Home or overseas?
Donor conception outside the UK
Recruitment of donors abroad
Whilst it is reasonable to assume that most donors will have mixed financial and altruistic reasons for donating, there have been anecdotal reports in the past that egg donors in some countries have been recruited in circumstances that suggest exploitation. The secrecy surrounding anonymous donation and the uneven pattern of regulation in other countries make it very difficult to know how much truth there is in these reports. The EU Tissues and Cells Directive says that EU donors should not be paid for donating but can be compensated for inconvenience. Clinics outside the EU are not bound by this directive, although the UK when it leaves the European Union, will remain highly regulated.
It is often difficult to get meaningful assurances about the circumstances in which overseas donors have been recruited. Some donor conceived adults have spoken of feeling demeaned by being the result of a commercial transaction. For others it seems to matter less or not at all. None of us can know how our children will feel in the future about this.
Donor information and selection
In the UK non-identifying information is given about both sperm and egg donors at the time of donor selection, although some clinics will withhold information beyond a basic physical description, age, nationality etc., until a woman has a confirmed pregnancy. The HFEA guidelines encourage clinics to show potential recipients, prior to selection, all the non-identifying information available, plus any pen portrait and ‘letter to the child’ that has been written by the donor, but some clinics still withhold the information until there is an established pregnancy. Most people will be able to make their own choice of donor, although choices may be limited in the case of some ethnic minorities and if people are wishing to match to specific features like red hair.
Outside the UK there is no standardisation of the non-identifying information about donors (including the reasons why the donor donated) that may be available. In some countries, such as the USA and to a slightly lesser extent Greece, South Africa, Ukraine and Russia, a large amount of information is obtainable about egg donors. There is also a lot of information available about Danish and US based sperm donors, including baby and sometimes adult photographs at extra cost. In most of the European countries where people from the UK go for egg donation there may be considerably less information given than in the UK. Most Spanish clinics claim that it is against their law to give more information than the age and blood group of a donor. Their law actually says that they can give all non-identifying information, although most choose not to do so. There is anecdotal evidence that some Spanish clinics are increasing the amount of information available because of demand from UK residents. You may want to consider using your power as a consumer to help change practice.
The UK is unique in having a central national register of donors and recipients. How records are kept and what might happen to them in the future (if, for instance, the clinic went out of business) may not be as clearly set out abroad as in the UK.
In most EU countries egg donors are selected by the clinic doctors and not by recipients. Requests can be made for specific hair, skin or eye colouring but parents have been known to be surprised, and sometimes unsettled, when their child has features that are typical of the country of origin of the donor, which may of course not be the country where treatment takes place. While unexpected features can crop up in any family, the focus on visual resemblances can become more laden with emotion in a donor family, particularly if the parents had anticipated not telling friends and other family members until the child was older. In a family where a positive decision to go abroad has been taken and parents plan on celebrating this connection, this is less likely to be a problem.
We also don’t know how children conceived with a sperm or egg donor from another country will feel about the half of their genetic heritage that comes from that country, particularly if their physical features make it obvious to themselves and to others. Feelings could range from pride in the special connection to discomfort at looking different and not ‘fitting in’ where they are growing up.
Anonymous or identifiable donors
In most countries outside the UK all donation is anonymous and this is a most difficult issue for some people who would prefer an identifiable donor. They are aware that a child might grow up wanting identifying information about his or her donor, and the choice to have treatment with an anonymous donor rather than an identifiable UK one, may have to be explained to the child later. If, on the other hand, an overseas donor (such as may be found in the US or Denmark) is to be identifiable when the child reaches 18, the systems for recording and eventually accessing the donor’s details may not be as robust as in the UK where information is held centrally by the HFEA. There are of course no guarantees that donors recruited inside or outside the UK will actually be traceable, or alive, or willing to have the sort of contact some donor offspring might be hoping for when they turn 18. This is a question that can be talked about with children and young people as they grow up.
