Donation and surrogacy A look at the issues and implications of using donated eggs, sperm or embryos in fertility treatments, or a surrogate mother.

In this article

Donation Important questions Egg donation Sperm donation Embryo donation

Telling the child A question of anonymity Making contact Imported sperm

Surrogacy Types of surrogacy Legal matters How to find a surrogate

Deciding to use donated sperm, eggs or embryos involves complex issues with far-reaching implications for parents and children. It's a difficult decision that should be made after careful consideration of the impact it's likely to have on everyone involved.

Counselling is probably more vital with donation

A couple may find they change their minds from day to day, and not always in unison. If this happens, it's important for one partner not to put pressure on the other. Time needs to be taken to reach a decision. For this reason, counselling is probably more vital with donation than with other forms of treatment.

When considering whether to use donation, you might want to ask yourself the following questions:

• Why do you feel using donated eggs or sperm is better than adoption or being childless?
• How would you feel about your child having the genetic characteristics of someone who isn't a family member?
• How would you feel knowing the donor may have other children, so your child would have half-siblings?
• How will the use of donated eggs or sperm be discussed with family and how are they likely to feel about it?
• How and when will any resulting child be told of their origins? Research suggests that children are better balanced if they know how they were conceived.

Watch Professor Susan Golombok talking about fertility issues in the family and the effects of IVF on resulting children.

Once you and your partner have discussed these questions and you both feel comfortable with the idea of donation, the next step is to go to a fertility clinic. Here, the team will explain the social, ethical and legal issues surrounding donation.

More information is available from the Donor Conception Network.

Why it may be necessary: the female partner has no ovaries or ovaries that are damaged, perhaps by cancer, has gone through a premature menopause, is producing too few or low-quality eggs, has had several miscarriages or is at a high risk of passing on an inherited disorder.
What happens? The female partner and the donor's menstrual cycles are synchronised, by taking drugs to ensure they ovulate at the same time. Eggs are taken from the donor and mixed with the partner's or donor's sperm before being transferred to the partner's womb by in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) or gamete intrafallopian transfer (GIFT).

Why it may be necessary: the male partner is producing little or no sperm or sperm of poor quality, has a high risk of passing on an inherited disease or has had a vasectomy. Single or lesbian women undergoing IVF also need donated sperm.
What happens? The sperm, which has been screened, washed and prepared, is used to inseminate the woman by intrauterine insemination (IUI). Donated sperm can also be used in IVF, ICSI or other assisted reproduction treatments.

Why it may be necessary: if IVF hasn't succeeded, or if there's a serious inherited condition, such as Huntington's disease, that could be passed on.
What happens? The female partner goes on a course of medication to prepare the lining of the womb for the transfer of donated embryos.

It's up to parents whether they tell their child that they were conceived as a result of donation, but it's generally thought preferable to be open. It's better a child learns about their origins from their parents than through gossip or from other people. Children conceived through donation also have a right to genetic and other information about the donor.

Making donation part of a child's life story as early as possible helps to 'normalise' it. A good time to introduce the idea is when they start to ask where babies come from. More detail can be given when they're older and better able to understand the implications.

The Donor Conception Network produces a range of useful publications, including simple storybooks for children created through egg, sperm or embryo donation.

Egg, sperm and embryo donors were anonymous until April 2005, when donor anonymity was ended. This means anyone who registered (or re-registered) as a donor after this date has to give identifying details including their name, address and date of birth, as well as physical characteristics and a range of family details, such as how many children they have and anything else they may want to share. This information is stored on a confidential database by the Human Fertilisation & Embryology Authority (HFEA).

When a child reaches 18 - or if they're 16 and want to marry - they can request this information from the HFEA.

UK DonorLink is a pilot scheme that has been set up to enable people conceived through donated sperm and/or eggs, their donors and half-siblings to exchange information and, if they want, to contact each other.

Anyone over 18 who was conceived using donated sperm or eggs, or anyone who donated in the UK before the HFEA came into force in August 1991, can access UK DonorLink's register.

Some clinics import sperm from abroad. In this case, they have to get a special licence from the HFEA and the same rules apply as for UK donors. That is, they must provide identifying information.

With sperm bought online from websites, there's no guarantee the donor is healthy or that they, or the sperm, have been screened and medically checked. However, a Government white paper on the review of the Human Fertilisation and Embryology Act 1990, published in December 2006, proposes that internet sales of sperm be subject to regulation.

Another woman carries and gives birth to a baby for a couple

If it isn't possible to have a baby of your own and donation isn't an option, surrogacy may be considered. This is when another woman carries and gives birth to a baby for a couple.

This is a complex issue, which is also legally complicated. Those seeking surrogacy need to consider all the implications carefully as well as seeking legal advice. The fertility clinic counsellor will be able to guide clients through all areas.

Again, when considering surrogacy, it's helpful to ask yourself some questions:

• What will you tell your family, friends and colleagues?
• How might you feel about another woman carrying your baby?
• What would your reaction be if the pregnancy resulted in twins or triplets?
• How will any current children you have, and those of the surrogate, be told? Children need to be prepared, and questions and possible fears dealt with.
• How will the baby be handed over?
• Will the surrogate continue to be involved with the child and, if so, to what extent?
• How would this affect the way the child was brought up and the emotions of everyone concerned? It could be especially sensitive if using a family friend or relative as a surrogate.

Straight surrogacy - the surrogate uses her own eggs, with sperm from the intended father. Fertilisation is done in a clinic or, more often, at home.

Host surrogacy - the surrogate carries a baby created from the egg and sperm of the intended couple. These are fertilised by IVF in a licensed clinic.

• The surrogate, or birth mother, is legally the mother of the child and her name will be on the birth certificate.
• A surrogate has the legal right to change her mind, even if the baby isn't genetically hers, which is why trust is so vital in this relationship or arrangement. Although this doesn't often happen, it's essential everyone involved understands the legal issues.
• A parental order will ensure the child becomes legally that of the recipient parents.
• In the UK, surrogate mothers aren't allowed to be paid. However, they may be given 'reasonable expenses', to cover clothes, travel expenses and loss of earnings.

By law, a fertility clinic can't find you a surrogate and you can't advertise for one. Ways to find a surrogate include:

• Asking a relative or friend.
• Asking other people who have used a surrogate for advice.

For more information, take a look at COTS - Surrogacy in the UK.