The Choices & Challenges of Going Abroad for Donor Egg IVF

The keynote talk at the Network National meeting in March 2008 was from members Penny and Lloyd. This is an edited version of their talk.

Penny

We were asked to talk about why we chose to go abroad for treatment and we agreed to give this talk as we thought it would help us to clarify our thoughts.

After 5 years of trying for a baby we decided to try for conception with donor eggs and IVF.

The clinics informed me that the waiting lists were at least 3 years long - possibly longer as I was CMV negative - and the costs were exorbitant at £7,000. The only way to move to the top of the list was to advertise for a donor in the national press. If a donor was found via my advert I would go straight to the top of the list. One of the leading fertility professors told me that ‘all’ I needed to do was to ask all the suitable female guests at every dinner party I went to if they’d be an egg donor! This same doctor told me that a miscarriage wasn’t a baby but just a bundle of tissue. Compassion didn’t seem to be his strong point. I felt overwhelmed by the condescending attitudes of the majority of the doctors at the clinics I visited in London. I felt very despondent, it seemed as if Lloyd and I would never be parents.

In March 2003 a good friend went for her first consultation at a fertility clinic in Seville. She was told the waiting list was very short and the cost was only £3,000. She had her embryo transfer 4 weeks later and became pregnant with twins! She found the doctors caring and professional and the clinic much more up to date than those in the UK.

Lloyd and I decided to go to Spain to find out for ourselves. We choose to go to Madrid, it’s a city we both love and is very special to Lloyd as he’d lived there for a year in his youth! We booked an appointment in Madrid but then unexpectedly found out I was pregnant. Sadly that pregnancy ended at 9wks and became my 4th miscarriage. I hadn’t cancelled the appointment in Madrid as I felt sure that the pregnancy would fail. That miscarriage only served to reassure us that we were doing the right thing by moving ahead with egg donation. We were very impressed with our visit to Madrid and the consultation went very well. The staff were kind and considerate and understanding of our situation. We felt optimistic for the first time in many years of trying for a baby.

We had the choice of egg donation treatment in England or Spain, but Spain seemed our best option. The treatment and medication in Spain was cheaper than the UK and waiting lists were much shorter. The staff in the Spanish clinics seemed more compassionate than their counterparts in the UK. The majority of the clinics in Spain don’t egg share and tend to use much younger donors than at clinics in the UK. We were told that these factors meant that our chances of success were much higher than in the UK. The Spanish clinic quoted a success rate of 65%. Our NHS miscarriage consultant at St Mary’s supported our decision to travel to Spain. In his opinion Spanish medical treatment and facilities regarding fertility treatment were far superior to that available in the UK. The Spanish clinics also seem to be much more efficient at communication, often replying within 24 hours to any queries via emails, unlike the clinics in the UK. We decided to have treatment in Madrid. Lloyd speaks fluent Spanish and we were very positive about bringing up an effectively half Spanish child and hoped any child we had would be proud of its Spanish ancestry.

The clinic in Madrid said that I could start treatment immediately but as I’d just had a miscarriage we decided to put it on hold for several months. In Jan 2004 we were ready to go ahead. We informed the clinic and they said they could have a donor for us straight away. Then an unexpected change in the law was announced that would result in the removal of donor anonymity in the UK from April 2005. It now seemed that children born from Donor Egg & sperm would have the option to find out more about their donor when they reached 18 years of age.

This was a huge dilemma, Lloyd and I had always wished that the donors in the UK and Spain weren’t anonymous. We were unsure what to do. On one hand the clinic was just about to match us, Lloyd’s sperm was already in Spain and all the papers were signed. On the other hand it was very important to us that any child born from Donor Egg should have the right to know about their heritage and have the chance to meet their donor if they wished.

If I cancelled the Spanish treatment I’d have to get on to a UK list which were already around 2-4 years long before the law change announcement. The feeling was that the lists would get even longer as it was assumed that some women may now not want to donate or egg share if they thought any children from a donation could contact them! The media was full of shock horror headlines about donor shortages and extensive waiting lists! It now seemed that a probable 3 year wait had suddenly become a 4 or 5 year wait. Even if I could get myself on to a UK list and successfully advertise for a donor, the wait would be at least another 2 years as the new law wasn’t due to come into force for another year.

Our clinic in Spain had told us we’d only have to wait another 3 weeks to start down regulating…it was all about to happen after so many years and so many disappointments. Our chance of becoming parents was tantalisingly close.

We considered everything very carefully: the removal of anonymity in the UK would lead to a situation in the future where children born from UK egg donors would be in a very different situation to children of the same age born from anonymous donors abroad…was this acceptable?

We also discussed the issues surrounding donor compensation. It’s illegal to pay donors for their eggs in Spain but the clinics ‘compensate’ egg donors by around 800 Euros - roughly £500. The majority of the donors are students and Lloyd and I felt that £500 was a reasonable amount of compensation to receive for egg donation, especially as the cost of living in Madrid is very high. We did not feel that £500 was an amount that would lead to the exploitation of donors as it might do in countries where the cost of living is much lower. But of course we have no way of knowing the individual circumstances of the donors.