We know that if children are conceived via sperm donation abroad then there may be very many half-siblings world-wide. If sperm is imported from the US or Denmark, then there may be up to ten families created from the same donor in the UK but an unspecified number of half-siblings around the world. Some donor conceived adults have said they feel very uncomfortable about the idea of there being the possibility of so many half-sibs. As egg donors usually donate far fewer times than sperm donors, the number of half-siblings is unlikely to pose the same issues for offspring.
Some heterosexual and lesbian couples and many single women are keen to explore the possibility of half-sibling contact to provide genetic links for their child. They need to be aware that conceiving a child by anonymous donation abroad may mean that this is less likely to be an option for their child, although independent donor sibling registries outside the US and UK are beginning to be set up and DNA testing may prove to be a game-changer in the future. Sometimes single women, and others, choose sperm donors from American banks so that they have the opportunity to link with half-siblings and potentially the donor via the privately run Donor Sibling Registry in the US or sperm bank message boards.
Additional issues to consider with embryo donation
Embryos are only rarely donated to other families for fertility treatment in the UK. One reason for this is the ending of anonymity for donors in 2005. This brought to the forefront for a donating couple the issue of resulting children making contact with them and with their own children when those born from embryo donation reach 18. They would be full genetic parents to those children who would also be full brothers or sisters to their own children.
Because counselling is virtually mandatory for people donating or receiving embryos in the UK, potential donors and recipients have to think through the range of feelings that children conceived in this way may have, knowing that they would have full genetic parents and brothers or sisters in another family. While for children conceived by donated sperm or eggs, there is a possibility of half siblings in other donor families or indeed in the family of the donor, for embryo donation children the existence of siblings is a near certainty, and they will be in the family of the donating couple and possibly another family as well.
Embryos that are donated in the UK come from couples or individuals who have completed their family by IVF and have remaining embryos in storage. However, at many clinics in West and Eastern Europe and the USA, embryos may be created with eggs and sperm from separate anonymous donors. Where two or more embryos are transferred, DNA testing of twins is beginning to reveal that sometimes the eggs and sperm used may not be from the same donor, although this fact is unlikely to have been told to the recipient(s) who will have one, rather than two donor descriptions. This situation could of course also happen in egg donation. If you are contemplating donor conception outside the UK and more than one embryo is being transferred, you may want to seek assurances that the gametes being used are from the same donor(s).
Conceiving with anonymously donated embryos means that not only will a child have no genetic connection to the recipient parent or parents, and virtually no information about the donors, but also there will be little or no possibility of future contact with the donors, whether they are a couple or individuals, and perhaps more importantly no chance of tracing siblings. DNA testing may change this situation significantly in the future but it may be some time before this sort of testing becomes commonplace everywhere and databases in all countries are as large as they currently are in the USA, Scandinavia and the UK.
Treatments abroad not available in the UK or EU
Some clinics outside the UK and European Union carry out procedures and treatments that are not allowed by the HFEA and are banned by the European Tissues and Cells Directive. These include gender selection and the transfer of large numbers of embryos potentially resulting in a dangerous multiple pregnancy and sometimes selective termination of some of the foetuses. ‘Tandem cycles’ are also available in some clinics. This is where embryos are created with both donor eggs and the woman’s own eggs and then nurtured to maturity. Where embryos of both types are transferred, only subsequent DNA testing could prove which embryo had produced a pregnancy/resulting child.
These procedures are not allowed in the UK and the EU for ethical reasons. With regard to the transfer of more than two embryos the HFEA website shows that putting back more embryos does NOT improve your chances of a healthy live birth. We would recommend reading the information on their website before agreeing to multiple embryo transfers.
The reference to DNA testing in the section on embryo donation shows just one way in which this technology, now available in kits sent to your home, is changing the donor conception world. Donors can no longer be considered anonymous, whether they started as identifiable or anonymous. Donor conceived adults are using DNA tests to find genetic relatives, who sometimes need only to have a very remote cousin on the same data-base, for them to be found. In other cases further detective work, not necessarily DNA-based, is necessary. Parents are testing their children and people seeking health information and with no prior knowledge about being donor conceived, are finding that the people they assumed they were biologically linked to, actually are not. It is a revolution that cannot be ignored. Being open with children about their beginnings has to be the way to avoid tragic future family confrontations as well as being in the children’s best interest to know from a young age.
