Information For Egg Recipients

Transcription

1 Egg Recipients Royal Devon and Exeter NHS Foundation Trust Information For Egg Recipients

2 What is egg donation? Egg donation is a type of in-vitro fertilisation (IVF) treatment in which eggs are collected from one woman (the donor), fertilised with sperm from another woman s (the recipient) partner or donor sperm and the embryo or embryos that are created are placed into the recipient woman to attempt a pregnancy. The baby or babies resulting from this treatment are genetically related to the donor but the woman giving birth (the recipient) is the legal mother of the child or children. Further details about IVF are contained in a separate information leaflet (IVF Information Leaflet) and will be discussed in detail with you at your consultation. The donation of eggs must be entirely voluntary and there must have been no moral or other pressure or inducements to this donation. Independent implications counselling is mandatory for both donors and recipients before donation can proceed. This is to ensure that all parties are fully informed and aware of the implications to themselves and their families of donating or receiving eggs prior to undertaking any treatment. Why is egg donation necessary? Treatment with donor eggs may be suggested in women: with repeated failure using their own eggs with IVF with a very low egg reserve who have experienced recurrent miscarriage at risk of passing on a serious genetic problem who have experienced a premature menopause. Most women go through the menopause between the ages of years but a small number of women will have a premature menopause, either because they ve been born with a smaller number of eggs than usual, because they ve had surgery, chemotherapy or radiotherapy for cancerous conditions or because they have a genetic problem. Why do women donate their eggs? There are two types of egg donor, an egg sharing donor and an altruistic donor. An egg sharing donor is usually a woman who needs IVF treatment but isn t eligible for NHS funded treatment. The Human Fertilisation and Embryology Act (HFE ACT) allows women to consider donating some of their eggs in a cycle of treatment in return for benefits in kind. This essentially means that eggsharing donors receive IVF or egg banking at a reduced cost to themselves. All potential egg donors are very carefully counselled about the implications of donating eggs and care is taken that financial implications are not the only reason for becoming a donor who is considering egg-sharing. The majority of egg donors at Fertility Exeter are those who are egg-sharing donors. Altruistic egg donation is where a woman donates her eggs to a recipient voluntarily when she does not receive any financial or other benefit herself. Altruistic egg donors are entitled to receive compensation or expenses as specified in HFEA directions. The Human Fertilisation and Embryology Act (HFE Act) allows women to donate their eggs to a known or an unknown recipient. When deciding to become an egg donor, the full implications of donation must be taken into account. A child or children may be born as a result of the donation and will be half-siblings of any children the donor herself may have. Any children born as a result of egg donation have the legal right to identifying information about 2

3 the egg donor when they reach the age of 18 (or 16 if they are contemplating marriage). Is the treatment confidential? The HFE Act requires that all assisted conception treatment is completely confidential. Fertility Exeter will not disclose any information about your treatment without your written consent. The HFEA encourages couples to tell children if they have been born as a result of egg, sperm or embryo donation as everyone has the right to know something of their biological origins. As the recipient, you are the legal parent/s of the child and although you are not legally obliged to tell them that they were born as a result of egg donation treatment, we would encourage you to do so. Our fertility counsellors can help you to prepare with how to explain this to the child/ ren from a very early age. If you intend not to disclose the child s biological parenthood to the child, relatives or friends; consideration should be given as to how this may come out and how that situation would be dealt with. Fertility Exeter will keep information about egg recipiency in the strictest of confidence; however Fertility Exeter cannot have any control over information that the recipient or donor may choose to impart to others, or indeed what those others themselves may pass on. It is suggested that couples keep details of their treatment as confidential as possible. Fertility Exeter will, where possible, match egg donors with recipients from different geographic areas. In order to minimise the chance that the donor and recipient may inadvertently be related or know one another, both couples would be invited to submit a Contact List of names of close friends and relatives to whom this might apply to Fertility Exeter. If you are planning to receive eggs from a known donor, Fertility Exeter advises you and the donor to keep details of the treatment as confidential as possible. What treatment will I need to undergo to receive donated eggs? You will have a consultation with the Fertility Consultant who will explain how the treatment is done. They will review your medical history to confirm this is the most appropriate treatment for you and your partner. In order to prepare the lining of the womb you will need to take a combination of drugs and this will be monitored with ultrasound scans. If you are using your partner s sperm to create embryos, he will need to provide a sperm sample on the day the donor undergoes the egg collection operation. You will be kept informed by the embryologists about how many eggs have been allocated to you, how many have fertilised and how many are suitable for transfer or freezing. The embryo transfer procedure is very similar to a smear test and does not need an anaesthetic. The transfer will be done under ultrasound scan control to ensure the embryo/s is/are placed optimally at the top of the cavity of the womb. You will then continue to take hormone supplements for two weeks before doing a pregnancy test. If the test is positive you will continue to take hormone supplements till 8-12 weeks as advised by your consultant. If you haven t fallen pregnant, you will be offered a debrief appointment with one of the fertility team. 3