I had many long conversations with Rachel Sergeant, the DCN egg donor coordinator at the time. She was hugely helpful and supportive and really helped me to put things in perspective. To be honest, we just didn’t feel we could wait any longer. We just wanted to be parents and we’d been through enough. At age 42, After 2 spinal operations and 4 miscarriages and endless fertility investigations I didn’t think I could wait for several more years. It didn’t feel like a choice at all. We stayed with the Spanish clinic.

I think it's important to be aware of all the issues involved before traveling abroad for treatment. Many clinics in the UK seem to refer patients abroad without providing adequate information on the issues involved in using foreign donor gametes. Indeed many of the top UK fertility clinics have now established their own links with clinics overseas and actively profit from sending couples for treatment abroad. Patients who go abroad via their UK clinic will at least benefit from the one session of counseling that is compulsory before treatment. Couples who take the route that we did and travel to Spain independently do not require any sort of counseling at all.

I’d also just like to add that things now seem more restricted at many of the Spanish clinics regarding the amount of information given to recipients. Many of the clinics now refuse to give away any information on their donors, except their blood group and age - and that’s only after a positive pregnancy test. Many of the Spanish clinics are now using Eastern European students to fill the huge demand for blue-eyed donors from overseas. The clinics do not always disclose the nationality of these donors to the recipients. I feel that the donor’s nationality is vital information for the child, especially when so little information is now available. The hope is that more non-identifying information on donors will be made available by the clinics in Spain in the future.

Lloyd

Penny and I decided to try for a baby with an anonymous donor in Spain because after the experiences Penny has just described we felt like we’d lost all hope from both the perspectives of time and the capacity to endure any more emotional heartbreak. The fact that my father had died from a stroke in his late fifties made us much more sensitive to the passing of time than most people.

When we made our decision could we imagine what it would be like for a child to grow up not knowing who his or her genetic parent was? ‘No’ is the honest answer. But we tried. We had some idea of what it might be like because both my sister and I are adopted. My experience of living without knowing my genetic parents was that it didn’t stop me from generally enjoying life. Was I glad that I had come into the world – rather than not ? Undoubtedly yes.

I am now reunited with my birthparents - the potential for this reunion always existed for me. My sister has chosen to date not to seek a reunion.

Because Penny and I chose to use an a donor in Spain, our daughter Eloise will never be able to choose to meet her genetic mother.

So…essentially the pressure of time and the belief that a human being could lead a fulfilling life without knowing some of his or her genetic origins lead Penny and I to Spain.

Some people seek common ground between donor conception and adoption, and this is understandable because in both scenarios the genetic link is interrupted. At the same time, there are significant differences between these two ways of making families, most notably that with donor conception the baby grows for 9 months in the womb of the woman who then continues to mother her after birth, whereas in adoption the opposite occurs. One of the reasons Penny and I chose to have a baby through donor egg conception was the fact that baby Eloise and Penny would be joined almost from the point of conception, and would grow attuned to each other from that moment.

Because donor egg conception is relatively new, we aren’t yet fully aware of the influence of donor conception on the child’s personality. Until more research is done in this area we shall not really understand how much common ground there is with adoption. This is relevant because research on adoption has indicated that being adopted may incline some adoptees to certain ways of being and this knowledge sometimes helps people meet the challenges that may follow from adoption.

Research on adoption has identified the importance of loss of cultural and country inheritance associated with international adoption. Intuition suggests that this same sense of loss may be felt by people born by donor conception from clinics abroad. As an adoptee with a birth father who was a West Indian, I can vouch for the importance of knowing where my land is, of the uncanny sense of familiarity, home and peace that for me is unique to the West Indies.

Penny and I will let our daughter know in the future that we believe a level of self awareness is valuable for all of us to make the most of our lives and that counselling, which facilitates self awareness, may be something she might like to consider, alongside other sources of support such as the Donor Conception Network and spending time with other people in the same situation.

We believe a duty we owe to our daughter is to tell her the truth of how she was conceived. Another equally important duty is to help her understanding that her means of conception may well have an influence on her psyche and that some self awareness of this may help her enjoy a more fulfilling life.

We are aware that the DCN has actively campaigned for years to remove donor anonymity and it must be difficult to embrace the idea that so many families now take the anonymous donor abroad route. We feel strongly that the DCN should be here for all parents and DC children, irrespective of the country of their conception and whether the donor was anonymous or not. Penny and I feel encouraged that the DCN has acknowledged the issues faced by families who choose to go abroad for treatment by inviting us to recount our experience.

Editor's note 2014:  Penny and her daughter feature on a poster about egg donation and DC Network which appears on waiting room walls in fertility clinics throughout the UK.  The same picture was used on the front cover of the DCN Journal in Summer 2013.

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