Beyond Your Own Eggs & Sperm: What is Third Party Reproduction?
By: Jessica Joseph, RN, BSN, MHA
The views and opinions expressed are those of the authors and should not be considered medical advice. Always consult your doctor, or a mental health professional, for the most appropriate treatment.
Third-party reproduction is a route to parenthood for aspiring parents who need assistance from a third-party source to help them achieve their dreams of pregnancy and having a child. Third-party individuals are egg donors, sperm donors, or surrogates (commonly referred to as gestational surrogates or gestational carriers). With the help of a fertility specialist (reproductive endocrinologist or RE), fertility treatments like intrauterine insemination (IUI) and in vitro fertilization (IVF) become an integral part of third-party reproduction.
Screening: Donors and Surrogates
Those who seek the help of third-party reproduction are known as intended parents. When screening a sperm or egg donor, intended parents look for a good match based on many different characteristics, such as physical attributes (for example, height, weight, eye color, or hair color), education level, personality traits, motivation to donate, and ethnic background. Once a donor is found, the fertility clinic will run additional tests to ensure the egg or sperm donor qualifies to donate. Sometimes the donor is known (not anonymous) to the intended parents. This often creates legal implications, and intended parents who take this route typically draw up a contract with the sperm or egg donor to establish parental rights.
Gestational surrogates who carry a pregnancy for another individual or couple are always known (never anonymous) and usually establish a relationship with the intended parents. Screening a gestational surrogate is a bit more involved than the process for donors. There is a rigorous qualification process for surrogacy, which includes medical screening, psychological evaluation, and legal consultations. The medical screening typically includes tests for prenatal blood work, an ultrasound to make sure the uterus is clear of fibroids or polyps, and a thorough medical history evaluation. Surrogates also need to meet basic criteria, such as being at least twenty-one years old, and having at least one biological child via an uncomplicated pregnancy. The psychological screen includes a comprehensive session with a therapist for clearance. Legal guidance is also provided to the surrogate, and the intended parents typically cover those costs. The matching process between the intended parents and the surrogate takes time and often involves numerous interviews.
Donor Sperm
Donor sperm benefits individuals or couples who are single women or single parents, lesbian couples, or those whose male partner has poor sperm parameters (issues with the amount, movement, or shape of the sperm). Most often, the donated sperm is acquired via a sperm bank, and is through an anonymous donor. Sperm banks are responsible for screening sperm donors for infectious diseases, genetic issues, and psychological conditions.
Donor Eggs
Donor eggs benefit individuals or couples who might struggle with infertility and have been diagnosed with diminished ovarian reserve (DOR) or premature ovarian insufficiency (POI). Individuals with these diagnoses often have a poor number of their own eggs and might be in either a peri-menopause or menopause state. Women who have had the surgical removal of their ovaries (a procedure called oophorectomy) also benefit from donated eggs. Male same-sex couples who want to have a baby may also utilize donor eggs to achieve their dreams of parenthood. Similar to sperm donors, egg donors also need to establish candidacy by screening for infectious diseases, genetic conditions, and psychological disorders.
Surrogacy
Individuals and couples seek surrogates for various reasons, including underlying medical conditions such as a hysterectomy (when a woman’s uterus is removed), or having a serious medical condition that can adversely affect her life should she carry her own pregnancy. Male same-sex couples who want to have a child also consider surrogacy as a reproductive option (in addition to donor eggs as noted above).
Screening: Intended Parents
Similar to donor and surrogate screenings, intended parents must also undergo a psychological evaluation. When preparing for third party reproduction, intended parents often raise concerns about:
- Expenses related to using an egg donor, sperm donor, or gestational surrogate
- Anxiety over lack of control with outcome
- Whether or not to disclose to their child or children that they were conceived via donor egg, donor sperm or surrogacy
- If choosing to disclose the child’s origin, how to handle the confusion it may cause
- Dealing with losing a genetic link with their children (if using donated egg or sperm)
Recruitment: Donors and Surrogates
The recruitment process for selecting your ideal candidate can be long and sometimes arduous. Egg donors can be selected via an agency, frozen egg bank, or fertility clinic. Some fertility clinics recruit egg donors and give their patients access to a database where they can pursue donors for fresh or frozen egg selection. Some egg donors are known (not anonymous) to the intended parents and may even be a friend or family member.
