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THE MAIN POINTS
All people who rely on medical assistance in order to become pregnant have one thing in
common: they really want a(nother) child. However for some, the only chance of fulfilling their
wish is by the use of donated sperm, eggs or embryos. Others still, have the material at their
disposal which could be used to help these people. At the CRG, we try to bring these two groups
together when possible.
THE DEMAND
Two specific groups of patients who rely on donor material are
single women and lesbian couples who want children. They can
make use of donor sperm to fulfil their wish for a child.
For the other patients, the need for donor material is largely due to
two conditions: either there are no reproductive cells of their own
available (the man or the woman is infertile) or the cells available
are not suitable for use (either the man or the woman or both have
some form of hereditary genetic abnormality).
If the man does not produce sperm cells, meaning that medically
assisted conception methods such as artificial insemination or IVF/
ICSI are not possible, AID (artificial insemination with the use of
donor sperm) forms a viable alternative.
Similarly, in some cases, the woman does not produce sufficient
egg cells, even though her partners’ sperm is normal and healthy.
The most significant cause of this is premature menopause: the
early failure of ovarian function (before the age of fourty). Other
reasons for the lack of egg cells could be that the ovaries have
been removed or were damaged due to cancer treatment. Another
DONATION
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77
DO YOU WISH TO BE A SPERM DONOR
Contact us through
www.spermadonor.be
or call the Andrology Lab
+32 2 477 66 52
situation could be that the woman does produce egg cells, but
that they are not suitable for use. Once a woman passes the age
of 43, her own genetic material is no longer used for any form
of medically assisted fertilization. The chance of the treatment
being successful would then be too small (0.5%) to justify it. In
all the above cases, egg donation may be considered as a possible
solution.
There are couples in which the fertility problem is a combination of
factors affecting both the man and the woman. These people can
possibly be helped by embryo donation.
THE SUPPLY
Concerning donor sperm demand and supply are more or less
balanced, partly thanks to the fact that we can rely on foreign
sperm banks like the Danish Cryos as well. Nevertheless our centre
is continually looking for new donors. The greater and more varied
the supply, the better the selection for the recipient couple.
Furthermore, due to the growing number of patients that appeal
to medically assisted fertilization the demand steadily grows,
which increases the risk for a shortage. Our campaign ‘Become a
Sperman!’ fits in with the efforts of the CRG to provide an answer
to this issue. Visit www.spermadonor.be if you wish additional
information.
DONATION
DO YOU WISH TO DONATE OVOCYTES
OR EMBRYOS
Contact us through
www.eiceldonor.be
Or call Consultation CRG on the main line
+32 2 477 66 99
The Consultation Department can also
provide you all relevant information about
obtaining donor material.
78
77| Image taken from the recruitment campaign for
sperm donors ‘Become a Sperman!’
78| Image taken from the recruitment campaign for
egg donors ‘There is more in you!’
As far as donor eggs and embryos are concerned however, there is
a critical shortage. As a result of this, the CRG is actively seeking
women and couples who are willing to help solve this problem. The
campaign ‘There is more in you’ fits in with this search. Surf to
www.eiceldonor.be if you want to learn more about this.
Initially couples who undergo an IVF treatment themselves are drawn
on for the recruitment of potential egg donors. For example, women
who produce more ripe eggs than they need for their own treatment
can donate some of them immediately after the egg pick-up. This
principle is known as ‘egg sharing’ or ‘partial donation’. Couples who
have a surplus of healthy embryos after successful treatment and
have no need for them anymore (e.g. because their child wish is
fulfilled) may also decide to donate them to (an)other couple(s).
A specific demographic group amongst these potential donor
patients are those who have need for donor material themselves,
in this case donor sperm. Through a system of ‘solidarity donation’
the CRG tries to motivate these women to act as egg donor, even
partially.
However, the CRG is also always actively looking for ‘voluntary’
donors, i.e. women without any infertility problems of their own
but who are willing to follow that part of the treatment required
94

to allow the ‘harvesting’ of ripe eggs. In most cases, a volunteer is
found by the couple who need treatment by egg donation, but the
CRG also tries to encourage healthy young women from outside
the IVF circuit to volunteer as egg donors.
