2.  Practical difficulties - travelling to and from the doctor or Concept Fertility Centre, explaining to employers the need to arrive late, leave early, or even take days off ... all without giving a reason why!!
3.  Anxiety can often delay the ovulation cycle and further complicate treatment.
4.  Couples under stress may develop some problems with their sexual relationship.
5.  Couples may also experience problems when one partner wants to undergo O.D. and the other partner is not comfortable with this form of treatment.

KNOWN DONORS

Some couples decide that the use of a donor known to them is preferable to the notion of an unknown donor. This is perfectly acceptable.

A known donor and if married, her husband and the recipient couple, will discuss their plans with t heir doctor and then the centre counsellor before donating or receiving oocytes. A six month "cooling off" period is recommended before ooycte collection or donation.

These are then either transferred or stored as for an unknown donor before embryo replac ement can take place.

SOME IMPLICATIONS FOR THE CHILD, PARENTS AND DONOR.

• Does a child have the right to know about his or her origins?
• Are there dangers inherent in telling a child about its OD status?
• Are there dangers inherent in attempting to keep OD a secret from the child?
• Should there be legislative changes nationwide, in order to safeguard a child's legal status and rights?
• What is the effect of denying OD on the marital relationship of the childless couple?
• Does secrecy have harmful effects on relationships within the wider OD network?
• The immediate transfer of an embryo (rather than storage for 6 months) will allow an increased success rate but does not allow for further health testing of the donor.