What we know and what we don’t know…
Due to the history of secrecy, there is no long-term research on donor conceived families, and little reliable knowledge. A number of individual sperm-donor-conceived adults have spoken up about their situation, with a variety of views, and there is now some research on their experiences and feelings. Most of those researched were told about their beginnings when they were teenagers or adults and often in very unsatisfactory circumstances. There is a growing body of research with some children who have ‘known’ since they were little but it is early days with this. So far there are only a few anecdotal accounts or small sample sizes of how teenagers and adults conceived by egg or embryo donation feel. No research has been carried out into how the feelings and needs of adults conceived with egg, double (egg and sperm) or embryo donation may differ from those conceived by sperm donation. It is possible that those who have no genetic connection to their parent(s) may have stronger feelings about their origins, but this remains unknown, as does any child or adult’s perspective on being conceived abroad.
Since identifiable donors are available in the UK, the best we can do is try to imagine our children’s feelings and reactions, and consider how we might explain our choices and decisions to them, and support them as they grow up.
What we do know is that psychologists and social workers experienced in this field say very clearly that openness between parents and children about donor conception (whether the donor is anonymous or identifiable) is supportive of warm family relationships, and parental confidence about choices made may be a key factor here. Many Network members have conceived abroad and are adopting different strategies about how to integrate the foreign connection into the story they tell their children. Some are encouraging their children to take an interest in the culture of the country by learning the language, deliberately taking holidays there or supporting that country’s team in international sporting events. Some see it as simply a fact to be shared and focus more on the ‘nurture’ side of cultural identity.
Some Dos and Don’ts
So, if after weighing up all the options and taking all the factors into consideration, you think that having treatment abroad is the course you will take, do make this a decision that you can feel confident about in years to come. There may be very positive reasons to go abroad –you or your partner may have a connection with that country, or you may want a greater range of donors to choose from with more information about them than is available in the UK. Get as much information as you can about the clinic and the country as possible. Do try to contact other families who have been there –the Network may be able to help with this. And do think about how you will tell your child the reasons for your decision, how much you will want them to feel a link with the country, and how you might become comfortable encouraging a connection of this sort.
Don’t accept that going abroad is the only option because UK clinics have told you about a shortage of donors in the UK. Both egg and sperm donors are available in the UK now, even if this requires you to travel across the country or wait a little longer, but the choice remains yours. Finances are not a trivial part of the decision making process, but they are not the only thing to consider. Whatever decision you make, or have made in the past, identify the positive aspects, record the thoughts that went into the decision and how you saw the options available to you at the time. This will help you develop a confidence that you made the best choice possible in the circumstances and later on will inform the story you share.
For couples or individuals needing donor conception, these are uniquely complex decisions that our friends who have glided into unassisted parenthood cannot begin to comprehend. And parental confidence and pride, gained in advance or retrospectively, is the key to children being able to manage the range of feelings they may have about their beginnings.
DC Network’s support for and promotion of openness about donor conception is based on research that started with adopted people – who now have the right to know about their birth parents – and has continued with adult donor conceived people who almost universally believe that it is their right to be told of their origins and as early in life as possible. The research included those people who didn’t consider the information to carry any deep meaning for them at that time.
Donor-conceived people’s views and experiences of their genetic origins: A critical analysis of the research evidence
Eric Blyth, Marilyn Crawshaw, Lucy Frith and Caroline Jones
(2012) 19 JLM 769
Modern Families: Parents and Children in New Family Forms
Cambridge University Press 2015
You might also want to read this document
The following document was produced following an international forum on cross-border reproductive care that took place in Canada in January 2009 but still holds valuable prompts to anyone considering travelling to a different country for treatment Cross-Border Patient Prompter (PDF)