Anonymous or not
A general rule is that the donors are not told who the recipients
will be, and vice-versa. To be sure the new legislation (2007)
concerning assisted fertilization and everything related leaves
open the option for known donation, but nevertheless implies in
the formulation of the rules altogether a marked preference for
anonymity. A specific situation in which this general rule may be
waived is that of egg donation, i.e. if the recipient couple explicitly
chooses their own egg donor or the donor offers to help a specific
couple. This is known as ‘named donation’.
However, there are also cases where several couples each provide
a donor and the donors are exchanged among the group. This
‘exchange donation’ system allows couples to find donors among
their own families or friends, while still safeguarding the principle
of anonymity. See ‘Named donation versus exchange donation’
p. 103 for the reason why this may be important.
Strict selection and genetic screening
Obviously, not everyone is a suitable donor. All donors need to
undergo rigorous medical screening before they are approved as
donors. For example, a detailed family history is mapped out and
analysed thoroughly to identify recurring characteristics. General
factors such as life expectancy, physical health, mental stability,
etc. are important here.
The preliminary testing procedures include determination of the
donor’s blood group and rhesus factor and the blood is also tested
for the presence of infections such as hepatitis (jaundice) and HIV
(the AIDS virus).
A phenotype profile is compiled of every sperm donor. This involves
the donor’s characteristics, i.e. hair and eye colour, skin colour,
build, etc. When donor sperm is used, great care is always taken
to ensure that the donor’s blood group and as many physical
characteristics as possible match those of the recipient couple.
79| Genetic map (karyotype) of a woman.
80| Genetic map of a man.
79
80
Unfortunately, this strict phenotype selection is not possible in
cases of egg and embryo donation because the supply of donors is
too limited and the treatment too complex. Furthermore, volunteer
egg and embryo donors can only be recruited from among women
up to the age of 35 years. Exceptions to this rule are only made in
certain cases of named donation and with the recipient couple’s
explicit permission.
DONATION
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Double screening after six months
All donated sperm, eggs and embryos are subjected to extensive
medical screening too. Naturally, this includes genetic screening
to avoid congenital disorders. Frozen sperm is always stored for at
least six months before use. This precaution is taken because some
infections, especially HIV, can only be detected during this period.
Repeating the screening processes after this period and before the
sperm is used allows the CRG to guarantee that the donor sperm
is healthy.
This double screening (double checking) cannot be applied to eggs,
however. Egg donation always requires fresh material because
eggs cannot be frozen and stored. All egg donors undergo the
same thorough medical and genetic screening processes as those
applied to donors of semen or embryos, but the eggs cannot be held
in quarantine for several months. This means that no conclusive
guarantee of infection-free status can be given for donor eggs.
Nevertheless, the CRG’s careful screening and precautions
are sufficiently rigorous to reduce the chances of infection to
practically zero.
WHO ARE THE LEGAL
MOTHER AND FATHER
DONATION
In Belgium, the law makes no distinction between couples who
conceive naturally and couples who use donor sperm, eggs or
embryos. The woman who gives birth to the child is always the legal
mother. If the woman is married, her husband is automatically the
legal father. If the woman is unmarried, her partner may voluntarily
acknowledge the child and thus become the legal father.
That is why your embryos, sperm or eggs cannot be used to help
other couples without your written consent. You will have to
complete and sign a form before any treatment can begin. By doing
so, you relinquish your sperm and eggs, they are no longer yours.
The woman or couple accepting the donor material as well are
required to sign a form confirming that they accept it.
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SPERM DONATION
As mentioned above, supply and demand are more or less in
balance with regards to sperm donation, although this is can’t be
taken for granted anymore since demand is steadily rising. Anyway,
the major advantage of sperm is that it can be produced easily and
frequently, then frozen and stored.
The most important prerequisite for sperm donors is that they
are aged between 18 and 44, and healthy. In order to verify the
latter a number of tests are conducted prior to the donation. But
apart from that donors do not require any medical treatment. They
are merely asked to refrain from ejaculating for a number of days
running up to the donation and to travel to the location where
they will produce or deliver the sperm sample.
