Having Your Baby Through Egg Donation. Evelina Weidman Sterling

as there have been changes in the availability and accessibility of donors, so also have there been shifts in the way people think about egg donation. In the early years there was a real sense that the science was advancing far more rapidly than our understanding of what it means for a person to be physically born to three people. Instead of taking note of what a seismic shift this marked in human reproduction, physicians presented egg donation as a treatment for female infertility. In so doing, they missed the opportunity to examine, make sense of and ultimately celebrate what egg donation means for identity formation and our understanding of kinship. Sadly, egg donation was pushed into the shadows, spoken of in hushed tones and burdened by secrecy.

      The experiences of parents through egg donation, their children and their donors changed significantly with the arrival of the Donor Sibling Registry (DSR) in 2000. This US-based worldwide registry was founded in 2000 by Wendy Kramer and her son, Ryan, who was conceived through sperm donation. The registry helps people connect with donor relations. In the 13 years since its founding, the DSR has helped connect more than 9200 individuals with their donor relations. Wendy Kramer reports there are on average two new matches every day. For egg donation families, this has meant that parents have connected with donors, donors with offspring and, as the name of the DSR suggests, offspring with other offspring. As word of the DSR has grown, and, with it, people’s appreciation of the significance of genetic connections, families have been turning to the DSR in new ways. Currently, there are several egg donor agencies in the US that include the DSR in their donor-recipient contracts, making it possible for people who want anonymity (or at least to start out with no identifying information) to remain in touch and share photos and updated medical and social information. The DSR’s global presence is growing steadily, with membership coming from around the world and in large numbers from Canada, Australia, Spain, Romania and Israel.

      Where are we today?

      Looking at egg donation today, we see a very different picture from what we saw even as recently as the original (2005) edition of Having Your Baby Through Egg Donation. In addition to the changes noted above, we see changes in the way egg donation (ED) parents feel about their path to parenthood. The secrecy that prevailed in the past has diminished significantly. True, there are some ED parents who still feel they have something to be secretive about, but increasing numbers are treating their child’s story as an open but private matter. They don’t go around saying “my egg donor baby,” but acknowledge donor conception when there is a reason to do so. In talking about it in a natural and appropriate way, most find that others are fully accepting of and comfortable with egg donation. Accompanying this more open approach to egg donation in general has been increased comfort with the donors. As one mother through egg donation put it:

      When I first heard about egg donation, I did not want to meet my donor because I thought that I would see her face in my child and it would upset me. Now I feel the opposite. I have twins and one looks just like the donor. I love it because it is a constant reminder of the remarkable woman who helped make us a family.

      With increased comfort and familiarity with egg donation has come increased use of this option. Or perhaps it is the reverse: as more people have become parents through egg donation, more of them have become comfortable speaking openly about it. Either way, the use of egg donation is on the rise. In 2010, the Society for Assisted Reproductive Technology (SART) reported there were 9321 transfers using donated eggs. Over 55 percent of these resulted in live births. This is the official SART number. Wendy Kramer of the DSR found, in surveying parents through egg donation, that 42 percent were never asked to inform their clinic whether they had a live birth. Some did so voluntarily and others did not. If we add in the pregnancies that resulted from cryopreserved embryo transfers, there were more than 8000 births in the US in 2010 alone from donated eggs.

      A current trend in the United States is the promotion of “egg banks.” Until recently, it was difficult to freeze human eggs, and few documented pregnancies resulted from eggs that had been frozen. The development of vitrification, an effective means of freezing and thawing eggs, has made it possible for women to freeze eggs for future use. As vitirication has been developed and improved, with reports of pregnancy rates between 54 percent and 63 percent per transfer, egg banks have become a source of donated eggs. We are hearing of more and more reproductive medicine centers partnering with egg banks and offering patients egg donation at one-third the cost and a much faster process.

      Challenges remain—ethical, legal and regulatory concerns

      Reproductive technology and egg donation practice are moving at such a rapid pace today that many important social, ethical and legal considerations are lagging behind significantly. Many of us, including leaders in the field of reproductive technology, are unsure what the next steps should be.

      Although egg donation has enjoyed widespread acceptance and relatively little scrutiny in the United States, this is not the case throughout the world. In Italy, for instance, a law was passed in 2004 to ban egg donation completely, banning also the use of donor sperm and helping women past childbearing age becoming pregnant via ARTs. The road to this law started in 1994 when Italy made headlines because Dr. Severino Antinori used donor eggs to allow 63-year-old Rosana Della Cortes to become pregnant. Robin Marantz Henig states:

      We are learning the wrong lessons from our earlier misadventures. Things got a little out of hand, yes, but that is because governments around the world adopted a hands-off policy towards the whole affair. It was too complicated to reach consensus about what steps were too intrusive, about when human life begins, about what risks were worth taking for the sake of having one’s own biological child. So governments turned their backs on reproductive technology and allowed the field to be taken over by cowboys. (Henig 2004)

      Still unable to come to a consensus about exactly what should and should not be accepted with regard to egg donation, countries such as Italy, Austria, Norway, Sweden and Switzerland have also nearly eliminated egg donation. While such strict laws serve to call everyone’s attention to the potential for ethical abuses in egg donation, they also create new social problems. There now exists what has been termed “fertility tourism”—people living in countries that ban egg donation are traveling to other countries to obtain eggs.

      Many counties in which IVF and other ARTs are part of national health care plans—such as France, the Netherlands, Spain, the United Kingdom, Canada and Australia—have legislation in place regulating egg donation. These policies especially place restrictions on anonymous donors. The Human Fertilisation and Embryology Authority (HFEA) is a government body in the UK which regulates and inspects all clinics providing IVF and donor conception. Its governing board, which includes people who have had personal experience of donor conception, along with experts in the field of reproductive medicine and bioethics, makes important decisions regarding regulations about the way donor conception is carried out. In January 2003 the UK announced a registry for donor offspring, which was established in 2004 as a pilot project. This voluntary registry enables donor offspring and donors who participated in gamete donation before 1991, when the Human Fertilisation and Embryology Act came into being, to exchange information. Since then more than 18,000 children have been born in the United Kingdom with donated gametes. In 2004 the United Kingdom also announced that, after April 2005, anyone looking to donate eggs or sperm would no longer be given anonymity. Similarly, some Scandinavian countries have always had open sperm donor files, and clinics in New Zealand do not accept anonymous donors.

      Another worldwide difference of note is the use of IVF patients as a source of egg donation or egg sharing. This is allowed and even promoted in Canada, Denmark, India, Israel, Spain and the United Kingdom, as well as sometimes in the United States. Many European countries, particularly those that support egg sharing, provide government funding to women attempting anywhere between two and five cycles of IVF. Many feel that this method of engaging egg sharing among government-funded IVF cycles ensures “more bang for the government’s buck.” On the other hand, New Zealand believes that egg donors are only able to give consent without the pressures of financial incentives; as a result, egg donors are not allowed to be paid in any case.

      The New York Times has an “Ask the Ethicist” column each Sunday in its magazine section. Evidence of how mainstream egg donation has become came on April 8, 2012, when the column concerned egg donation. Specifically, the writer complains