Monash IVF Counselling Services Manager
There are two types of treatment options when accessing donor, DI or donor insemination and IVF In Vitro Fertilisation.
Donor Insemination (DI) involves the artificial insemination of donor sperm into the woman’s uterus during her fertile window. DI is only available to women aged 39 and under; if the procedure is unsuccessful after 2 cycles, the patient would normally be recommended to move onto an IVF cycle. The success rates of DI for women aged under 35 years are approximately 10-15%; and 5-10% for women aged over 35 years.
Whilst DI is a less invasive procedure; if time is a concern, or if you want to maximise your potential for a pregnancy the success rates for an IVF cycle are much higher. Typically, the fertility specialist will refer the patient onto an IVF cycle to minimise the time to pregnancy or if they had undergone some DI which has been unsuccessful.
Donor In-Vitro Fertilisation (IVF) is usually done with treatment involving one partner’s gametes. Common presentations include a couple where the male partner has male factor infertility; or single women or lesbian couples. There may be cases where there are fertility issues for both partners and the couple have donor egg and donor sperm treatment or even donor embryos. It’s important to consider in these cases that there is not going to be a genetic relationship to one partner or the other, and there are a number of factors that couples need to understand in order to decide if they are comfortable heading down that path, such as: the legal implications for the parents, the child and the donor in future; working through grief over loss of genetic connection to child; how you’re going to tell your child about his/her donor conception; and who else may need to know about this.
There are two types of Sperm Donors; clinic recruited sperm donors and known sperm donors.
Known donor arrangements indicate that the donor is known to the recipient(s). The known donor could be the male partner’s brother, cousin or a friend who offers to assist the couple. Or for single women or lesbian couples it may be a friend or the brother of one of the women (not the egg provider). In known donor situations it is very common that the donor has an existing relationship and history with the recipient/s. In many instances, patients have expressed their preference to have a donor that they know, are aware of the family history and intend to remain in contact with. It is important to note that if the donor has a partner, then the partner must also participate in the donor counselling. Clinic recruited donors are donors that have been recruited through the clinic and their sperm is available for use in donor treatment services. Donors in the Monash IVF sperm program need to be aged between 21 and 45. We prefer donors over 21; predominantly because of the emotional and psychological maturity required to be a donor. We won’t accept men over the age of 45 into our donor program, as there is an increased risk of complications with the sperm and potential impact to the quality of the embryos that might be formed.
If the sperm donor is married or in a de-facto relationship, we require that the partner is involved in the counselling sessions as well as consenting to the process. It’s a very big decision to be a sperm donor and the implications for the future may impact the donor’s family and potentially that relationship so it’s important to have a cohesive outcome for everyone involved. We want to ensure everyone understands the process and the implications now and into the future.
It’s very important that the donor is fit and healthy, and does not have a history of any genetic disorders. Donors need to have a normal semen analysis, as determined by an andrologist, undertake infectious diseases screening and undergo a medical and physical examination with a Monash IVF fertility specialist, as well as have a medical history taken.
After the medical screening process has been completed, and the results deem them medically suitable to be a donor, the next step is to engage the donor in the counselling process.
In addition, we would undertake a test freeze of a semen sample; this is to determine if the sperm freezes and thaws adequately. Then the donor would be required to provide several samples for freezing that would be held in quarantine for a period of six months. After the six month quarantine period, the donor is re-screened for infectious diseases and if results are clear from a medical perspective, the sperm is then available through our sperm donor program.
All Monash IVF clinic recruited donor sperm wait the maximum period of six months in quarantine; this ensures the infectious screening is up to date. For patients accessing treatment with a known donor, and where all parties consent, this quarantine period can be reduced to just 3 months, providing all parties to the arrangement are counselled about the implications and provide written consent for doing so.
