To understand the situation, it is important to know that there are three types of egg donation:
- Designated donation: The donor and recipient are close to one another – cousin, sister, friend… - and they go to the clinic together to proceed to the transfer.
- Crossed donation: the woman who does not want to meet her donor recruits another donor to accompany her to the clinic but who will donate an egg to another recipient who will be accompanied by the first recipient’s donor on another occasion to avoid meeting.
- Altruistic donation: anonymous donors go to the clinic to donate eggs that will be put in contact with the husband’s sperm of a recipient that they do not know.
Who are the recipients?
Donated eggs help women who cannot conceive, whether because their ovarian function is reduced or because they have no ovaries. Women with a genetic disease or who have a genetic history also use them.
Requests for egg donation are becoming more frequent, especially because a growing number of women wait until their forties to conceive for professional or other reasons and unfortunately, their ovaries are not as young as when they were in their twenties.
More and more gay couples also use sperm banks or egg donors to have a child.
Who are the donors?
They must be 35 years old or less and should not suffer from any genetic diseases. Women who would like to donate must undergo blood tests to that effect.
Egg donors are not lining up at the clinic’s door and are obviously must less inclined to donate than sperm donors.
Why? Because the process for this type of donation takes more time, is more complex and is more intrusive.
Egg donation: the process
The donor, as well as the recipient and her spouse must first undergo preparatory genetic tests (blood tests) to ensure that there is no risk of a genetically transmitted disease.
All three then meet the psychologist of the clinic to ensure that their decision was well thought out. They must also discuss the risk that the donor may eventually feel attached to this child who will carry her genes.
Then, hormonal medication is given to the donor to stimulate the production of eggs. It is called controlled ovarian hyperstimulation. That way, ovaries can produce up to 15 eggs.
After maturation, the eggs are removed under local anaesthesia.
This process takes between 10 and 26 days.
It is also possible to remove eggs without ovarian stimulation but the doctors must adapt to the donor’s cycle and fewer eggs are harvested.
Once collected, the eggs grow for a few days and are put in contact with the sperm of the donor’s husband and placed in an incubator.
Finally, doctors introduce the embryos in the recipient’s uterus (usually up to three).
The only risk for the donor is to develop hyperstimulation syndrome that can cause infection, pain or haemorrhage and may require hospitalisation. This risk is very low (around 1%) and can be controlled, says Dr Jacques Kadoch, MD Medical Director at the OVO clinic.
Too few donations: why?
Donations of sperm and eggs have never been paid in Quebec and are no longer paid in the rest of Canada since the adoption of the Assisted Human Reproduction Act in 2004.Young women can no longer pay they university fees by being generously paid to give eggs like they used to.
However, the law authorizes clinics to compensate donors for their travel, upon presentation of a receipt. The amount varies from one clinic to another.
We know for sure that the number of donors has significantly declined since the law was adopted. In Quebec, the supply of sperm banks has barely changed since the law was adopted, there is no shortage but because AHR is subject to a growing number of requests, clinics sometimes have to “import” the precious seed from Ontario.
The situation is even more worrying with egg donation because it is impossible to “stock up” on eggs since they are harder to store, unlike the male gametes. The situation is more problematic in Quebec than anywhere else because a new technique of ultra-fast freezing (vitrification) has been used for over two years in other provinces but not in Quebec, says Dr Jacques Kadoch. “Until then, before the advent of this technology, we could only use fresh eggs”, he says.
Lack of eggs: the consequences
No egg banks, rare voluntary donors surrounding women who want eggs and even less altruistic donors. Result: more and more women from Quebec are going to the United States or to Mexico to seek the egg that will be fertilized by their man. This is what we could call reproductive tourism and, according to Dr Kadoch, it is on the rise.
The word shortage is not part of the vocabulary in the fertility clinics of these countries because the banks are well supplied by paid donors.
“We see more and more requests from women in Quebec who go buy eggs there or stay in Quebec and buy them in a catalogue. Eggs are sent vitrified, they are thawed here and we proceed to the fertilization with the partner’s sperm”, says the gynaecologist.
The problem is that the Quebec government refunds the expenses of couples who buy sperm outside the country but those who buy eggs outside of the country do not receive the same treatment, why? “Only because the technology of vitrification did not exist when the law passed (on Assisted Human Reproduction)”, says Dr Kadoch.
All these women who cannot spend thousands of dollars to buy eggs overseas will surely denounce this double standard eventually. And if they ask for reimbursement, the government is heading towards a financial catastrophe, says the specialist.
The solution: pay the donors?
Yes, says Dr Kadoch without hesitation. He cites Spain where the government sets the amount given to the donors.
If our government decided to do the same, it would reduce the amount of women who go outside of the country to buy eggs and possibly ask to be reimbursed eventually.
Furthermore, “when paying the donors, we have a better control over the donations and, therefore, on inbreeding problems related to multiple donations…”
Paid donations: the opposition
The opinion of Dr Kadoch is far from unanimous. Many people are against paid donation and ague that it would be an ethical breech.
Abby Lippman, teacher at the Department of Epidemiology, Biostatistics, and Occupational Health at McGill University and member of the board at the Federation for Planned Parenthood of Quebec (FQPN) thinks that the reproductive human material should not be bartered and commercialised because some poor women could see an opportunity to earn substantial amounts of money.
Her opinion is widely shared but, according to Dr Kadoch, “we should have think tanks on this subject regrouping experts from various fields…”
The “black market” in Quebec
Even if we cannot size its importance, we know that there is an illegal business of eggs donation in Quebec. “Professional donors” even place ads and are handsomely paid for their eggs, says Dr Kadoch.
The remuneration of donors would not eradicate this type of business but the gynaecologist thinks that it would refrain its propagation.
We should also keep a registry of women who donate repeatedly because they are more at risk of developing ovarian cancer.
According to Abby Lippman, a registry of children born from assisted human reproduction should also exist to be able to monitor their health. It could also be useful to avoid the possible consequences of meeting with their half-brothers and half-sisters.
She goes further and affirms that we should also start thinking about the increase in infertility and, incidentally, the increasing use of assisted reproduction. What causes this decrease of fertility?
But that’s another matter…