For example volunteers are recruited amongst the student
population of the Vrije Universiteit Brussel (VUB), the staff of the
Universitair Ziekenhuis (UZ Brussel), among men due to have a
vasectomy or men who are to undergo a fertility treatment with
their partner and whose sperm has been deemed fit.
But of course also other men are welcome!
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Although in principle there is no limit to the number of times a
donor may donate, practice tells us differently. When the donor’s
sperm has resulted in the successful birth of a certain number of
children sperm donation has to be discontinued to avoid the risk
for consanguinity, i.e. the risk that children from the same parents
have children together.
81
All in all these factors allow a sperm bank to be built up for use
at the right time during treatment and ensure the availability
of sperm from a wide range of different donors. Be advised this
doesn’t mean that as a patient you can reserve donor sperm for
multiple inseminations (yet).
82
Donor sperm may offer a solution for couples where the woman’s
fertility is normal but the man produces no or too few (motile)
sperm for use in the treatment. Couples in which both partners
are carriers of the same genetic defects may also be able to reduce
the risk of transmitting the genetic abnormality to the child they
conceive by using donor sperm .
81| Donor sperm bank.
82| Healthy sperm.
ARTIFICIAL INSEMINATION
Details of what the treatment involves are given in the ‘Artificial
insemination’ section of this guide (p. 53).
DO YOU WANT TO BECOME A SPERM DONOR
Please surf to www.spermadonor.be or call the Laboratory
of Andrology: +32 2 477 66 52.
For more information about receiving donor materiaal, please
contact Consultation CRG on the main line:
+32 2 477 66 99
DONATION
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EGG DONATION
Egg donation offers the only chance of conception for a woman
who produces too few or no eggs, or eggs that are unsuitable for
genetic reasons. Sperm supplied by her partner (the ‘recipient man’)
are injected directly into the eggs donated by another woman to
inseminate them (a technique known as ICSI).
If this in vitro fertilization produces a number of embryos, one
or two will be transferred to the woman’s womb, where they can
implant and grow to full term.
The CRG has four egg donation formulas: partial donation (known
as ‘egg sharing’), named donation and exchange donation. Those
last two formulas apply to couples who can present a donor
themselves; the first one to couples who don’t/can’t do that. The
latter automatically land in the waiting list donation system as
candidate acceptor, where they – apart from egg sharing – can
appeal on voluntary anonymous donation (which is the fourth
formula).
RECRUITMENT
We have reviewed the general conditions to which donors must
conform previously (see p. 95-96). One of these is that the
maximum age for egg donors is 35. Exceptions to this rule are only
made in certain cases of named donation and with the recipient
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83| Through the awareness campaign ‘There is more
in you’ the CRG aims at making the egg cell
donation issue known to a wider audience.
83
couple’s explicit permission. If egg donation and IVF treatment
result in a pregnancy, the recipient couple are advised to have a
prenatal diagnosis (see ‘More than medical’, p. 84 and further)
Another general principle is that donation is preferably anonymous.
This is one of the reasons why the CRG has organised the ‘exchange
donation’ system for couples who introduce their own donor to
our Centre, since it allows an anonymous alternative to ‘named
donation’ (see further on). Nevertheless, if the couple and the
donor in question explicitly request that the donated eggs be used
for the couple’s treatment, we will always give this request serious
consideration.
Whatever may be the recruitment of egg cell donors is a lot less
obvious than that of sperm donors. The treatment is rather time
consuming, physically slightly uncomfortable and not entirely riskfree.
In other words, egg donation requires substantial motivation
and commitment on the part of the donor.
As a result the number of voluntary anonymous donors – those
who undergo the treatment solely to donate their eggs to a couple
unknown to them– is rather limited. This is one of the reasons why
the CRG prefers to recruit women who already have children or are
having treatment. They are not only ideally placed to understand
the longing for a child, their body also has ‘experience’ with the
physical effects of hormonal changes.
MOTIVATION AND RISKS
DONATION
What exactly is expected of an egg donor
First of all, she needs to be able to make time available for the
various examinations and visits to the hospital. The necessary and
frequent blood samples and ultrasound scans mean she will have
to remain available constantly over the course of treatment.
