‘It takes a village’ – fertility treatment using donor gametes, embryos and/or surrogacy

Abstract

Key content Fertility treatment using donated gametes and embryos is increasingly common. Indications for the use of donated sperm and oocytes include azoospermia, single women and women in same‐sex relationships, inherited conditions, poor quality embryos or failed fertilisation in previous cycles of assisted reproductive technology, and ovarian insufficiency. Causes of azoospermia and ovarian insufficiency include congenital and genetic disorders, infectious and traumatic conditions, iatrogenic causes and age‐related decline. These treatment cycles have ethical and legal implications and require appropriate pre‐conception counselling and completion of Human Fertilisation and Embryology Authority (HFEA)‐mandated forms to ensure the safety of donors, recipients and any children born as a result of treatment. All donors are screened for infectious diseases and can also be screened for genetic conditions. Sperm donation can be organised outside of recognised fertility clinic settings, which increases the possibility of infection transmission. Compared with cycles using autologous gametes and embryos, treatment outcomes can increase live birth rates and reduce incidence of low birthweight, but may increase hypertensive disorders of pregnancy. Learning objectives To understand the clinical indications for the use of gamete and embryo donation, including potential risks to donors and recipients, and success rates. To learn the practical considerations of donation and procurement processes, screening, quarantine, legal and regulatory aspects in the UK and international comparison. To appreciate special issues, including psychological assessment and support requirements, ethical considerations, intrafamilial donation, commercial DNA testing and family tracing implications. Ethical issues Donors must be made fully aware of the implications of donation and the lack of anonymity once resulting children reach the age of 18, according to UK law. Recipients must be thoroughly counselled regarding the implications and psychological impact of treatment. The HFEA obliges all clinics to offer implications counselling to those undergoing treatment in terms of the impact of treatment on them and how to broach the subject with future children.