The use of IVF with donor eggs and sperm is now commonplace in the IVF field. Improved donor screening, vitrification processes and improvements in scientific technology and knowledge have contributed to ensure that procedures involving donor gametes are more successful than ever.
IVF with donor eggs and sperm refers to treatments where an egg or sperm has been donated by an individual to assist male or female patients conceive. A donation may be used when the man or woman cannot produce their own viable sperm or eggs capable of creating a pregnancy or in cases which involve patients without a partner or same sex couples. Treatment providers may have their own gamete banks to retrieve donations from or use the services of a third party bank. Donors are compensated for any donation and are screened to ensure they are physically, psychologically and genetically fit to donate.
Patients denied the chance of parenthood because of their inability to produce viable sperm and eggs of their own are now able to access treatments all over the world. These treatments are amongst the most successful of all IVF procedures and as more and more countries and treatment providers offer donor treatments the cost for patients is reducing. Once, access to donor intervention was solely owned by the privileged but now thanks to increased availability it has moved into mainstream assisted reproduction and patients have the option to travel to destinations offering treatments at very competitive prices.
On the back of increased demand for donor treatments individual clinic providers have invested in developing their own donor banks which alongside independent third-party sperm and egg banks have ensured that patients can generally satisfy their specific requirements by accessing gametes in a number of ways.
Patients can choose to receive anonymous or non-anonymous donations and consequently are able to find as much, or as little, about the donor as they wish.
IVF with donor eggs and sperm have meant that many more people have had the opportunity to become parents, but such treatments do come at a price, and not necessarily just a financial one. The intervention of a third party in the reproductive process can have emotional ramifications for the recipient. Naturally, patients might wonder whether any baby born from a donor will inherit their physical or mental characteristics; whether accepting a donation carries any risk to the unborn baby or having to decide what information about the donor treatment to share with the child as they grow.
With this in mind countries and treatment providers have developed safeguards to monitor and restrict unfair practices in relation to donor treatments. Appropriately regulated and registered IVF clinics screen donors to ensure their physical and mental wellbeing and many provide additional support services designed to ensure patients who undergo donor treatment receive all the information they require pre and post procedure.
This article illustrates how both egg and sperm donation treatments are offered in a select number of European countries, concentrating on the make up of donors from each country, the cost of the treatments offered and any restrictions regarding access to the procedures.
IVF with donor eggs and sperm: when might this be appropriate?
The use of donor eggs and/or donor sperm may be advised by your doctor in cases where a negative diagnosis is made; that is to say, when there is no or very little possibility of a pregnancy being achieved because of you or any partners ability to produce viable gametes. This may because of a number of problems linked to a woman’s endometrium including ovarian function or other disorders like endometriosis which might make conception difficult. The use of IVF with donor eggs and/or sperm might also be advisable where a single woman is seeking treatment or in the case of a lesbian couple. A sperm donor would be required in either case but depending on the woman patient and her fertility health she may well be reliant on an egg donor as well.
Successful IVF procedures depend on a number of variables but one of the main determinants of success if the age of the woman. As a woman ages so does her ability to produce healthy eggs. As a rule of thumb, a woman is at her most fertile between her late teens and mid 20’s; from the age of 30 her fertile health begins to decline. This decline is particularly apparent after the age of 35 and by the time she reaches her mid 40’s it is especially difficult to conceive with her own eggs as the menopause begins. In cases involving maturity of age or a diagnosis which is irreversible it might be advisable that she undergoes IVF with donor eggs.
IVF success is also dependent upon the woman’s ability to maintain a pregnancy; if she has had a history of miscarriages, or has problems associated with other disorders. The use of donor gametes therefore may well be advised in such cases or when, for instance, chromosome defects were detected which could result in serious genetic diseases or problems with fertilisation or embryo implantation.
For male patients the use of a sperm donor might be advisable when there are issues involving sperm quantity, quality and morphology. It may be appropriate also when male factor infertility has been identified in previous failed cycles that the patient has undergone or in situations where the patient has undergone an irreversible vasectomy or chooses not to reverse it.
Decisions about the use of donor eggs and sperm is a complicated one. It depends on multiple factors including age, the physical health of the patient, genetics, and a patient’s ovarian function and sperm quality.
IVF with donor eggs and sperm: how does it work?
IVF with donor eggs and sperm involves the involvement of a second or third party in the assisted reproduction process. Put simply oocytes or sperm are collected from a donor and made available to patients whose ability to achieve a pregnancy has been restricted or denied due to the absence of a partner, or due to their ability to use their own eggs or sperm in way that would create and maintain a pregnancy.