She must also be prepared to follow the hormone treatment which
suppresses the normal menstrual cycle and stimulates her ovaries
to produce several ripe eggs. Over the course of this stimulation
process, she may have a painful or hypersensitive abdomen.
Cysts may also form in some cases, although this is a harmless
phenomenon. Cysts only need to be removed in a small medical
procedure guided by ultrasound scan (see ‘Medical practice’, p. 60)
if they start producing hormones themselves.
However any egg cell donation requires a churgical procedure to
collect the eggs. This is only a minor procedure, almost always
carried out under local anaesthetic, but it is an operation. Although
all necessary medical precautions are taken, the chance of an
infection cannot be entirely excluded. Any such infection carries a
risk of infertility for the donor, which is all the more delicate in view
of the fact that young women are preferred for egg donation.
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Finally, and strange as this may seem, the greatest ‘risk’ that an
egg donor runs is of becoming pregnant herself during treatment!
If she had no plans in this sense, this can be a severe problem.
Egg donors are therefore expected to refrain from unprotected
sexual relations for a significant period of time. Total abstention
from all sexual activity at the end of the stimulation cycle is
necessary. She must also avoid intercourse for several days after
egg collection (pick-up) unless protected by a condom to avoid
fertilization of any remaining ripe eggs.
THE TREATMENT
Timing and synchronisation
The fact that eggs cannot yet be frozen and stored presents a
further complication for egg donors. This means that fresh eggs
are always required, and the donor’s and the recipient’s treatments
need to be perfectly synchronised.
The donor follows the IVF treatment course through to egg pickup:
medical screening and analyses, ovarian stimulation via
hormone injections, intermediate blood tests, ultrasound scans
and, finally, an hCG injection to conclude the egg ripening process.
For precise details, we refer to the ‘Medical practice’ section, p. 31
and further on.
Naturally, the egg recipient follows the same procedures as for
embryo transfer in the full IVF treatment. Her womb is prepared to
receive the embryo after (medically) fooling the normal menstrual
cycle into an artificially-induced cycle.
Because of all these factors, the
CRG pays great attention to medical
counselling of egg donors. As a result
of the severe shortage of donor eggs,
we apply our greatest professional
skills because we expect a high degree
of commitment and motivation from
egg donors. Every measure is taken
to reduce the risk of infection to the
smallest possible degree.
Why an artificial cycle
Egg cells must be fertilized as quickly as possible after collection, with the recipient man’s sperm. Then ideally,
one or two of the resulting embryos are placed in the recipient woman’s uterus three days or five days after
conception. The artificial cycle means that the uterus can easily be kept in an optimal condition for the arrival
of the embryos for a number of days. The hormones used to do this have no negative effects, even with
prolonged use.
In practice, the recipient’s cycle is always synchronised to the
donor’s cycle. If the donor is ready for egg pick-up, the recipient’s
womb must be prepared for embryo transfer. Naturally, a delay of
three or five days is also required between pick-up and transfer to
allow for insemination and development of the fertilized eggs into
embryos.
Insemination: preferably by ICSI
The recipient man is expected to supply a fresh sperm sample on
the day the eggs are collected from the egg donor; this sperm is
used immediately to inseminate the eggs.
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84
Frozen sperm may be used if the man is unable to supply fresh
sperm on the day of pick-up (e.g. because he lives or has to travel
abroad). The frozen sample is then thawed a few hours before
insemination. However, fresh sperm is always preferred, especially
when used with donated eggs, because the chances of a successful
IVF outcome increase significantly.
For the same reason insemination of donated eggs with sperm from
the recipient woman’s partner is best done using ICSI (i.e. direct
injection of one sperm into each egg). This insemination technique
has a ninety percent success rate (in terms of fertilization), which
is essential to have a reasonable chance of pregnancy. After all,
in the case of egg donation, fewer eggs are available for each
fertilization attempt.
84| ICSI.
85| Lab set up for ICSI.
86| Consent form for egg sharing.
