Most clinics offer a choice of treatments that can be ranked in order of complexity, with the simplest unmedicated donor insemination (DI) or intra-uterine insemination (IUI) at one extreme, and highly medicated invitro-fertilisation (IVF) with intra-cytoplasmic sperm injection (ICSI or IMSI), and egg donation, egg sharing or embryo donation at the other. Many clinics will only offer some of these options, but you should be allowed to choose to start at a moderate level of intervention before upping the stakes if you don’t succeed, or to go straight to the top level if that’s what you prefer. At all stages, the pricing should be clearly explained, including all the extras and options. If you need donated eggs, you can consider the option of egg-sharing or embryo donation, which are not available everywhere. The clinic staff should be willing to discuss all the options so you can make an informed choice.
For a list of UK clinics and details of the treatments they offer you can use the HFEA Clinic Finder Tool.
Choosing your donor
All clinics, whether in the UK or abroad, will try to match you with a donor of a similar physical type to the non-genetic parent. Beyond that, there may or may not be a choice, according to availability and/or clinic policy. In the UK recipients can usually know something about the donor as a person and should be able to have a personal message that has been written by the donor for a child. UK clinics vary in how much they encourage donors to write about themselves and include in this message. Some people struggle when offered a donor who does not meet one of the criteria that feels important to them. Sometimes this has to do with the donor’s build or colouring or sometimes their family medical history or level of education. Whilst it is really important to feel at ease with your donor but one Network couple has spoken poignantly about having to let go of 'trying to create a perfect image of us'. Sometimes potential parents do not want much information for themselves but are keen that there is good information available should their children wish to have this in the future.
In most countries in Europe where UK residents go for egg donation, very little information is available about donors. Spain has very many fertility clinics that are popular with UK residents. Spanish law allows for all non-identifying information about a donor to be given to recipients but it is unusual for most clinics to actually give more than a donor's age and blood group. This practice is only likely to change if recipients make it clear that this information is important for them and their children. In the USA enormous amounts of information are available and there may be the possibility of girlhood photos and/or a voice message. Identifiable donors are increasingly available via some agencies in the US. It may also be possible to meet the donor before both parties decide if they are right for each other. South African egg donation agencies also offer good donor information and the possibility of letter-box contact.
Types of donor
UK clinics have varying supplies of egg, sperm & embryos: some have been successful at recruiting as many donors as they need, and others no longer recruit their own donors. They might buy their supplies of UK donor sperm from other centres or have arrangements to import sperm from abroad, or they might have links with a clinic abroad where you would go for part or all of the procedure . There are varying categories of donors, the main ones being as follows:
Anonymous donors: these donors have been promised that the recipients and their offspring will never be given identifying information. This is no longer allowed in the UK, but is an option in the USA and the rule in many other countries.
Identity release donors: ID release donors are those whose identifying details will be released at a certain age to the offspring. This has been the law in the UK since April 2005, with 18 being the age at which the offspring have a right to the identifying information. It is important to note here that this information does not guarantee that the donors can be found, as they may have moved, maybe abroad, or even no longer be alive. There can’t be any guarantee that they will be available or willing to meet your child. Any egg or sperm imported to the UK must meet UK legal requirements, so the donors will also have agreed for their details to be released and their information will be included on the register kept by the HFEA.
Known donors: a known donor is someone whom you may have known for some time, or met with the intention of using as a donor. If you intend to self-inseminate with sperm it is important to familiarise yourself with the legalities, as the courts will generally give precedence to the child’s right to contact with both parents, and a known donor, unless the insemination has taken place on licensed premises, will have the status of parent if you are unmarried. In such circumstances it is advisable to draw up an agreement with your donor stating the intentions of both parties for the future. This will not necessarily be binding in any future court action but it will serve as a document of intent. If insemination or egg donation takes place in a clinic licensed by the HFEA such documents are unnecessary.
Family donors: this is where a family member donates their eggs or sperm. These arrangements can provide a happy compromise when everyone is well prepared and supported. If self-insemination is involved in family donation then the precautions above should be observed.
Egg-share donors: some clinics will offer younger women the option of donating some of their eggs in exchange for reduced charges or free fertility treatment.
Donated embryos: donated embryos are usually embryos that have been frozen when too many were produced in one cycle of treatment. At a later date, the parents decide they will not be using them to increase their own family and donate them. In this situation, your child might later discover that they have full genetic siblings and donor parents in another family. In some overseas clinics embryos may be created from surplus eggs and sperm from a bank, rather than having been produced as a result of another woman’s treatment cycle.
