The phrase “third-party reproduction” refers to the use of eggs, sperm, or embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become parents. Donors may be known or anonymous to the intended recipient. “Third-party reproduction” also includes traditional surrogacy and gestational carrier arrangements. Traditional surrogacy refers to a treatment in which a woman is inseminated with sperm for the purpose of conceiving for an intended recipient. The surrogate in this scenario has a genetic and biological link to the pregnancy she might carry. In contrast, a gestational surrogate (also called a gestational carrier [GC] or uterine carrier) is an individual in which embryos created by the intended parents are transferred into the surrogate’s uterus, which has been prepared hormonally to carry a pregnancy. The gestational surrogate has no genetic link to the fetus she is carrying. Traditional surrogacy arrangements often are perceived as controversial with the potential to be complicated both legally and psychologically. Despite the requirement for in vitro fertilization (IVF) to create embryos, the utilization of a gestational surrogate, legally, is a lower-risk procedure and is the more common approach conducted in the United States.
Third-party reproduction is a complex process requiring consideration of social, ethical, and legal issues. The increased use of egg donation has required a reconsideration of the social and ethical impact this technology has had on prospective parents, their offspring, and the egg donors themselves. Surrogacy has been acknowledged within the reproductive-medicine community as well as by the American Society for Reproductive Medicine (ASRM). Surrogacy arrangements nevertheless remain controversial and are subject to both legal and psychosocial scrutiny. This booklet will discuss the options for third-party reproduction, reviewing sperm donation, egg donation, embryo donation, and both traditional surrogacy and gestational surrogacy.
Embryo donation is a procedure that enables embryos that were created by couples undergoing fertility treatment to be transferred to infertile patients in order to achieve a pregnancy. Indications for embryo donation include untreatable infertility that involves both partners, untreatable infertility in a single woman, recurrent pregnancy loss thought to be related to embryonic factors, and genetic disorders affecting one or both partners.
The process of embryo donation requires that the recipient couple undergo the appropriate medical and psychological screening recommended for all gamete donor cycles. In addition, the female partner undergoes an evaluation of her uterine cavity and then her endometrium is prepared with estrogen and progesterone in anticipation of an embryo transfer.
In the United States, embryo donation must meet established FDA guidelines for screening of the donors. In the case of embryos that have been created previously, the FDA recommends–but does not require–that the couple who created these embryos undergoes the requisite screening and testing required of all egg and sperm donors. For embryos that are created specifically for donation, the sperm donor and egg donor must be screened and tested as any other sperm and egg donors who are not intimate sexual partners of the recipients.
Embryo donation is a controversial process from both an ethical as well as a legal standpoint. What differentiates embryo donation from either egg or sperm donation is that the child born to the couple will have no genetic link with them, yet all parties will benefit from the biologic relationship they share through the commitment the parents have made to gestate this embryo. Of paramount importance is that informed consent and counseling be provided to both the donors of the embryos and the recipient couple to address all of the potential issues embryo donation might raise. In addition, due to the absence of explicit laws regarding embryo donation, couples should consult with legal counsel regarding the necessity of a pre-donation agreement as well as the necessity of seeking a judicial determination or recognition of parentage.
Pregnancy following embryo donation depends on the quality of the embryos that were frozen, the age of the woman who provided the eggs, and the number of embryos transferred. There are no national statistics on the pregnancy rate with embryo donation due to the limited number of embryo donation cases nationwide.
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