Donors will undergo extensive screening by clinics or sperm/egg banks to ensure they are physically and psychologically fit; they will be young and healthy (usually under the age of 35) and capable of producing viable eggs and sperm. Depending on the country where the donation was given the donor’s details will either be anonymous or will be made available to the recipient and any child born as a result of the donation at some point. Donors do ordinarily get paid a compensation for donating. Depending on the patient’s requirements an egg donor or a sperm donor will assist the fertilisation process. In certain cases a so-called double donation will be required – when a patient required a donation from both, an egg donor and sperm donor. The fertilisation process will be undertaken in a laboratory and when embryo cultivation has been achieved the embryo is transferred to the recipient, hopefully resulting in a pregnancy which can be maintained and lead to the birth of a healthy baby.
IVF with donor eggs and sperm: success rates
IVF with donor eggs and/or sperm is a much requested and much advised treatment. The reasons for this are bound up with the physical needs of patients (their inability to undergo treatment using their own gametes) and the successful nature of the procedure(s). The composition of donors (age, health and so on) means that they are more likely to produce healthy, viable eggs and sperm and consequently, in general treatments of this kind are more successful than IVF procedures using patients’ own eggs and sperm.
Whilst we have to display some caution to some of the claims made by treatments providers who suggest that donor treatments can rise to 80 or 90%, a look at country based professional organisations and regulators does substantiate the view that, on average success rates in treatments where a donor is involved are higher than in IVF procedures which use the patient’s own eggs and sperm. According to the most recent figures produced by SART (Society for Assisted Reproductive Technology) in the United States live births (the most important indication) can rise to 45 – 50% when frozen or fresh donor eggs are used.
Sperm donor treatment: availability
Sperm donor treatment is widely available in a number of countries but there some caveats which exist that preclude some patients from accessing the treatment and differences in cost are widely experienced. This is exemplified by the inequitable access for single women and lesbian couples where sperm donation is only available in a select number of countries across Europe. The ethical standpoint adopted by most countries is that donors should not receive ‘payment’ but merely compensation or reimbursement. The amount of compensation can, however, vary from country to country. All sperm donors will be screened for to ensure their psychological and mental wellbeing and will have undergone a semen analysis to ensure the viability of the sperm. Treatment providers offer donors recruited by themselves as well as donations purchased from registered third-party sperm banks.
Before we take a look at a snapshot of sperm donor availability and costs which are offered by treatment providers themselves it is important to discuss the role in which third party sperm banks play in the provision of sperm donation treatment.
Sperm banks can supply donated sperm to both treatment providers and individuals. Dependent upon where they operate they will be required to work under licence and their working practices will be overseen by a regulating body. In Europe this is undertaken via the EU tissue Directive, in the UK it is the responsibility of the Human Fertilisation and Embryology Authority (HFEA) and in the United States sperm banks are regulated by the Food and Drug Administration. Sperm banks are able to export donations across borders under strict safety regulations but this movement may be restricted due to the legal rules around anonymous/non-anonymous donors in different countries. For instance, if you are undergoing treatment in a country in which all donors need to be known you will only be able to access a donation from a donor who has given it with the knowledge that his or her identification will at some point be passed on to the recipient and child. You will need to check with your choice of clinic if donor sperm can be obtained from a specific bank.
IVF with donor sperm and eggs in UK
Since 2005 anyone born as a result of donor sperm can, at the age 18, request the donor’s name and last known address; therefore, donors are regarded as non-anonymous. Sperm donors in the UK receive a payment of £35 per clinic visit to cover identifiable expenses and one donation can be used to create a maximum of ten families. All donors are checked to ensure they are genetically and psychologically fit. The use of donor sperm can add an additional £500 plus to the overall cost of IVF treatment and can be used by single women, lesbian couples and unmarried heterosexual couples. Waiting times are relatively short and as clinics utilise the services of external gamete banks donor availability (all races) is good.
IVF with donor sperm and eggs in Spain
Spain continues to be one of the go-to places for international patients seeking donor treatments and consequently donors are plentiful. It is not permissible to use the sperm of a friend or family member and donors are anonymous, meaning their personal details are not accessible by any child born as a result of their donation. Donors are paid an average of €50 compensation (for any inconvenience) per donation and are limited to creating a maximum of six births. All donors using the facilities of a licensed clinic are comprehensively screened for sperm quality and to identify the presence of any genetic or sexually transmitted disease. The use of donor sperm can add an additional €500 to €1,500 to the overall cost of IVF treatment. Donor sperm is available to single women, lesbian couples as well as unmarried heterosexual couples. The availability of diverse donors is good and where there is a shortage many clinics use external gamete banks who offer anonymous donors. There are no waiting times.