Altruistic donors: this is the term used for egg donors who are not going through a cycle of treatment themselves. In the UK, eggs donors are compensated to the tune of £750, and sperm donors at £35 per donation. Imported gametes should also meet this requirement but this is hard to police. If you are going abroad, the providers of sperm or eggs may have been paid significant sums of money, which bears two risks: it may entice the donor to exaggerate their desirability (e.g. education & achievement) or minimise their flaws (e.g.family illness), or it may encourage vulnerable people to donate when they do not fully accept the implications of their action e.g. young women donating eggs without taking heed of the risks of the treatment.: it may entice the donor to exaggerate their desirability (e.g. education & achievement) or minimise their flaws (e.g.family illness), or it may encourage vulnerable people to donate when they do not fully accept the implications of their action e.g. young women donating eggs without taking heed of the risks of the treatment.
The decision about the type of donor may depend on many factors. Do you have a brother or sister (or other close relative) who could donate to you? Does this solution feel like one you could be comfortable with? How would both your extended families feel about it? Would a friend you have known all your life be the right person to help create your family or would you prefer a donor who is unknown to you but could be known to a child from age 18. These are intensely personal decisions that only a couple can make, but good counselling can help with.
In the interest of donor conceived people DCN campaigned for the ending of donor anonymity and the law changed to this effect in the UK from April 2005. It is possible to find identifiable donors in some other countries but in most places overseas frequented by British people, donors are anonymous.
What can help with making the decision about the type of donor –
- Imagine the story you might tell your child at different ages about your choice. Can you feel proud, comfortable and confident about your decision? If not, your child may not either.
- Join DCN to be in touch with others who have considered all these options before you. We have a group of members at the moment (2012) each of whom are using a donor from within their family and we have other members whose donor is a family friend. Most members attending UK clinics have used donors unknown to them but (from 2005 only) identifiable to the child from age 18.
- Read the section in the Telling and Talking booklets about Using a Known Donor.
- If you are seriously considering using a known donor from within or outside the family, talk this over with the counsellor at your clinic or have some independent counselling sessions. These can be helpful in challenging you with difficult thoughts and feelings that may be avoided when talking as a couple or with your potential donor. All good clinics will want all parties to the donation, including the partner of the donor, if there is one, to have counselling before going ahead with treatment. The British Infertility Counselling Association www.bica.net can help you find an appropriately qualified counsellor.
Where to have treatment
Choosing a fertility clinic can feel like a very fraught process. If you are lucky enough to be funded for your treatment then you may have little or no choice about where your GP refers you, but as the majority of fertility procedures take place in the private sector, the choice can feel confusing and daunting. And that is even without contemplating going abroad as many people are now doing.
In the UK we have a regulatory body, the Human Fertilisation and Embryology Authority that provides enormous amounts of information about each and every UK fertility clinic. Read the information about the clinics that are accessible to you or carry out the particular treatment that you require (you can search on different criteria on the HFEA website www.hfea.gov.uk). You will find that success rates are pretty similar for most clinics and what might mean most to you is how easy it is for you to get to the clinic (you will probably be going there a lot), how efficient they are (do you get fast responses to emails or ‘phone messages) and how you feel they treat you as a person. You can tell quite a lot from an initial ‘phone call and even more by visiting in person. Behave like a very friendly and courteous assertive consumer and ask all the questions you need to. They are providing a service you are paying for at a very vulnerable time of your life.
If you are thinking about going abroad, there is no one body that can give information about the standards and success rates in overseas clinics. Some countries have regulatory bodies and others do not. Most overseas clinics have doctors and staff who speak English but independent information, if it is available at all, may only be available in the local language. It may be worth trying to get some information from the local infertility patient organization. http://fertilityeurope.eu/
See our guidance document on Donor Conception Treatment outside the UK for a comprehensive overview of the range of short and long-term issues that need thinking about when considering going abroad.
What can help when choosing a clinic in the UK is –
- Contacting Infertility Network UK to find out if you are likely to get funding in your area -http://www.infertilitynetworkuk.com/FundingforFertility/?id=5216
- Checking out the Human Fertilisation and Embryology site www.hfea.gov.uk and then personally contacting the clinics that interest you. Have a pre-prepared list of questions to talk with the donor co-ordinator about.
- Talking with others who have made these decisions before you. Forums like the private one on this site for DCN members or Fertility Friends can be a way of getting unofficial information and impressions from others going through treatment. But you need to remember you are only getting individual experiences and points of view this way.
- Making a spread sheet of the clinics that interest you and comparing waiting lists, prices, accessibility, availability of donors etc.