85
86
PARTIAL DONATION
A logical form of donation is partial donation (egg sharing), whereby
the donor is a woman who is already having IVF treatment herself.
Naturally, this applies to women who are able to produce their own
fertile eggs, that will be fertilized with their partner’s sperm.
One treatment, two chances
Egg sharing cancels out all the objections already discussed
under ‘Motivation and Risks’. The woman is already having the IVF
treatment and is well aware of the potential risks and physical
discomfort. The fact that she is an egg donor at the same time
involves no extra burden or treatment.
It is therefore standard procedure at the CRG to ask this woman,
or more correctly this couple, if she or they might be willing to
donate any surplus eggs. Motivation is rarely a problem because
two people who use assisted fertilization techniques to achieve
their dream of a child understand another couple’s problems of
infertility more readily.
However, it is not a foregone conclusion that every ovarian
stimulation cycle will lead to the production of sufficient quantities
of eggs to allow donation. Thus, while a recipient may be ready
for embryo transfer, the procedure may need to be postponed
if the donor has not produced sufficient eggs to allow in vitro
fertilization and transfer to the other woman’s womb.
DONATION
Counting the eggs
A certain number of eggs need to be fertilized to have a real chance
of embryo development. Egg sharing donations can proceed only
if ovarian stimulation has allowed the collection of at least eight
ripe eggs. Half of those are reserved for the donor’s own use, the
rest is donated.
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In case of an uneven number of eggs, the extra egg
goes to the donor. If ovarian stimulation only yields
seven or less eggs, the egg-sharing is terminated.
Surplus embryos
If the in vitro fertilization produces more than the
required number of embryos needed for transfer to
the recipient woman’s womb, the surplus embryos
are frozen and stored for transfer at a later date.
Mevr. L. Van Waesberghe
Laarbeeklaan 101
B-1090 Brussel
Anonymous
tel.: +32 2 477 88 88
fax: +32 2 477 88 89
Egg sharing donations are always anonymous, as are
sperm and embryo donation. The couple who donate
the eggs are not told who is to receive them, and
the recipient couple are not told the identity of the
donor couple. Eligible couples are those who can’t
provide their own donor and thus were put on the waiting list
(cfr. p. 106).
NAMED DONATION VERSUS
EXCHANGE DONATION
Centrum
Reproductieve Geneeskunde
If a couple supplies its own egg donor this does not necessarily
imply named donation. Exchange donation is also an option.
Named donation
Pressure can be considerable to opt for named donation when a
couple provides its own donor. This means the couple in question
will be treated exclusively with eggs collected from their donor.
For the donor it can often be an ‘exclusive’ motivation to give her
eggs to that specific couple. Very often, the donor is the woman’s
sister or her brother’s wife. Family loyalty can also influence the
recipient couple in their decisions. They have asked someone they
trust to be a donor, to whom they may be related, who may even
look like them and with whom they may share a common genetic
history.
Sometimes named donation is the only possible solution, for
example when the donor the couple provide is over 35 years old,
and therefore cannot be considered for inclusion in the regular
donor network. Skin colour may also limit the available options.
Exchange donation
This donation procedure involves exchanging the donors supplied
by several couples among the group. Using a well-defined, tried
and tested allocation system, especially designed to exclude the
possibility of a couple receiving eggs from their own donor, each
04/2007/DRUK
Geachte mevrouw,
U staat geregistreerd als kandidaat acceptor
van eicellen en/of embryo’s in het CRG van
UZ Brussel.
Als u in de toekomst verder in aanmerking
wil komen als acceptor, gelieve dan bij elke
nieuwe menstruele cyclus waarin u een eicel
of embryo zou willen ontvangen, bijgevoegd
kaartje in te vullen en op te sturen.
Het ingevulde kaartje moet ons in staat stellen
om u op het juiste moment van uw cyclus
te contacteren ingeval wij over biologisch ma-
teriaal zouden beschikken.
Graag terugzenden of -faxen naar:
UZ Brussel
CRG - Monitoring
Laarbeeklaan 101 – 1090 Brussel Tel. +32 (0)2 477 66 99 – Fax +32 (0)2 477 66 49 www.brusselsivf.be
Chère madame,
Vous êtes sur la liste des candidates receveuses
d’embryons et/ou d’ovocytes du CRG de
l’UZ Brussel.
