The gift of hope
Have you ever considered donating your eggs so that an
infertile couple may also experience the joy of parenthood?
Each year, a small number of New Zealand couples rely on donor eggs
to conceive a child. Dr Richard Fisher explains who the donors
typically are, and what the process involves.
One of the many challenges to
modern relationships is the increasing incidence of subfertility
and the consequential strains that this can place on a marriage or
partnership. When the reason that the failure to conceive is that
the gametes (eggs or sperm) are present in insufficient numbers or
insufficient quality, this complicates those difficulties further.
The most common resolution to this type of problem is to use the
gametes of someone else.
Last year, around 80 couples had treatment using
donor eggs at Fertility Associates. In Australia and New Zealand,
the numbers have increased from 450 in 2000 to 1,800 in 2006.
Although the social issues that come with using
either sperm or eggs are similar, the physical processes involved
are, of course, quite different. Women who donate eggs submit
themselves to an IVF cycle and all its attendant treatment and
risks, whereas it is somewhat less complex for men.
In 2008 at Fertility Associates, there were more
couples involved in treatment with donor eggs than there were with
donor sperm. The major reason for this is the increasing ability of
reproductive medicine clinics to use the sperm of men in treatment
even when they are present in only very small numbers. Whereas with
women, as egg numbers diminish from whatever cause, there is often
an associated change in the quality of the eggs as well as an
underlying much-reduced chance of conception.
So, who uses donor eggs to enhance their chances
of conception, and what are the issues surrounding this
When the use of donor eggs was first introduced,
most women who were the recipients were young and had run out of
eggs much earlier than they might have imagined. This was either
from underlying genetic causes leading to premature ovarian failure
and premature menopause, or from a surgical event in which the
ovaries had been removed because of pre existing disease, or
damaged by the presence of ovarian cysts and recurrent surgery.
Premature ovarian failure occurs in around 2% of women where
periods stop before the age of 40 as a consequence of simply
running out of eggs.
Fertility declines dramatically, however, some
ten years before menopause. Even women whose menopause might occur
much nearer the usual time can expect their fertility to be quite
limited, much earlier than they might wish or expect. As a
consequence of this, an increasing number of women in their late
30s and early 40s find that they are unable to conceive naturally,
and that the processes involved with IVF using their own eggs are
unable to produce enough eggs of sufficient quality to enable
conception to occur.
With the delay in starting a family in Western
societies, this has meant that an increasing number of women
who would otherwise have conceived without difficulty begin to face
complex dilemmas. The development of a new test measuring
anti-Müllerian hormones may help us predict in advance whether
individual women will be in this group, although I suspect that for
some time yet, the social structures of our community will continue
to drive the time that women choose to conceive rather than their
Whereas 2% of women will reach menopause before
40, a further 15% (approximately) will do so before 47, and this is
the group of women caught with more rapidly diminishing
fecundability (the chance of conception each month), and who
consequently become much less fertile in their 30s than they would
ever have expected.
Within this group are couples already involved
in complex treatment where eggs are found to be abnormal, or that,
for some unexplained reason, it is not possible to stimulate the
production of sufficient eggs to make IVF a viable option.
Unfortunately, mature eggs are not simple to
create or extract. A woman wishing to donate eggs needs to undergo
a cycle of treatment using drug protocols identical to a woman
undergoing IVF. The only difference is that, at the point of
collection of the eggs, they will be fertilised by the recipient
woman's partner's sperm, rather than that of the donor's
As fecundability decreases with age in all
women, the biologically ideal donor would be as young as possible.
The fact that treatment is complex, however, and not completely
without risk, either physical or emotional or both, has led to some
broad guidelines around the suitability of individuals to be
donors. Generally, it is preferred that women have completed their
own family before being a donor, and that they are 25 years or
more. We ask donors to discuss the issues surrounding donating
their own genetic material with one of our counsellors in
circumstances independent of the recipient's presence. Because the
chances of conception not only depend on the age of the donor, but
also her general health, donors should be non-smokers and have a
body mass index within the usually accepted healthy range. Donors
are also seen by a doctor, independent of the recipient's doctor,
who makes a medical and genetic history assessment to ensure their
own safety and to ensure availability of knowledge about any
potential genetic risks for a subsequent child.
Who then are these donors? It says much for the
innate altruism of women that we have more egg donors presenting
than sperm donors.