4 What checks are made about us as recipients and about the donor? IVF clinics have a legal duty to consider the welfare of the potential child or children that might be born after assisted conception treatment including egg donation. The same welfare of the child considerations apply to donors, recipients and any patients receiving licensed fertility treatments. The HFE Act requires Fertility Exeter to carry out an assessment of the welfare of the child which includes the following: Treatment will usually only be offered to couples (heterosexual or same sex) in a stable relationship. Fertility Exeter has adopted the same criteria as NEW Devon Clinical Commissioning Group (CCG) by defining a stable relationship as one lasting two or more years. There should be no past or current mental or physical conditions that would lead to an inability to care for, throughout childhood, any children born as a result of the treatment. There should be no substantial risk that any child who might be born would suffer from a serious medical condition. The prospective parents should enjoy sufficiently good health such that the parental needs of the child could be met without serious difficulty. If the child born as a result of treatment might have no legal father (e.g. posthumous treatment, single women) that the woman or couple undergoing treatment have considered the need for supportive parenting by considering the need for male role models, a will and a legal guardian and support from friends and family. There should be no risk of harm or neglect to a child who may be born as a result of treatment. These factors include any aspect of a patient s or their partner s past or current circumstances that may lead to a child experiencing serious physical or psychological harm. This includes, but isn t limited to, previous convictions relating to harming children, child protection measure regarding existing children or serious discord or violence in the family environment. If necessary, further information may be sought from General Practitioners, other healthcare professionals, the police or social services before a couple is accepted for treatment. If information hasn t been provided or there is evidence of deception and Fertility Exeter cannot get enough further information to conclude there is no significant risk, then the woman/ couple will not be accepted for treatment. Women recipients of egg donation should be aged less than 50 years at the time of embryo transfer. Fertility treatment is not offered to women who smoke and men are strongly advised to be non-smokers as well. Women/couples seeking treatment are required to provide evidence of their identity in the form of photographic ID which includes their name and date of birth (e.g. a passport or driving licence). Who can become an egg donor? Fertility Exeter has strict criteria for accepting an egg donor based on the legal requirements of the HFE Act and clinical evidence. Egg donors should: be between ages 18 to 35 years at the time of donation. In exceptional circumstances for donation to a known recipient, donors more than 36 years of age may be considered but the recipient will need to carefully consider the chance of success, risk of miscarriage and risk of fetal abnormality based on the age of the known donor. 4

5 not be at risk of passing on any diseases or illnesses to the recipient or any children. This means they need to be screened for inherited disorders, sexually transmitted infections and virus infections including hepatitis and HIV. have undergone tests to ensure there is good egg reserve. have a body mass index in the range In exceptional circumstances for donation to a known recipient, donors with a BMI of may be considered but the recipient will need to carefully consider the chance of success. Donors with a BMI >35 will not be accepted in accordance with Fertility Exeter policy be a non-smoker. Fertility Exeter does not accept donors who are smokers due to the toxic effect of cigarette smoke on the eggs which increases the risk of miscarriage and complications during pregnancy. What screening tests do the egg donors have? The fertility consultant carries out a detailed review of their medical, family and fertility history. They will explain IVF treatment and discuss the full implications of treatment including the side effects, discomfort, risks of egg collection, failed fertilisation and failure of embryos to implant with the donor. As a routine part of fertility treatment, the donor is screened for immunity to rubella. Donors undergo additional investigations as required by the HFE Act. This includes blood tests for: Hepatitis B Syphilis Karyotype (chromosomes) Hepatitis C HIV (human immunodeficiency virus) Cytomegalovirus (CMV) Antimullerian hormone Cystic fibrosis gene alteration Other tropical diseases depending on travel history They also have swabs taken from the cervix and the vagina to screen for sexually transmitted infections. 5

