We are accustomed to the fact that the mother is the one who conceives, bears and gives birth to a child. But modern technologies allow to delegate these tasks, partially or completely. We understand how IVF with donor eggs solves the problems of severe infertility – and creates new ones
In the previous article, we toldhow women choose a sperm donor and what society thinks about it.
Where to start
Is it time to think about IVF with a donor egg?
Denial, anger, bargaining, depression – a woman goes through several stages of acceptance in response to this offer of a reproductive specialist. Sometimes it takes several years for a donor cell to turn from a sentence into an opportunity. The main candidates for the role of IVF with a donor egg are women 40+. This is the time when the train of reproductive possibilities is rapidly leaving: at 43, IVF efficiency is only 5%, and after a couple of years it drops to almost zero. While some cling to the footboard of the last carriage and try to conceive a genetically related child, others take a shortcut and take a “taxi” – someone else’s egg, in order to surely get to the destination “parenthood”.
The first successful IVF with donor oocytes was done in 1984. The doctors were convinced that the female body does not care who to bear – a genetically native child or a “stranger”.
Another common indication is premature ovarian failure due to surgery, oncology treatment, or genetic features. 33-year-old Katerina says: “At the age of 20, my menstrual cycle went astray, and then it completely disappeared. She was diagnosed with premature ovarian failure. It took five years to accept the idea of IVF with a donor egg. But then my husband and I realized that this was our only option to have a baby.”
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Such IVF almost does not differ from the usual one, except that an intermediate stage is added – the choice of a donor. It was more difficult at the dawn of technology, when the eggs were not yet able to freeze “on demand”. It was necessary to synchronize the menstrual cycles of two women – an oocyte donor and a mother who would carry the resulting embryo.
Now the egg donor is selected according to the bases, based mainly on appearance – the expectant mother is looking for a donor who looks like herself. In Russia, any woman under 35 who has no contraindications for health can become one. Our country is one of the most liberal in the field of reproductive legislation. In some European countries, oocyte donation is generally prohibited: if donating sperm is a simple and safe matter (in the worst case, the material will be rejected), then egg donation is a risky enterprise. For two weeks, the woman makes hormonal injections, goes for an ultrasound, and finally plunges into a drug-induced sleep so that the doctors can extract the eggs. All this does not fit well into the paradigm of humanistic values. Two couples from Austria even applied to the European Court of Human Rights to be allowed to use donor oocytes. We were refused: you can’t risk someone else’s health for the sake of a hypothetical birth of a child. And if you really want to, go to another country. At the same time, the probability of complications is not so great – from 0.5 to 2%. However, the process of oocyte donation is really energy-consuming. Hence the impressive cost of female germ cells: on average in Russia it is 80-100 thousand rubles per cycle, in the USA – 20 thousand dollars. On the one hand, compensation is reasonable, on the other hand, it creates a field for earning. “In our country, there are no legal restrictions on the number of treatment cycles for an egg donor,” says Elena Mladova, head physician of the REMEDI clinic. “But you have to keep security in mind. It is impossible to have a child from one donor in every first grade in Moscow. Therefore, sometimes we refuse our regular donors, even if their cells give a huge percentage of pregnancies.”
Women without serious health risks Maybe donate eggs up to six times. Further, the likelihood of complications, including delayed ones, increases.
Ethicists are indignant: the choice of a donor, the purchase of eggs, the genetic testing of embryos – all this smacks of eugenics, the science of selection among people. To somehow solve this issue, governments come up with cunning moves. In the UK, ordinary patients are offered to donate the eggs left after IVF, and in exchange receive a bonus – a discount on the program payment. This measure allows you to keep a balance between supply and demand. However, the term from the market economy is not quite correct here. Researchers insist: according to polls, egg donation is not so much self-interest as altruism. The only question is the ratio of these motives.
Finally, close people can become egg donors: sisters, cousins, girlfriends, and so on. The doctor gives an example: “I had a patient who did IVF for herself and along the way “shared” eggs with a sister who did not have her own. On the day of the puncture, a nurse comes up to me and asks: “Elena Sergeevna, there are three of them: a patient and two men. Will they both donate sperm?” “Yes,” I say, “this time there are two: the husband of the patient and the husband of her sister.” The story ended happily, and the women gave birth to sons who are half-brothers “by blood”, but are brought up in different families and different women are called mothers.
Yours or someone else’s?
Russian legislation answers this question unequivocally: a mother is a woman who has given birth to a child. But how is this event perceived emotionally? Our heroine Katerina says: “Having learned about the onset of pregnancy, I was happy and forgot that this was a child from a donor egg. Now my daughter is two years old. This is my child for 100%, she even looks like my husband and I. Elena Mladova adds: if there is anxiety, it usually goes away after the fetal movements begin. That is, the biological connection overpowers the genetic disunity (sociologists say the same).
Worldwide 5 out of 100 IVF programs are held using donor oocytes. In Russia every year is born about 3,000 children conceived using donor cells.
More complex formulas are also possible, when two aspects of motherhood are given “for outsourcing” at once. A donor egg is taken, fertilized with the partner’s sperm, and the resulting embryo is transferred to the uterus of a surrogate mother – thus, four people are already involved in the birth of a child.
Anna, 43 years old, says: “We entered the path of IVF in 2015. We had a lot of protocols, several missed pregnancies, one miscarriage at 22 weeks. Then – childbirth at 26 weeks. Our daughter lived for nine days. Then we tried to bear the child with the help of a surrogate mother – and also all to no avail due to genetic “breakdowns” in the embryos. When I was already 43 years old, my husband and I came up with the option of a donor egg and a surrogate mother. This is our last chance.” The case was in the fall of 2022, and in December the State Duma adopted amendments to the law on surrogate motherhood. In the new version, such a scheme is prohibited: now only genetic parents can use the services of a surrogate mother. The use of a donor egg in such programs is prohibited.
It is believed that the law is directed against homosexual couples (many cases are known when male partners resorted to such an algorithm legally). As a result, the amendments also hit other people: women with cancer and autoimmune diseases, with multiple unsuccessful IVF in the past.
Evgenia Markova, one of the founders of the project for women on the path to motherhood “We Plan Together,” says: “Surrogacy, and even in combination with donor eggs, is actually a rarity. But because of the series and the media, where, according to the law of the genre, the wildest stories fall, an aura of scandal has formed around this topic. The law, public opinion, homophobia, church lobbies, everything was mixed up, and ordinary people suffered.” According to Elena Mladova, patients can try to obtain the right to implement such an IVF program through the courts: “In addition to the law, there is an order of the Ministry of Health No. 803n. It clearly states: if the spouses are married, we can use the construction “donor egg, husband’s sperm and surrogate mother””.
It is generally accepted that assisted reproductive technologies break family ties: they say, what kind of families are these, where the child was born from someone who is not clear? This splitting is reflected even in the language: terms appear biomother, gestational mother, social mother – and they are all different people.
However, “auxiliary kinship” is temporary. Having played their roles, the donor and the surrogate mother go behind the scenes: “…The paternity and motherhood, distributed among the different participants in the procedures, regain their integrity. Other participants in conception, except for social parents, disappear from discussion, the significance of their role is hushed up, ”writes sociologist Olga Tkach. The more conservative the society, the more often it hides the origin of children from themselves and their environment.
In the UK, where only open donation is allowed, one and a half hundred people born using donor cells were interviewed. It revealed:
- almost everyone faced a crisis of self-identification when they learned about their origin in adulthood;
- 60% were upset that their parents once “bought” a donor biomaterial, and thought that it would be better if it was donated;
- at the same time, 86% still advocate open donation – so that a person can find out who his biological parents are.
“Donor” children mainly want to know about hereditary diseases in their genetic mother: did she have hypertension? Did she die of breast cancer at 45? However, now many questions are removed by popular genetic tests. The largest American survey among children of donors showed: 8 out of 10 have already found relatives – a biological parent, sisters and brothers – simply by passing a portion of saliva for a DNA test.
Perhaps IVF with donor eggs is only an intermediate stage in the development of technologies. The future belongs to stem cells, which can be “transformed” into almost any cell in the body, including eggs.