It should be highlighted that there are family limits for donors and every state in Australia is government by either specific state legislation or the National Health and Medical Research Council Medical Guidelines:
- In Victoria, there is a 10 woman limit
- In New South Wales, there is a 5 woman limit
- In Queensland, there is a 10 family limit
The interpretation of the woman limit and family limit can be confusing, for example, with a same sex couple accessing fertility treatment: potentially both women in the relationship may wish to have a child each using the same donor and thus having genetic siblings. Although they are a couple and one family, in the eyes of the law in Victorian and New South Wales they will be considered 2 separate families. However in Queensland and other states they would be considered 1 family.
The family limit has implications, particularly when allocating sperm donors to patients. We need to ensure we are complying with the state specific legislation as well as trying to plan ahead in terms of thinking about how many potential families this donor might actually have. For instance, if we use an example of a 10 woman limit in Victoria: we might already have 8 separate women who have had children from the same donor, and 2 others who may have embryos frozen from that donor that haven’t yet become pregnant. In this case, we need to consider the embryos in the equation, because that embryo, until it has been realised is still a potential child. So this means there will be lots of discussion with you around the donor and the family limit, particularly if you are selecting a donor that is close to reaching the family limit.
The donation process for egg donors is more medically involved in comparison to a sperm donor. Egg donors are also required to go through medical checks, involving a consultation with a fertility specialist, blood tests, base line ultrasounds. The IVF Specialist will need to ensure they are medically fit and in good health as well as undergo infectious diseases screening. Implications counselling for an egg donor will also include reviewing the process involved for them in context of the medical treatment and possible risks factors, exploring the psycho-social and legal implications, and the implications for their own fertility in future.
The process of egg donation involves having a course of hormone treatment to stimulate egg growth in the form of daily injections for approximately 2 weeks, ultrasounds to check the size of the follicles growing in the ovaries, and blood tests to check hormone levels, and all going well with results of bloods and scans, they will undergo a minor medical procedure under anaesthetic to extract the eggs from the follicles in the ovaries.
If a woman is a clinic recruited donor, she and her partner must also undergo 2-3 counselling sessions to discuss the implications of becoming an egg donor. Due to the long waiting list for clinic recruited egg donors it is quite common for people to recruit donors through online forums or through ads in Melbourne’s Child or Sydney’s Child magazines. There are some women who have donated more than once, and although the woman would be familiar with the process, it’s a new situation with new parties involved, and therefore a different dynamic with different expectations. In this case, we would need to counsel the donor again, and need to take into account information relevant to that specific this situation.
Like sperm donors, egg donors also have a maximum family limit: 10 woman limit in Victoria, 5 woman limit in New South Wales and 10 family limit in Queensland.
Whether undergoing treatment with a clinic recruited donor or a known donor the recipient will also need to undergo medical screening and counselling. This is to ensure that the recipients are both medically fit to undergo treatment and emotionally and psychologically prepared to cope with the treatment process and also the future with a child that does not share their genetic history. In preparation for receiving donor eggs, the recipient woman may undergo hormone treatment to ensure that the embryo will be transferred into a suitable environment for pregnancy. To do this, both the egg donor and recipient woman will have their cycles synchronised, so that when the egg donor has undergone her egg retrieval, embryos then formed in the laboratory, the recipient woman’s body has been hormonally prepared to receive the embryo. Your fertility specialist will discuss and plan with you the best course of action that will be most appropriate for your situation.
This can be a very challenging time for recipients, particularly being reliant on a third party to be a donor. There will be concerns that the donor will attend scheduled appointments, that they are taking medications correctly at the right time etc and this can create anxiety and uncertainty. It is important to remember that you can access support from your nurse or counsellor at any time. It is very normal to feel anxious and worried.
How to find a donor
For some people, it may be important to have a genetic connection with their donor and may seek assistance from a sister, cousin or other relation. Others may feel that as long as they know a little about their donor, can freely obtain a history if needed then an acquaintance or friend of a friend could be an option. Others may not feel comfortable asking someone they know and prefer someone who has some emotional distance from them. Advertising may be another way to source a potential donor. It may seem a daunting idea to advertise for a donor; often people think “who is going to respond to an ad for an egg donor”. If you choose this avenue, it’s important to think about who your target audience is. For example, it may not be suitable to put an ad in the local suburban paper in the Classified Section, whereas an ad in a magazine targeted to young women with children may been seen by someone who is more likely to empathise with you and respond to your advertisement. The increase in social media enables the facilitation of a number of online forums and facebook pages that can also assist in finding potential donors and starting the conversation.