At Fertility Associates, around 50% of women
presenting as donors are friends or family, personally recruited by
the recipient woman. The remainder are women who have volunteered
in response to an advertisement in a magazine such as OHbaby!, or
on websites with fertility-specific areas. Our advice to potential
recipient women seeking egg donors is to be very careful in the way
they approach others, as there is a potential that their not
unreasonable answer to decline involvement may lead to a more
distant relationship in the future from someone who was close
enough and important enough to approach in the first place.
The nurses who coordinate our donor egg
programme act as the intermediaries in recruitment by
advertisement. They ensure that the recruitment process is
initially at arm's length, so that both parties are well informed
without the necessity for complex personal interactions, with
potential disappointments, if the process does not proceed.
Our experience with women who are donors is that
they are primarily driven by altruism. It is illegal in New Zealand
to buy or sell eggs, and no "valuable consideration" can change
hands as part of this gift. Donating to friends and family often
just seems the right thing to do for many women, particularly those
who have experienced the joy of parenthood themselves, and many
women who are initially strangers to the recipient couple have a
very similar feeling. Non-family donors may place restrictions on
the people they would wish to donate to and many do. A good fit is
important for future comfort. Donors usually gain a great deal of
satisfaction from this process. Some say that next to having
children themselves, it is the most worthwhile thing that they have
Some donors wish to meet the recipients prior to
donation, and others do not. Likewise with the recipient couples.
The coordination of such relationships by clinics is critical to
the long-term success of such arrangements. The law in New Zealand
is quite clear: the woman who carries and delivers the baby is the
mother of the child; the man who is that woman's partner is the
father. The donor has no legal responsibilities and clearly, as
circumstances differ, may make different degrees of contact, from
none to significant involvement, after the birth of the child. The
law in New Zealand requires that the birth of a child conceived
from the use of donor gametes should be registered on a specific
register with Births, Deaths and Marriages, which allows that child
to find out his or her biological parentage in time if he or she
wishes. It is the very clear view of our clinic that children
should know from early on the way in which they were conceived. Any
sociological data available suggests that this is in the child's
best interests, and early introduction to the concept leads to far
fewer potential problems. Secrets are damaging to family
relationships and openness offers the best chance of comfortable
Internationally, the law varies considerably.
Some countries, such as Italy, ban the use of donor eggs. Many
other countries in Europe, however, have essentially open access to
the possibility, and in the United States, a thriving commercial
market in donor eggs and sperm exists. In the United States, many
young university undergraduates fund their way through university
by donating eggs. The value of their eggs depends on their
academic, social, and physical history. The fact that the women are
young makes them desirable donors. Were it not for payment for
eggs, they would be very unlikely to donate, and so the model for
egg donation differs greatly in the US from New Zealand. At the
time the Human Assisted Reproductive Technology (HART) Act was
passed here, a decision was made by our Parliament to use only
non-commercial donors. The effect is to both limit the available
pool of potential donors, and to lower the chance of success, given
the relatively older age of most New Zealand donors. This is the
choice we made and we, as practitioners, live with it comfortably.
It is hardly surprising, though, that a significant number of
couples choose to have treatment internationally, and in the United
States in particular.
I have never doubted, however, that couples
seeking treatment in this way have the best interests of their
children at heart, and they are probably better protectors of their
childrens' interests than those who govern us. The balance between
philosophical, political, and cultural concerns, and the enactment
of practical legislation to ensure a particular outcome, seems
beyond our joint endeavours. Those who choose to have children, by
whatever means, usually care for them pretty well. Children
conceived in the US are unlikely to be worse off than those
conceived in New Zealand, given the commitment of their parents.
The concerns which led to the enactment of this part of the HART
Act are proving to be unfounded, given that most US clinics use
Donating eggs is the most generous gift, and a most
greatly appreciated one by many women who would otherwise be unable
to experience the joys of parenthood.
Richard Fisher (FCROG,
FRANZCOG, CREI), together with Freddy Graham, established Fertility
Associates in 1987 after previously starting up New Zealand's
integrated infertility medicine group at National Women's. He is
New Zealand's foremost medical spokesperson on matters of
reproductive health, and has been an advocate for better access to
care for couples with infertility throughout his career. He has
four children and is married to Leigh, without whom he could never
have practised medicine with the enthusiasm and commitment he
www.fertilityassociates.co.nzwill tell you
more about Richard and the team at Fertility
As seen in OHbaby!
magazine Issue 7: 2009
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