6 What information is stored about the donor? Fertility Exeter will keep a copy of your egg Fertility Exeter will keep a copy of the egg donor questionnaire and her IVF notes for at least 30 years. The HFEA requires egg donors to complete the Donor Information Form: Donor.pdf which contains information about the donor and her family. There is also an optional section for her to write about why she has donated her eggs and a goodwill message for any children born as a result of the donation. The recipient and her partner will be given information about the donor s age, physical appearance and ethnic origin. Fertility Exeter will try to match at least some of the donor s physical characteristics to those of the recipient. The recipient can request any of the other non-identifying information recorded on the HFEA Donor Information Form. This includes: Her marital status Year and country of birth The number and sex of children she already had at the time of donation Her reasons for donating The ethnic group of her parents Any medical conditions in her family Whether she was adopted or donor conceived Her medical and screening history Her skills Her interests Other personal details e.g. religion, occupation, pen portrait etc A goodwill message For donations where the donor is unknown to the recipient, no potentially identifying information about the donor will be given. What information is given to the child/children about the donor? Anyone born as a result of egg donation, from age 16, is entitled to the non-identifying information about the donor that is recorded on the HFEA Donor Information Form as above. Anyone born as a result of egg donation, from age 18, is entitled to identifying information about the donor. They will be informed of her full names and any previous names, date of birth and town or district where born and last known postal address. Can I find out anything about the donor s treatment? Anyone born as a result of your donation, Due to the confidential nature of assisted conception treatment, Fertility Exeter is not permitted to give you any information about the donor s treatment cycle. Can the donor place restrictions on treatment with her donated eggs? The donor is allowed to specify extra conditions on the use or storage of her donated eggs or the embryos created using them. This is commonly used for known donors who want to donate to a specific person/couple. They can also specify a limit on the number of families created as a result of their donation up to a legal maximum of 10 families. 6

7 Fertility Exeter is required to comply with the Equality Act 2010 which is the law relating to discrimination. Fertility Exeter must not treat people less favourably because of a protected characteristic. If the restrictions she wishes to place relate to protected characteristics, Fertility Exeter will not accept her as an egg donor. Protected characteristics are: Age Pregnancy Sex and maternity Disability Race Sexual orientation Marriage and civil partnership Religion or belief Gender reassignment Can I withdraw my consent to being an egg recipient? The HFE Act states that you can withdraw your consent to treatment up to the point at which embryos have been transferred, discarded or used for training. If the donor withdraws from treatment you may be matched with an alternative donor or in exceptional circumstances may be offered treatment with frozen eggs. If the donor does withdraw, most commonly your treatment has to be stopped until a new donor can be found. Fertility Exeter recruits donors very carefully and ensures they have been fully counselled to minimise the risk of them withdrawing consent, however Fertility Exeter cannot be held responsible for events that are outside their control such as short term illness of the donor. The Fertility Consultant will discuss the cost implications of treatment with you and the consequences if you or your donor changes your mind about proceeding with treatment. Counselling Independent fertility counselling is available to all patients as part of IVF treatment. In order to become an egg recipient, you must see the counsellors before finally deciding whether to proceed with treatment. They will help you to understand the full implications of your recipiency both to you and your family. The consultant will discuss the legal and ethical implications of IVF and egg recipiency but all couples are advised to seek independent legal advice if they have any concerns about proceeding with treatment, legal parenthood or being an egg recipient. What information about me is given to the donor? The donor is permitted to ask and receive information about any children born as a result of donation of her eggs. Fertility Exeter must provide her with information about the number of children born, their sex and their year of birth on request. Fertility Exeter will not disclose identifying information about you or your child/ren to the donor. 7

8 Royal Devon and Exeter (NHS) Foundation Trust (Heavitree) Gladstone Road Exeter EX1 2ED Tel: Filename:Information For Egg Recipients V1.0.Doc QPulse Ref: F/PI/16 Authors: L.Joels & R.Cowie Approved by: FGG Date: Review date: