Altruistic Donation of Surplus Embryos to Known and Unknown Recipients, The Dutch Approach

Document Type : Original Article

Authors

TFP-Medisch Centrum Kinderwens Leiderdorp, Leiderdorp, The Netherlands

Abstract

Background: Previous studies have shown that embryo donation can be a successful treatment for infertile couples,
however the willingness of Dutch couples to donate or accept embryos was unknown. The aim of this article is to
describe the protocol and results for altruistic embryo donation of the only embryo bank in the Netherlands.
Materials and Methods: This is a descriptive study. Since 2011, donated cryo-embryos from couples that have undergone in vitro-fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments, are being stored in our embryo
bank. The majority of the donated embryos were frozen on day 3 or 4 by slow freezing techniques. We perform a
thorough medical and psychological screening of donor couples and recipients, according to the protocol drawn up in
close collaboration with the Dutch Ministry of Health.
Results: Up to June 2021, 54 women have received embryos from our embryo bank, all single embryo transfers.
While the clinical pregnancy rate in ‘unknown’ embryo donations was relatively high (25.3%), the live birth rate
shows limited success (12.6%), partly due to high pregnancy loss through miscarriage. In known donation procedures,
the recipients tend to undergo more procedures, depending on the number of donated cryo-embryos. Twentyeight
women received embryos from known donors, with a clinical pregnancy rate per embryo transfer of 24%, and
live birth rate of 14%. In total, 82 recipients were granted donated cryo-embryos, twenty had an ongoing pregnancy
(24.4%), nineteen of whom have given birth to a healthy child (23%).
Conclusion: Altruistic embryo donation of embryos appears to be satisfying for the donors, as they are not obliged to destroy their embryos, but instead help others build a family. Although success rates are still limited, partly due to the relatively high miscarriage rates and inferior freezing techniques, to this date nineteen out of 82 recipients have given birth to a healthy child.

