Archive for the ‘open’ Category

The first segment of this series introduced the disclosure topic and linked to our first of three surveys. There were a total of 17 respondents with the results examined below.

Survey Results: “Imagine You Are an Embryo Donor”

1. If you were an embryo donor, which would you prefer (choose only one)?

• I would prefer an Anonymous Embryo Donation process.            18% (3/17)
• I would prefer an Approved Embryo Donation process.                41% (7/17)
• I would prefer an Open Embryo Donation process.                         41% (7/17)

Comments:

Anonymous and Approved Embryo Donation procedures together were only slightly preferred over Open Embryo Donation. It would appear those answering the question wanted to know more about the recipients than a simple anonymous process would provide.

2. If I donated my embryos, I would tell the following:

Relationship	Yes	No	N/A (not alive or no current relationship)
My parents	71% (12/17)	29% (5/17)	0% (0/17)
My in-laws	47% (8/17)	41% (7/17)	12% (2/17)
My siblings	59% (10/17)	24% (4/17)	17% (3/17)
My children	65% (11/17)	29% (5/17)	6% (1/17)
My friends	65% (11/17)	35% (6/17)	0% (0/17)
Average:	61% (52/85)	32% (27/85)	7% (6/85)

Comments:

Twice as many respondents would tell family and friends about donating their embryos than would not tell. Embryo donors have previously stated telling friends and family might result in harsh judgments from those who didn’t fully understand their motivations for donation. This concern for judgment may have been reflected by the fact that in-laws were the least frequently told group in the poll above.

3. Would you want to have the embryo donation offspring told that they came from donated embryos?

• Yes                          47% (8/17)
• No                           18% (3/17)
• Not certain              35% (6/17)

Comments:

About half of the donors would want the offspring told they were from donated embryos. The other half was uncertain or definitely would not disclose. The uncertain group may gravitate towards nondisclosure over time unless committed to disclosure process early.

4. If I choose an Anonymous or Approved Embryo Donation process (both are still anonymous), I would prefer (choose only one):

• To remaining Anonymous:                                                                                                       12% (2/17)
• Be initially Anonymous with the possibility of Open-Identity at Any Age:                                 59% (10/17)
• Be initially Anonymous with the possibility of Open-Identity at 18+ Years of Age:                  29% (5/17)

Comments:

About 88% wanted an Open-Identity process. The respondents also wanted offspring to have the ability to contact donors when the children were younger than 18 by two-to-one over those wanting Open-Identity at 18 years of age or older. This is very different than what is currently done with adoption.

5. If I choose the Open Embryo Donation process, I would prefer:

• Open Embryo Donation with Open-Identity at Any Age:                          71% (12/17)
• Open Embryo Donation with Open-Identity at 18+ Years of Age:            29% (  5/17)

Comments:

Consistent with question four, the respondents wanted Open-Identity younger than 18 years of age, which is very different from what is done in the adoption world.

Thank you for your input. Tomorrow we will release the next installment of this series – Disclosure Issues From the Perspective of the Embryo Donor. We’ll also launch our next survey this week as well and hope you will give us your feedback.

Gamete donation of sperm, eggs or embryos has been occurring for quite some time. Sperm donation probably occurred as far back as 1884 in the US (Wikipedia, 2011). Embryo donation was first reported in Australia in 1983 using both fresh and frozen embryos. (Trounson  A, Mohr L, 1983). Egg donation probably first took place in the U.S. in 1984 around the same time as the first embryo donation procedure (Blakeslee S, 1984).

Certainly in the early years of sperm/egg/embryo donation, the procedures were almost always done anonymously. Designated donations also took place using family and friends but they were the exception rather than the rule. Having donors and recipients meet was not really an option in the past.

Is non-anonymous sperm/egg/embryo donation becoming more common?

