Ovum Donation by Alan B. Copperman, MD and Eric Flisser, MD
Ovum Donation and Prospective Donors
by Eric Flisser, MD and Alan B Copperman, MD
The decision to pursue assisted reproduction using donor eggs is an emotional, and often, difficult decision to make. Though the loss of the dream of passing on one’s own genes can be shocking, hopefully soon can arise a new dream, albeit through alternative means, of achieving a successful pregnancy and having a healthy baby. This transition doesn’t occur easily for many women, and they often first go through denial, anger and sadness before, finally, acceptance. Through the use of donor eggs, a woman may still build a family.
Using donor gametes, such as oocytes, provides the patient with a chance similar to that of a reproductively young woman to carry a pregnancy. When a woman makes the decision to proceed with oocyte donation, she has a new set of questions to answer: what characteristics should I seek in an oocyte donor?
Oocyte donors come in two categories: known and anonymous. Known donors can be family members, such as a sister, or someone outside of the family who already has an existing relationship with the patient. A family member who is willing to donate oocytes and who qualifies as a candidate for donation can be helpful in reducing the cost of the procedure. Additionally, some of the family genetic characteristics will be inherited by the future offspring.
However, asking a family member if she would be willing to donate oocytes can be, in some cases, a significant emotional strain. In addition, complicated issues about family relationships and childrearing should be thoroughly explored before this path is chosen. Family members must never feel they are being coerced into participating. Most fertility clinics have psychologists or psychiatrists that are included in a patient’s care when third-party reproduction techniques are used. These professionals can help analyze potential conflicts before treatment starts and can provide strategies for dealing with ethical issues for after a child is born. Similarly a known, but unrelated donor, can complicate childrearing if these emotional issues are not explored thoroughly.
Anonymous donors offer freedom from conflicts of interest, but because they are compensated for their time and effort, may add to the cost of treatment. Some fertility clinics with oocyte donation programs also recruit donors and may have a large enough pool from which a donor may be selected. But how does one choose an appropriate donor?
Physical characteristics such as height, hair color and eye color may play important role, in hopes that the child will look similar to his or her parents, which can help in avoiding prying questions from the too curious. Choosing a donor with a similar ethnic background may provide some comfort, but in many cases, the patient and donor may have mixed ethnic ancestry, making a perfect match difficult, if not impossible. Depending on the policy of each particular donor program, varying amounts of personal information about the donor may be available. Sometimes a photograph (either a current photo or even a baby photo) can be viewed, but in some cases only a physical description is available. Characteristics of height, weight, hair and eye color may influence a patient’s decision, but it should be kept in mind that some physical characteristics are influenced by environmental factors. Level of education may be of interest, but may not paint a complete picture of a donor’s abilities or personality. Talents, such as skill with musical instruments, drawing or painting, may also be listed. Patients should keep in mind, however, that specific talents and interests of a donor may not manifest in offspring generated from her oocytes.
Patients should also take care to avoid over-selecting the number of characteristics that their donor should be required to possess, because it will make a match more difficult to complete.
Although it would be wonderful if patients could select a panel of personal ideals as if from a menu, few real people will ever rise to these standards, so a few, realistic characteristics should be chosen and prioritized. Because all donors are screened according to FDA requirements, risks of acquiring infectious diseases when using donor oocytes should be minimal or non-existent. When genetic backgrounds pose increased risks to offspring because of higher carrier rates for recessive genetic diseases, appropriate screening of the sperm source and/or of the prospective donor should be completed, as they would when patients use their own eggs, to prevent the birth of an affected child. For example, donors of Eastern European Jewish ancestry should be tested for the “Ashkenazi panel” of recessive diseases, including but not limited to Tay-Sachs’, Gaucher’s and Canavan’s disease, if there is a increased risk to offspring because the sperm source is also from the same genetic background.
In summary, the dream of parenthood is not reserved to those with functioning ovaries or viable eggs. It is now possible with a high degree of success for such couples to conceive healthy happy children. Given strict donor screening policies, available psychological support services, and informed patients with realistic expectations, egg donation can be a successful treatment for many.
Drs. Flisser and Copperman are in practice in New York at RMANY. More information about their practice can be found at http://www.rmany.com/.