Keywords

References

  1. Cattapan A, Baylis F. Frozen in perpetuity: 'abandoned embryos' in Canada. Reprod Biomed Soc Online. 2016; 1: 104-112.
  2. Bruno C, Dudkiewicz-Sibony C, Berthaut I, Weil E, Brunet L, Fortier C, et al. Survey of 243 ART patients having made a final disposition decision about their surplus cryopreserved embryos: the crucial role of symbolic embryo representation. Hum Reprod. 2016; 31(7): 1508-1514.
  3. Wilsdon L. Embryo donation in New Zealand: considerations of the health and wellbeing of children. J Law Med. 2019; 26(3): 691-701.
  4. Klatsky P, Delaney S, Caughey A, Tran N, Schattman G, Rosenwaks Z. The role of embryonic origin in preeclampsia a comparison of autologous in vitro fertilization and ovum donor pregnancies. Obstet Gynecol. 2010; 116(6): 1387-1392.
  5. Blazquez A, García D, Vassena R, Figueras F, Rodriguez A. Risk of preeclampsia in pregnancies resulting from double gamete donation and from oocyte donation alone. Pregnancy Hypertens. 2018; 13: 133-137.
  6. Blazquez A, García D, Vassena R, Figueras F, Rodriguez A. Risk of pre-eclampsia after fresh or frozen embryo transfer in patients undergoing oocyte donation. Eur J Obstet Gynecol Reprod Biol. 2018; 227: 27-31.
  7. Preaubert L, Vincent-Rohfritsch A, Santulli P, Gayet V, Goffinet F, Le Ray C. Outcomes of pregnancies achieved by double gamete donation: a comparison with pregnancies obtained by oocyte donation alone. Eur J Obstet Gynecol Reprod Biol. 2018; 222: 1-6.
  8. Goedeke S, Daniels K, Thorpe M, Du Preez E. Building extendedfamilies through embryo donation: The experiences of donors and recipients. Hum Reprod. 2015; 30(10): 2340-2350.
  9. Bracewell-Milnes T, Saso S, Bora S, Ismail AM, Al-Memar M, Hamed AH, et al. Investigating psychosocial attitudes, motivations and experiences of oocyte donors, recipients and egg sharers: a systematic review. Hum Reprod Update. 2016; 22(4): 450-465.
  10. MacCallum F, Golombok S, Brinsden P. Parenting and child development in families with a child conceived through embryo donation. J Fam Psychol. 2007; 21(2): 278-287.
  11. MacCallum F, Keeley S. Embryo donation families: a follow-up in middle childhood. J Fam Psychol. 2008; 22 (6): 799-808.
  12. Practice Committee of American Society for Reproductive Medicine Practice Committee of Society for Assisted Reproductive Technology. Recommendations for gamete and embryo donation: a committee opinion. Fertil Steril. 2013; 99(1): 47-62.
  13. Cohen I, Adashi E. Made-to-order embryos for Sale — a brave new world? N Engl J Med. 2013; 368(26): 2517-2519.
  14. Söderström-Anttila V, Miettinen A, Rotkirch A, Nuojua-Huttunen S, Poranen AK, Sälevaara M, et al. Short- and long-term health consequences and current satisfaction levels for altruistic anonymous, identity-release and known oocyte donors. Hum Reprod. 2016; 31(3): 597-606.
  15. Goedeke S, Daniels K. We wanted to choose us: how embryo donors choose recipients for their surplus embryos. J Reprod Infant Psychol. 2018; 36(2): 132-143.
  16. ESHRE Task Force on Ethics and Law. Gamete and embryo donation. Hum Reprod. 2002; 17 (5): 1407-1408.
  17. ASRM Ethics Committee of the American Society for Reproductive Medicine. Disposition of abandoned embryos: a committee opinion. Fertil Steril. 2013; 99(7): 1848-1849.
  18. ASRM Ethics Committee of the American Society for Reproductive Medicine. Defining embryo donation: an ethics committee opinion. Fertil Steril. 2016; 106(1): 56-58.
  19. ASRM Ethics Committee of the American Society for Reproductive Medicine. Informing offspring of their conception by gamete or embryo donation: an ethics committee opinion. Fertil Steril. 2018; 109: 601-605.
  20. ASRM Ethics Committee of the American Society for Reproductive Medicine. Interests, obligations, and rights in gamete and embryo donation: an ethics committee opinion. Fertil Steril. 2019; 111(4): 664-670.
  21. Zimon A, Shepard D, Prottas J, Rooney K, Ungerleider J, Halasa- Rappel Y, et al. Embryo donation: survey of in-vitro fertilization (IVF) patients and randomized trial of complimentary counseling. PLoS One. 2019; 14: e0221149.
  22. European Commission. COMMISSION DIRECTIVE 2006/17/ EC of 8 February 2006 implementing Directive 2004/23/EC of the European Parliament and of the Council as regards certain technical requirements for the donation, procurement and testing of human tissues and cells. Official Journal of the Europian Union. Available from: 2006, http://eurlex.europa.eu/legal-content/EN/ TXT/?uri=celex:32006L0017 (9 Sep 2021).
  23. Goedeke S, Daniels K, Thorpe M. Embryo donation and counselling for the welfare of donors, recipients, their families and children. Hum Reprod. 2016; 31(2): 412-418.
  24. Goedeke S, Daniels K. The discourse of gifting in embryo donation: the understandings of donors, recipients, and counselors. Qual Health Res. 2017; 27(9): 1402-1411.
  25. Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011; 26(6): 1270-1283.
  26. Keukens A, van Wely M, van der Meulen C, Mochtar M. Preeclampsia in pregnancies resulting from oocyte donation, natural conception or IVF: a systematic review and meta-analysis. Hum Reprod. 2021; 37(3): 586-599.
  27. de Lacey S. Decisions for the fate of frozen embryos: fresh insights into patients' thinking and their rationales for donating or discarding embryos. Hum Reprod. 2007; 22(6): 1751-1758.
  28. Millbank J, Stuhmcke A, Karpin I. Embryo donation and understanding of Kinship: the impact of law and policy. Hum Reprod. 2017; 32(1): 133-138.
  29. Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2016 (6): CD002118.
  30. Hogan R, Wang A, Li Z, Hammarberg K, Johnson L, Mol BW, Sullivan E. Oocyte donor age has a significant impact on oocyte recipients' cumulative live-birth rate: a population-based cohort study. Fertil Steril. 2019; 112(4): 724-730.
  31. Braga DPAF, Setti AS, Iaconelli A Jr, Borges E Jr. Predictive factors for successful pregnancy in an egg-sharing donation program. JBRA Assist Reprod. 2020; 24(2): 163-169.
  32. Flamigni C, Borini A, Violini F, Bianchi L, Serrao L. Oocyte donation: comparison between recipients from different age groups. Hum Reprod. 1993; 8(12): 2088-2092.
  33. Soares S, Velasco J, Fernandez M, Bosch E, Remohí J, Pellicer A, et al. Clinical factors affecting endometrial receptiveness in oocyte donation cycles. Fertil Steril. 2008; 89(3): 491-501.
  34. Keenan JA, Gissle Mr, Finger R. Assisted reproduction using donated embryos: outcomes from surveillance systems in six countries. Hum Reprod. 2012; 27(3): 747-752.
  35. Kawwass JF, Crawford S, Hipp HS, Boulet SL, Kissin DM, Jamieson DJ, et al. Embryo donation: national trends and outcomes, 2000 through 2013. Am J Obstet Gynecol. 2016; 215(6): 747. e1-5.
  36. Macklon N, Geraedts J, Fauser B. Conception to ongoing pregnancy: the 'black box' of early pregnancy loss. Hum Reprod Update. 2002; 8(4): 333-343.
  37. Larsen EC, Christiansen OB, Kolte AM, Macklon N. New insights into mechanisms behind miscarriage. BMC Med. 2013; 11: 154.
  38. Levron Y, Dviri M, Segol I, Yerushalmi G, Hourvitz A, Orvieto R, et al. The ‘immunologic theory’ of preeclampsia revisited: a lesson from donor oocyte gestations. Am J Obstet Gynecol. 2014; 211(4): 383.e1-5.
  39. Saito S, Nakabayashi Y, Nakashima A, Shima T, Yoshino O. A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health. Semin Immunopathol. 2016; 38(6): 687-697.
  40. Huele E, Koo El, Bos A, Fauser B, Bredenoord A. The ethics of embryo donation: what are the moral similarities and differences of surplus embryo donation and double gamete donation? Hum Reprod. 2020; 35(10): 2171-2178.

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