IVF with donor sperm and eggs in Czech Republic
Sperm donation is anonymous under Czech legislation and the country is rapidly becoming one of the more popular destinations for patients seeking fertility treatment. Donors are paid compensation for identifiable costs incurred when donating and can contribute to the development of ten families. Checks are made to ensure donors don’t pass on any genetic or sexually transmitted disease. Using donor sperm will add an additional €200 or so to costs and is available to single women or those in a same sex relationship. Donor availability is limited mostly to Caucasian phenotypes although working with external gamete banks ensures clinics can offer alternative donors. In the Czech Republic there are no waiting times for IVF with donor eggs and sperm.
IVF with donor sperm and eggs in Greece
Sperm donors are anonymous across Greece and the act of donation is seen as voluntary with a compensation for travel expenses and loss of earnings during the donation process being the only acceptable financial compensation allowed. By law, donors can only contribute to the development of ten families and all undergo a series of tests to ensure their physical and genetic suitability. The cost to use donor sperm could reach €800 per treatment and is only available to single women but not strictly for those women in a same sex relationship. There is no waiting time which is available via the clinic or external gamete bank and which ensures a diversity of donors.
IVF with donor sperm and eggs in North Cyprus
In North Cyprus, sperm donors are anonymous and once again the act of donation is seen as voluntary with a compensation for travel expenses and loss of earnings during the donation process being the only acceptable financial compensation allowed. Treatments involving sperm donors can increase the overall cost by €200 to €500 – as you would expect all donors are psychologically and genetically fit for purpose; there are no waiting times for diverse donor sperm (from clinics or independent gamete banks) and it is available to unmarried heterosexual and lesbian couples as well as single women.
IVF with donor sperm and eggs in Ukraine
Sperm donors are anonymous in Ukraine and can contribute to the creation of up to six families. They can receive up to €400 in compensation for their donation, patients requiring donor sperm will pay an additional €350. Donors (mostly Caucasian) are required to pass stringent screening tests to ensure their fitness to donate and is available for single women and married (heterosexual) couples but not for same–sex couples. There are no waiting times for donor sperm which can be obtained via independent gamete banks if required.
IVF with donor sperm and eggs in Russia
Sperm donors in Russia can donate anonymously or non-anonymously and can receive up to €1,500 in compensation for their donation. Donor sperm is available for single women and married heterosexual couples only, and can cost anywhere between €150 and €400. Donations from individual donors who are deemed physically, mentally and genetically fit are available direct from treatment providers or third party gamete banks. Most phenotypes are offered and there is no waiting list to access treatments involving sperm donors.
IVF with donor sperm and eggs in Portugal
Recent legislative change in Portugal means that sperm donors are considered as non-anonymous. They are paid €44 for each donation and can help create a maximum of eight families. They are screened to ensure they are genetically and physically healthy and the use of donor sperm is subject to approximate additional cost €450. It is available for single women, same sex (women) and heterosexual couples. The country offers a diverse donor database and can, with the help of third party gamete banks offer treatment without a waiting time.
The Emotional Impact
One of the most discussed areas of concern for donor recipients is the issue of genetic association. For many who undergo donor treatment the desire to have a baby significantly outstrips the absence of a direct genetic link with the child.
Deciding whether to undergo IVF with donor eggs and sperm is a big decision and is one that is only considered when all other options have been considered and discounted. As a patient you should discuss the practical arrangements with your treatment provider and seek consultation, and if necessary, counselling with an appropriately qualified professional who will discuss the potential emotional and psychological ramifications of receiving this type of treatment.
One important point to remember, however, is that the donor merely performs the biological aspect of conception; their involvement is functional and necessary for you to achieve a pregnancy. Once a pregnancy is achieved it will progress like any other ‘natural’ pregnancy, your role as a ‘mother’ or a ‘father’ will be just that.
A lack of genetic association can also lead the patient to question whether the baby will exhibit any physical or behavioural similarity with them. Sharing a genetic identity however does not automatically guarantee a physical resemblance to the biological mother or father. Genetic composition is complicated and therefore there are no guarantees or certainties that physical resemblance will be passed onto a child in any circumstance.