Pourriez-vous remplir la fiche ci-jointe chaque
fois que vous commencerez un cycle menstruel
pendant lequel vous voudriez accepter
un embryon ou ovocyte disponible.
Veuillez bien nous envoyer cette fiche à
l’adresse mentionnée ci-dessous.
Cette fiche nous permettra de vous contacter
au cas où nous aurions du matériel biologique
disponible à un moment propice de votre
cycle.
ACCEPTOR
RECEVEUSE
Meisjesnaam / Nom de jeune fille /
Dear Madam,
Veuillez retourner à:
Please return to:
Voornaam / Prénom /
UZ Brussel
UZ Brussel
First name k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CRG - Monitorage
CRG - Monitoring
You are enrolled on the waiting list for accepting
oocytes and/or embryos of the CRG of
UZ Brussel.
May we kindly ask you to send to us the enclosed
document – filled out – each time you
start a menstrual cycle during which you are
prepared to accept available oocytes and/or
embryos. Please return this document to the
address mentioned below.
Maiden name k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
This document will enable us to contact you in
case of availabilities according to your cycle.
Mevr. L. Van Waesberghe
Mevr. L. Van Waesberghe
Laarbeeklaan Geboortedatum 101 / Date de naissance /
Laarbeeklaan 101
B-1090 Birthday Brussel k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1090 . . . . . . . . . . . Brussel . .
tel.: Eerste +32 2 dag 477 van 88 88 de cyclus / Premier jour des règles tel.: /
+32 2 477 88 88
fax: +32 2 477 88 89
fax: +32 2 477 88 89
First day of cycle k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meisjesnaam / Nom de jeune fille /
Maiden name k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Voornaam / Prénom /
First name k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Geboortedatum / Date de naissance /
Birthday k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eerste dag van de cyclus / Premier jour des règles /
First day of cycle k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meisjesnaam / Nom de jeune fille /
Maiden name k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Voornaam / Prénom /
First name k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Geboortedatum / Date de naissance /
Birthday k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eerste dag van de cyclus / Premier jour des règles /
First day of cycle k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meisjesnaam / Nom de jeune fille /
Maiden name k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Voornaam / Prénom /
First name k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Geboortedatum / Date de naissance /
Birthday k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eerste dag van de cyclus / Premier jour des règles /
First day of cycle k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
fax +32 2 477 88 89
fax +32 2 477 88 89
fax +32 2 477 88 89
fax +32 2 477 88 89
INS-ACCEPT
Meisjesnaam / Nom de jeune fille /
Maiden name k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Voornaam / Prénom /
First name k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Geboortedatum / Date de naissance /
Birthday k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eerste dag van de cyclus / Premier jour des règles /
First day of cycle k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meisjesnaam / Nom de jeune fille /
Maiden name k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Voornaam / Prénom /
First name k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Geboortedatum / Date de naissance /
Birthday k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eerste dag van de cyclus / Premier jour des règles /
First day of cycle k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meisjesnaam / Nom de jeune fille /
Maiden name k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Voornaam / Prénom /
First name k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Geboortedatum / Date de naissance /
Birthday k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eerste dag van de cyclus / Premier jour des règles /
First day of cycle k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meisjesnaam / Nom de jeune fille /
Maiden name k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Voornaam / Prénom /
First name k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Geboortedatum / Date de naissance /
Birthday k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eerste dag van de cyclus / Premier jour des règles /
First day of cycle k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
87
87| The form with which a waiting list acceptor
states every month that she is still a candidate for
egg cell donation.
fax +32 2 477 88 89
fax +32 2 477 88 89
fax +32 2 477 88 89
fax +32 2 477 88 89
The major advantage of exchange
donation, medically speaking, is the
two attempts with freshly donated
eggs. This system gives each recipient
couple two chances in each treatment
cycle, thus proportionally increasing
the chances of success.
As mentioned above, any surplus
named donation embryos can be frozen
and stored for later use, but our
experience of assisted fertilization
shows that the chances of success are
undisputedly higher using fresh donor
embryos for transfer.
