24-30 September 2018

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Embryo Donation

What is embryo donation (ED)?

ED is the donation by a couple who have “surplus” embryos following IVF to someone else struggling with infertility. ED has only been available in New Zealand since late 2005. The regulations are quite different from those of many other countries, following guidelines that have been set out by ACART (the Advisory Committee for Assisted Reproductive Technologies) under the HART (Human Assisted Reproductive Technologies) Act of 2004.

The main requirements include that:

-          the embryos are “surplus” to the donors’ requirements, i.e. they remain after the donors feel that their family is “complete”

-          the recipients are medically infertile

-          the donation can occur to one family only, so that there aren’t full genetic siblings in more than two families

-          the embryos have been created from the donors’ own eggs and sperm

-          the donation cannot be anonymous. Donors must be prepared to have their identity recorded and disclosed to the children

-          The donors and recipients receive both individual counselling, as well as joint counselling, discussing the implications of ED and expectations around information-sharing and contact

-          All applications have to be submitted to ECART (Ethics Committee on Assisted Reproductive Technology)

 What are the advantages of ED?

ED has the potential to be an attractive option. For donors, the positives include:

-          Feeling like they are respecting and valuing their embryos. Much time, energy, physical and emotional resources have gone into the creation of embryos and many donors would like to see their embryos used, rather than discarded;

-          Some donors see their embryos as life, or a child already, and donation allows an opportunity for this life to be realised;

-          Donation allows donors to help others in a similar situation, or is a means for them to express thanks for the gift of having children that they have received

For recipients, the advantages of ED include:

-          ED is a technologically simple option and less expensive than some other options to build a family (such as international adoption);

-          ED may be an option for couples who have struggled to achieve embryos from their own eggs and sperm;

-          ED may be seen as “adoption with benefits”, as it offers the opportunity to experience pregnancy (allowing control over the prenatal environment and the opportunity to bond with the baby before birth), birth, and the parenting of a young child. The recipients, as birth parents, are also automatically recognised as the legal parents

However, ED can also be a challenging option, and many potential donors and recipients change their minds about proceeding with ED. Careful consideration needs to be given to the longer-term implications of donation, both for the adults involved as well as for the donor-conceived child, and any children that donors and recipients might already have. The children will in effect, be full brothers and sisters but growing up in different families.

New Zealand research on ED:

Between 2012 and 2014, Dr Sonja Goedeke of Auckland University of Technology conducted a study on ED, exploring how donors and recipients have experienced ED in New Zealand. This study suggests that donors and recipients regard genetics as important, and believe that donor-conceived children need to know about their genetic background and roots.  They see this as important not only so that children have access to medical information they may require, but that they know what their roots are and can establish a healthy sense of identity. Many donors and recipients talk about being aware of how closed adoption practices may have been difficult for adopted people, and that it seems to be better for adopted kids to know who their birth parents are. Much research suggests that telling children about their origins and from a young age onwards, rather than keeping their conception secret, is best for their psychosocial wellbeing. It also appears to promote, rather than negatively affect, healthy family relationships.

Donors and recipients tended to see ED as similar to adoption, almost like a “pre-birth adoption” or as one recipient put it, “growing your own adoption”. By drawing parallels with adoption, donors and recipients were able to make sense of ED, seeing it as a somewhat familiar form of family building, and it helped them to think through the possibly similar implications of ED.

Donors and recipients spoke about how they saw the role of the donors in relation to the children and the recipient family. Most regarded the donors as some sort of extended family members. They saw ED as akin to creating an extending family network, particularly given the fact that the children in the two families were full brothers and sisters, and that many felt that they should know about, and possibly even get to know each other. The donors were described as something like aunts, uncles, god parents, or distant relatives. This was a useful concept. It meant that they could regard the donors as part of the wider family, able to express interest in the child’s wellbeing and have a role to play (at the discretion of the parents). However, just like other extended family members, donors had no parental rights and responsibilities. In the study, donor and recipient families had different levels of contact with each other. Some maintained occasional contact through email, Facebook, password-protected blogs and/or phone calls. Others had face-to-face contact with each other, including meeting up for special occasions or social get-togethers. In these cases, most donors and recipients had been able to build healthy relationships with each other with clear boundaries and expectations – recipients were clearly seen as “the parents”, and yet donors were acknowledged as having some role in the child’s life. Most donors and recipients however spoke of their relationship as evolving over time, and as being something that was difficult to plan for – particularly since ED is a relatively new practice and donors and recipients had few models to guide them. This created some anxiety and uncertainty about the future, especially since the children born from ED are still young, and donors and recipients wondered about how ED would unfold in the longer term and how children might respond at a later stage.