Over the years, there has been movement towards non-anonymous or known donations. Countries such as Sweden, Norway, Netherlands, Great Britain, Switzerland, Australia and New Zealand only allow non-anonymous sperm donations. In a future blog, we will cover some of the consequences that occur when countries completely move from anonymous to non-anonymous donation procedures. At least in the U.S., there is a choice, though Washington State recently passed legislation that makes it more difficult for anonymous sperm and egg donation to take place. I will discuss this legislation and topic in a future blog since this is an important and concerning development. An increasing number of donor sperm and donor egg banks offer non-anonymous donation, although, with rare exceptions, this remains a minority of the procedures performed in the U.S. (personal communication).

Does EDI offer non-anonymous embryo donation?

At Embryo Donation International, we offer Open Embryo Donation where the donors and recipients have the ability to communicate, meet and establish a relationship. Other facilities tend to call it “embryo adoption”, a term we are at odds with (click here for more information), where there is an attempt to foster relationships. Interestingly, at EDI, this is rarely requested although we feel it appropriate to offer such an alternative.

If embryo donors & recipients meet, what is the outcome?

If families do connect, there are a number of relationships that need to be considered. The first involves the donor(s) and the recipient(s). No one knows if these relationships will last. Romanticizing the idea of everyone being one happy family may be misguided. There are certainly examples where friendships have developed, such as the families profiled this Good Housekeeping article, but the number of relationships that don’t flourish are simply unknown. We all have to go through so many acquaintances to eventually find our true friends, so it remains uncertain if these initially awkward relationships will last beyond the transfer process. Long-term studies are lacking.

The second relationship to be considered would be with the resulting donor offspring and the donor(s). In an Open Embryo Donation procedure, the child will not only know the genetic and family history in detail but they will most likely know the names of the donor(s). The likelihood of this child trying to eventually connect with the donors is great. While there is a genetic bond, it remains uncertain if the relationship will always be welcome or beneficial. Certainly in the adoption world, adoptees that eventually find their family are not always rewarded with utter acceptance and may experience rejection, as they see it, a second time. Once again, long-term studies are lacking about the effects of an open embryo donation process with regards to the potential relationships between the donors and the donor offspring.

Lastly, there are the potential relationships between the siblings created when the donor has children of their own or donates to other recipients with offspring created. These children share a solid genetic bond and may feel rewarded in forming a relationship with their genetic brothers and sisters. Only careful, long-term and unbiased research will be able to identify the outcomes of such relationships. My best estimate is that these relationships may be sustainable but what will happen if the donor offspring are not fully accepted by the donors or the donors and recipients are no longer close?

Will my doctor be able to help me with my decision to have an open embryo donation?

So, would you want to meet your donor? Would you want to meet your recipient? It would be ideal if your clinician could clearly guide you as to the expected outcome of an open process. In reality, we are also diving into the thorny question regarding disclosure of one’s origins to embryo donor offspring, something that I will be touching upon in the months to come. For now, however, I suggest a point of caution. The world of embryo donation is simply not the same as the world of adoption and extrapolating one to the other is not without risk.

The issues we are discussing involve currently unknown long-term consequences and we need to be careful, thoughtful and unbiased in recommending one embryo donation procedure over another. For now, I believe it is a very personal decision that only embryo donors and recipients can make based on how they currently feel and what they believe will happen in the future.

I hope that we physicians deeply involved in the world of embryo donation will better be able to discuss the long-term advantages and disadvantages of open vs. anonymous procedures, but for now, the patients will simply have to guide us.

References:

“Sperm Donation.” Wikipedia, The Free Encyclopedia. Wikimedia Foundation, Inc., 23 July 2011. Web. 24 July 2011. http://en.wikipedia.org/wiki/Sperm_donation.

Trounson A, Mohr L. Human pregnancy following cryopreservation, thawing and transfer of an eight-cell embryo. Nature 1983;305:707-9.

Blakeslee, Sandra (1984-02-04). “Infertile Woman Has Baby Through Embryo Transfer”. The New York Times. Retrieved 2009-11-05.