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donor’s eggs are used in the treatment of two recipient women,
also known as acceptors. Thus each acceptor is entitled to two
donations.
However, if ovarian stimulation fails to produce sufficient eggs for
donation to two recipients (the number of eggs is less than or
equals five), they can still be used for one recipient. In this case
the acceptor who has presented the donor of five egg cells or less
only is entitled to one donation.
As soon as a recipient is pregnant, she drops out of the allocation
system and her place is taken by a new recipient. If however there
is no resulting pregnancy, she is entitled to a second attempt, with
(logically) other material. Just to be perfectly clear: if the acceptor
becomes pregnant at the first attempt she has no right to a second
donation, unless the pregnancy results in a miscarriage.
Benefits and drawbacks
It is not always easy for a couple with a donor to weigh the two
donation options. What are the benefits and drawbacks
In terms of treatment
From a purely medical viewpoint, named donation may be seen as
a benefit or a drawback.
For the recipient couple
In principle, a couple that supplies its own donor will automatically
have exclusive use of all the eggs produced by their donor. If the
donor produces a large number of eggs, this is a definite benefit. All
the eggs are fertilized using the recipient man’s sperm and, if this
produces more embryos than needed for transfer to the woman’s
uterus, the surplus embryos will be frozen and stored. These can
later be used if the first treatment fails to produce a pregnancy or
if the couple wants another child at a later date.
However, if the donor produces only a few eggs after ovarian
stimulation, the benefit turns into a drawback. The smaller the
number of ripe eggs available for fertilization, the smaller the chance
of the treatment producing surplus embryos. If embryo transfer
using all the available embryos fails to produce a pregnancy for
the recipient woman, she will have to repeat the entire treatment
cycle, either using the same donor (if she is willing) or with a new
donor.
DONATION
For the donor
The fact that the same batch of donated eggs can be used to
help two women can be a strong motivation for the donor. She
undergoes ovarian stimulation treatment with a positive mindset:
the desire to donate her eggs to benefit other women. This positive
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contribution can have an amplified effect in the exchange donation
system, not only because the donation helps two recipients, but
also because it increases the chances of pregnancy for the woman
whom the donor originally set out to help.
In terms of waiting list
One undisputed advantage of named donation is that there is no
waiting list. Once the couple has found a donor who meets all
medical requirements, the treatment can begin. Synchronising the
donor’s and the recipient’s treatment is more easily arranged too
because direct arrangements can be made.
There is indeed a waiting list for exchange donation, which varies
according to the supply. On the other hand, the benefit of waiting
should not be neglected. Because exchange donation entitles the
woman to two attempts using freshly donated eggs, her chances
of pregnancy at the end of the treatment are higher than through
named donation.
In terms of anonymity
Then there is the argument of anonymity. By definition, named
donation cannot be anonymous, whereas exchange donation is.
As stated previously, the CRG strongly recommends the second
option for a number of psychological reasons.
Anonymity is a good way to safeguard both the donor and the
recipient from disappointment, arguments and conflicts of interest.
No matter how good their relationship today may be, there is no
way of predicting what might happen in five or ten years’ time. This
is especially the case if something goes wrong with the pregnancy
or the child has a congenital disorder. Under these circumstances
chances are that the relationship between the donor and recipient
couple become very strained because of the feelings of guilt.
However, conflicts cannot be excluded even if everything goes well.
Differences of opinion may arise over how open the parents should
be with the child regarding his or her origins. The recipient couple
may expect the donor to remain emotionally involved with the
child, whereas this may not be what the donor has in mind at all.
Or the donor may want to remain emotionally involved throughout
the pregnancy and birth, whilst the recipient couple have difficulty
with this.
All these potential psychological
complications can be avoided by
keeping the donation anonymous.
Anonymous donation draws a clear
line between the lives (and perhaps
the family) of the donor and the
recipients, and everyone’s attitudes
are clear right from the start.