If, however, the patient wants the baby to exhibit certain phenotypes that are similar to their own treatment providers now employ a sophisticated range of tools to enable them to match donor profiles with recipients. One example is the increased use of artificial intelligence which can assist the process of facial resemblance between donor and recipient. Many treatment providers now offer different products to ensure facial similarity.
Treatment providers also employ a range of genetic and blood tests to ascertain the donor’s health and use their medical history to ensure that they do not have a family history of genetic or chromosomal issues that may have a negative impact on a pregnancy involving a recipient couple. In countries where donors are anonymous, information relating to their medical history and core physical traits such as eye and hair colour and blood type will be shared with donor recipients.
The emotional aspect of donor treatment can not be underestimated however and there are a number of psychological and practical considerations which need to be contemplated. The recipient(s) will potentially need information from different sources to rightfully be in a position where they can agree to informed consent and there is the ethical dilemma of sharing information with the baby as it grows into childhood.
Donor treatment is the only solution available to many, the process involves multiple considerations but there are a number of independent agencies, therapists and counsellors with the experience and knowledge to assist anyone who wants to address the emotional and psychological nature of the treatment.
We know you will have many unanswered questions regarding treatments using both donor egg and sperm, and we hope this article has been useful in providing some baseline information regarding policies and practices undertaken in various countries. We have provided below some answers to the questions we are asked most often.
IVF with donor eggs and sperm – FAQ
Can you do IVF with donor sperm?
IVF with donor sperm is offered by treatment providers across the world although there are country-based differences in terms of accessibility, cost, legal restrictions and success rates. It is a widely used treatment for heterosexual and lesbian couples as well as single women. Depending on the country in which you receive treatment donor identity may be anonymous or non-anonymous. Donor sperm in IVF is used in exactly the same way as if the sperm was obtained by the patient. Namely, eggs are removed from the patient and are fertilised with the donated sperm in a laboratory petri dish before being transferred back into the patient’s womb.
How successful is IVF with donor sperm?
On average IVF with a sperm donation has a higher success rate which is mainly due to the use of high quality, viable sperm obtained from a younger, healthy donor. When assessing success rates, a note of caution has to be applied as particular countries and treatment providers use different benchmarks to judge success and these rates go up and down depending on the patient’s age and general health. However, if we look at some average figures, we can see how donated sperm treatments tend to be more successful. According to figures produced by ESHRE (European Society of Human Reproduction and Embryology) in 2019 the average success rates were 27.1% per IVF treatment. Comparing a number of leading fertility clinics who publish success rates relating to sperm donors, rates jump to over 30% and more – cumulatively, this figure can rise to 80%.
How successful is IVF using donor eggs?
Donor egg treatment once again fairs very well compared to treatments using a patient’s own eggs. The reasons for this are numerous but the quality and viability of donor eggs is the key to high success rates. The rates themselves will again depend on the age and general health of the recipient and caution is required once more when comparing success rates between treatment providers as they may present rates in different ways. According to the Human Fertilisation and Embryology Authority (HFEA) in the UK average success rates using donor eggs in 2018 were 27.5% for women aged over 44 rising to 32.8% for women under 35; both higher than the overall average figure quoted by ESHRE for the same period.
What is cost of IVF with donor egg and sperm?
The cost of treatment using donor egg or sperm will vary considerably between countries and within them also. Public funding systems for supporting patients to access treatment is patchy across Europe with four of the 44 countries in Europe not providing any financial assistance to patients. are extremely variable. Four countries provide no financial assistance to patients.
IVF programs that involve the intervention of a donor are the most expensive treatments in any country. Average costs are difficult to calculate precisely as prices vary considerably in each country. For a ballpark figure however average prices across Europe run from 1,500 euros through to 10,000 euros. Countries like the Czech Republic, Poland and Ukraine tend to offer the least expensive treatments whilst the more expensive costs are found in the U.K. with countries like Greece and Spain somewhere in the middle.
What is double donor IVF success rates?
The so-called ‘double donation’ or embryo donation treatment involves the use of both an egg donor and sperm donor. Donor embryos which have been created by male and female donors is the most successful technique to increase the birth rate used by treatment providers for all ages of patients. This type of treatment This type of treatment is widely available although there are a small number of countries in which it is not permitted including Germany, Norway, Switzerland and Turkey.
This treatment is particularly appropriate when a woman has experienced ovarian failure or has a genetic disease; for single women or where the male partner cannot produce any viable spermatozoa. Vitrified embryos created from double donors represent the best chance for creating a pregnancy and as such success rates are extremely high compared to other treatments.
If you are considering embryo donation treatment consult a number of providers to gain an appreciation of the success rates quoted.