Sperm donations are typically selected via a sperm bank unless the donor is known to the intended parents and is not anonymous. Whether using a known or anonymous sperm donor, the medical screening and psychological evaluation are the same. Using a known donor may carry more legal risk, and using a reproductive attorney would be an important course of action.
Surrogates can be screened and selected via an agency, or chosen via a friend or family member. Gestational surrogacy laws vary state by state. It is always wise to consult the fertility clinic or provider performing the embryo transfer (or the agency that screened and recruited the surrogate) regarding what “type” of surrogates can be selected in your state. For example, some surrogates are known as compassionate carriers, meaning they voluntarily choose to carry a pregnancy for another individual or couple (often a friend or family member). On the other hand, compensated carriers are reimbursed financially for carrying a pregnancy for someone else. Whether they are compassionate or compensated carriers, surrogates are not responsible for any medical or legal fees accrued. The intended parents cover these costs.
Treatment: Third-Party Reproduction and Assisted Reproductive Technology (ART)
Intended parents have the option to try to achieve pregnancy via third-party reproduction using multiple methods depending on the source. One option with donor sperm is at-home insemination. Other options include fertility treatments like IUI or IVF. Intended parents who use donor eggs, for example, can only do IVF (except in the rare case where the egg donor is also going to be the surrogate). Intended parents who plan to use a gestational surrogate also have to go through at least one IVF cycle, as they need to create embryos via an egg retrieval. The eggs are then fertilized with the partner (or donor) sperm, and the resulting embryos are frozen to be used for a frozen embryo transfer (FET) with their gestational surrogate at a later date.
Success Rates: Third-Party Reproduction
A multitude of factors determine the success rates of third-party reproduction, in the form of positive pregnancy tests, continued pregnancy and eventually a live birth. For instance, when using an egg donor, most donors are screened by a fertility clinic to ensure they are ideal candidates for the donation process. Screening for an egg donor, besides ensuring she does not carry any infectious diseases or genetic disorders that can be passed on to the offspring resulting from her egg donation, includes ovarian reserve testing. Ovarian reserve testing looks at several factors to predict how many eggs and embryos might result from an IVF procedure. Standard tests used in ovarian reserve testing include anti-müllerian hormone (AMH), follicle-stimulating hormone (FSH), and antral follicle count (AFC), as well as the age of the donor. A fertility doctor will evaluate the donor’s results and inform the intended parents if the egg donor candidate is suitable for egg donation and if so, what the success rates might look like.
Sperm donors must undergo medical screening and provide a semen sample for testing. In addition to screening for sexually transmissible diseases, the sperm donor’s semen parameters will be evaluated to ensure he is an ideal candidate to donate. Standard parameters measured are sperm count, movement, and shape. These results will help the fertility specialist determine potential success rates for conception and beyond.
Gestational surrogates are screened to make sure they can carry a healthy pregnancy to term. Factors reviewed to ensure a viable pregnancy and live birth are if the surrogate had a previous healthy birth without complications. The fertility specialist will also look at the surrogate’s uterus via a procedure known as a hysteroscopy to rule out any uterine abnormalities, such as fibroids or polyps. All of these evaluations will be used to help determine the success rates of an FET.
Ethical and Legal Considerations: Third-Party Reproduction
Third-party reproduction is a complex and evolving field within reproductive medicine that has many benefits and also ethical considerations. It provides hope and opportunities for individuals and couples who may not be able to conceive on their own, allowing them to experience the joys of parenthood. However, it also raises questions about the rights and well-being of all parties involved, including the donors, surrogates, and the children born through these arrangements.
As society continues to navigate the intricacies of third-party reproduction, proper regulations and safeguards must be in place to protect the rights and interests of everyone involved. Open and honest communication, comprehensive legal frameworks, and ongoing ethical discussions are crucial in shaping a responsible and compassionate approach to third-party reproduction.