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WAITING LIST DONATION
Precious
harvest
Egg cell Donation
Awareness Campaign
By this donation formula we mean that the recipient couple
does not provide a donor, perhaps because they do not want to
involve anyone they know in their treatment. They need to wait
for an anonymous donor who either follows the fertility treatment
exclusively to donate her eggs or is willing to share her eggs (see
above). In the latter case this concerns a woman who undergoes a
fertility treatment herself.
Not for free
Although legislation explicitly forbids the sale of body cells or
organs for profit, this doesn’t mean donor egg cells come for
free. Indeed the treatment of the donor must be paid for. On the
one hand there are costs involved with the medical treatment
– consultation(s) and examinations, (the non-refundable part of)
the medication, the egg pick-up, etc. – on the other hand the
expenses made by the donor – e.g. travel costs or loss of income
– must be compensated.
www.eiceldonor.be
88
88| Through the brochure ‘Precious harvest’ the
CRG tries to motivate its waiting list acceptors to
help search for a solution to their problem. Indeed
we firmly believe that without joint action between
different groups of prospective parents the donation
problem will eventually become unsolvable.
An alternative
Couples who specifically express a wish to remain in the anonymous
donation system but who have been waiting for a very long time
(perhaps because the first attempt was not successful), may
also be recommended to consider embryo transfer using a donor
embryo, or even simple adoption. Because if there is one factor
that negatively affects the treatment of all types of infertility
disorders, that factor is time.
At the same time it must be said that there is a long waiting list
for embryo donation as well, while adoption does not constitute a
valid alternative for everyone.
That’s why the CRG developed the principle of solidarity donation.
This gives candidates who aren’t able to provide an egg donor
the opportunity to improve their position on the waiting list by
providing a sperm donor. This can be the own partner (if his sperm
is fertile) but also a family member or friend. In exchange for
twenty sperm samples from ‘their’ donor the prospective parents
obtain the right to one IVF attempt with donor eggs. The couple
pays for its own treatment (in this case the woman’s) but not for
that of the donor woman.
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EMBRYO DONATION
A couple’s infertility problem may also be due to a combination
of physical factors that affect both the man and the woman. If
standard IVF treatments (even using ICSI) fail or offer too small
a chance of success, the transfer of a donor embryo into the
woman’s womb may be the solution.
NOT GENETICALLY RELATED,
BUT DEFINITELY YOUR BIRTH CHILD
Although neither the sperm nor the eggs used in this type of
donation belong to the couple, and some people like to compare
it with adoption, there is a fundamental difference between the
two concepts.
The embryo is donated by a couple who have had successful
infertility treatment themselves. They donate an embryo and not
a fully developed child.
In contrast to adoption, the recipient couple go through the entire
pregnancy process together in that the woman carries the donor
embryo to full term. If everything goes well, she gives birth to a
baby after nine months, during which period the ‘adopted’ embryo
becomes her own child.
This is every bit as true from the child’s point of view. From the
very start of his or her existence, his or her entire life history is
intimately interwoven with that of his or her parents, and there
is no question of moving from one social, geographical or racial
environment to another.
89| The embryo bank
89
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The situation is radically different from a legal viewpoint too.
Contrary to an ordinary adoption, the couple do not have to go
through any formalities before they can consider the child legally
theirs.
THE TREATMENT
As discussed above, donor embryos are donated by couples who
have had IVF treatment and produced more embryos than they
needed for transfer. These remaining (or surplus) embryos are
frozen and stored for potential use at a later date by the couple
or for donation.
The treatment needed by the recipient woman is described in
the ‘Medical Practice’ section, p. 48-50. The woman’s natural
menstrual cycle is either medically reinforced and monitored or
replaced entirely by an artificially-induced cycle. In both situations
her body is prepared for the embryo transfer.
The thawed embryos are tested immediately before transfer takes
place. Only those embryos who have succesfully withstood the
thawing process - without too much damage to their cells - can be
transferred with a reasonable chance of successful implantation.
Consequently the more frozen embryos are available for donation,
the greater the chances of a successful pregnancy.
Once the embryo has been transferred to the womb, the woman’s
medical and drug follow up is exactly the same as with standard
IVF treatment (see Medical Practice, p. 46-48). The chances of
a successful embryo implantation and a full-term pregnancy are
practically the same too.
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