Drawing on the research findings, if you are thinking about ED, either as a donor or as a recipient, you may wish to consider:

For Donors:

-          A successful donation means you will have a genetically-related child growing up in another family, and you will have no rights over the child. You may still feel a sense of connection to the child, and this may be particularly difficult if you have children of one sex and the recipients have a child of the opposite sex. Think carefully if you feel able to manage these feelings, and plan for ways (e.g. counselling) to help you to do so, possibly on an ongoing basis e.g. when the baby is born, or around the time of significant events

-          You may feel anxiety around selecting recipients, and feel like you need to try and select the best possible parents. This may be someone you feel “fits with you”, sharing similar values and philosophies. This can be a difficult process, and some donors struggle with the fact that no formal assessment of parenting suitability is done in ED. Think about what your expectations and requirements are in terms of recipients and how flexible you are around these. Some donors have met their recipients through their clinic, who can provide profiles of potential recipients; others have met them through family, friends or social networks

-          Some donors struggle with the fact that while ED in New Zealand is “open” and donor and recipient families meet each other in joint counselling, there are no guarantees that the recipients will tell the child of his or her background. This decision remains theirs, even if policy strongly encourages disclosure. On the other hand, you also need to be aware of the fact that even if you do not desire contact, the child may wish to initiate contact with you, and/or your children, at a later stage. You may wonder about how the child will feel about the donation, whether he/she will feel rejected, and about what questions he/she might have of you

-          You may wish to think about the potential needs and rights of your children too, since the donor-conceived child will be the brother/sister of your child/ren. Age-appropriate counselling is offered by clinic counsellors at the time of ED, and may also be appropriate as your children mature

-          You may wish to consider the impact of donation on your extended family. The parents of donors often regard themselves as still being the child’s grandparents, and this may present some challenges for them and for you.

-          ED is still a relatively new practice, and there is not much research available about the longer term outcomes. If you proceed with ED, you need to be able to manage the uncertainty and potential anxiety that may accompany embarking on a practice that has as yet, unknown implications, and you need to be flexible and accommodating to deal with any challenges and changes in the relationship with the recipient family

For recipients:

-          ED may offer you an opportunity to have children. Sometimes, however, you may need some time to cope with the reality of not being able to have genetically-related children. This grief is natural, and does not mean that you will be unable to form a strong attachment with your child conceived through ED

-          You may find that even if you were very much in favour of ED, you have some feelings of ambivalence during pregnancy and concerns about your attachment to the child, and relationship to the donors. Again, this is to be expected and can be resolved

-          Your child will have ties to another family. This may mean that you have to adjust what it means to parent, acknowledging that your child may need to know about, and may want some degree of contact with the donors. You may worry about how the relationship between the two families will evolve, and the degree of involvement from the donors.  Expectations, needs and wishes need to be clearly discussed before ED proceeds, but you may also need to be aware that these may change over time, and think through ways in which these can be addressed, e.g. setting up processes for counselling

-          You may feel indebted to your donors, seeing the ED as a tremendous gift. You need to be aware that seeing the donation as a gift may sometimes evoke social expectations of reciprocity e.g. gifting-receiving-reciprocation. This may lead to you agreeing to more information-exchange and/or contact than you will eventually be comfortable with. These issues need to be discussed in counselling and it may be helpful to regard the donation as something that is also of benefit to the donors, providing a solution for their embryos

-          You will need to think through if and how to discuss ED with your friends and family. Some recipients are very anxious about this and if their child will be accepted. You may also wonder about how to share your child’s background with him or her (there are many excellent resources that can support you in this and clinic counsellors may be helpful)