If you do find a donor through advertising or online; this will be treated as a known donor situation as effectively once you know their name they are identifiable to you. Although you may not know too much about them, they are no longer anonymous. This would involve counselling sessions for the recipient/s and the donor and their partner separately and jointly, to ensure that everyone has a clear understanding of the process and the implications for all parties in the future, including the child to be born from the treatment procedure. It is important to ensure that boundaries are clear, expectations are understood and processes in place to manage ongoing communication. Decision making around the fate of unwanted surplus embryos will also be addressed in these sessions, and depending on which state the treatment occurs, the implications may be quite different. Many people will find this process daunting and may instead prefer to go down the clinic recruited donor option or The World Egg Bank (TWEB).
The World Egg Bank (TWEB) is an egg donor bank based in the USA. Monash IVF has entered into an arrangement with TWEB to provide altruistic egg donors for Monash IVF patients. The TWEB altruistic egg donor program complies with legislation in all states of Australia. Egg donors are aged between 21 – 29. This can be an attractive option for some people as the donors are within an ideal age group given that we know the implications of age on the health and quality of a woman’s egg. The amount of information and profile available about the donor is quite comprehensive, with photos, interests, childhood photos and can give you a greater insight, in terms of what that person is actually like.
The medical screening for infectious diseases and psychiatric conditions testing for TWEB donors is as rigorous as what we undertake in Australia at Monash IVF. In fact, the egg donors go through psychometric testing, meaning they undergo individual psychological assessments to ensure there is no history of psychopathology. Once the recipient has chosen an egg donor, a Monash IVF Counsellor will contact the donor by phone or Skype and counsel the donor about the implications of being an egg donor in Australia including laws around identity release in future; psycho-social implications for herself and family; and other matters important to ensure she is giving informed consent and to ensure compliance to local regulations and legislation. TWEB egg donors complete the same medical screening, counselling and consent forms as any other donor at Monash IVF. VARTA approval is required for bringing into Victoria any donor eggs or sperm from any state of Australia or overseas country. This is only required for Victorian patients and involves registering and making an application through the VARTA website or by contacting our donor program coordinator.
Clinic Recruited Donors
We collect two types of information on our clinic recruited donors: non-identifying information and identifying information.
- Physical characteristics
height, build, hair colour, eye colour, complexion, blood group
- Ethnic background
- Education and occupation history
- Medical background
- Family history
- Social interests
- Motivation for donating
- Description of themselves (personality / temperament)
The motivation for donating is something we really encourage our donors to think about prior to completing. This statement is not only for the recipient to read, but also potentially for the donor child at a later stage in their lives who may be interested to find out more information about their donor.
Choosing a suitable donor
When choosing a donor, it’s important to think about the type of relationship that is going to be appropriate for you. Do you want to have a distant or a close relationship with your donor? Have a think about and understand the advantages and the disadvantages of using both known donor and clinic recruited donor that relate to you personally. It’s really helpful to think about what is going to be right for you, before you go down this path, then trying to match with someone who has similar expectations and ideas.
Receiving information from a fertility specialist that you need to consider donor treatment can be extremely daunting. You don’t have to wait till you have found a donor to access counselling and support. Many people find it helpful to talk through with a counsellor any concerns and fears they have at the very beginning and work through the options available to them. Then they can be better prepared to undertake a pathway that fits in with their needs and values. It is normal to experience feelings of grief. It is healthy to give yourself time to process and work through these emotions, so that you can embark on the next stage of your treatment with a clear mind and conscience. To make an appointment with a counsellor contact your clinic directly.
Rita Alesi is the Monash IVF Counselling Services Manager, a Counselling Psychologist with 20 years’ experience in IVF, Donor and Surrogacy related counselling. For more information about counselling services at Monash IVF please contact 1800 628 533 or complete the enquiry form below.