By Sue Taylor, President, IVF Traveler

The world of frozen embryo donation (also sometimes referred to as embryo adoption) is somewhat unique in the ART community in that the programs are incredibly diverse. Each program offers slightly different (or sometimes dramatically different) options for transferring surplus frozen embryos from those who are done with their family building and have decided to generously relinquish them to help another family achieve their dreams of having a baby.

Currently, programs for matching available donated embryos to recipients typically come through three primary sources: 1) fertility clinics and embryo storage companies who partner with fertility clinics, 2) embryo adoption organizations (often through traditional adoption organizations), and 3) through private matches. The latter category includes matches made through various independent sources like PVED or online services that allow for donating and recipient families to connect and negotiate the terms of the donation and current or future contact.

Fertility Clinic Embryo Donation Programs

Within the programs available through fertility clinics or embryo storage facilities, there are possibly as many different options as there are clinics because there is no one standard for this process. I will separate them out by typical US clinic programs and foreign clinic programs because they are quite different.

United States Fertility Clinic Donated Embryo Programs

Fertility clinic based embryo donation programs in the United States, and other areas where donor anonymity is not mandated, may allow both the donors and recipients upon mutual agreement to have the option of current or future contact under whatever guidelines they may mutually agree upon. Currently, reports suggest that the majority of US fertility clinic based programs are still mostly anonymous donations, occasionally with the donors being allowed to specify criteria for the recipients if they desire (such as age, geography, religion, ethnicity) and only rarely allowing donating families to interview and select the recipients directly.

In these programs, there are two variations of what typically happens once you have been selected to receive embryos.

• In the first type of program, you receive the rights to all the remaining embryos from the batch to do with as you wish regardless of whether you conceive on the first try or not.

• In the second type of scenario, the clinic may only relinquish enough embryos for a single frozen embryo transfer holding the remaining embryos from that batch for you pending the results of your outcome. Often once a pregnancy with the donor embryos is well established (clinical pregnancy or first trimester completed) the remaining embryos are then made available to other waiting families. Many of the US fertility clinic programs have a wait list – some are several months to years long. However, often clinics will also have criteria for prioritizing potential recipients on their wait list, rather than in order of when they were added to the list. Their weighted criteria for prioritization may include prior infertility treatments, recipient health history, age, infertility diagnosis, whether they have children, and sometimes limiting it to patients who otherwise would not be able to adopt or get pregnant. Some clinics do also give priority to patients who have already had failed IVF cycles at their clinic.

In the US, it is common that the embryos are donated from couples who have done IVF (with some combination of their own eggs, donor egg, own egg/donor sperm, or donor egg/donor sperm) and had a surplus of embryos that were frozen and stored. This means that either the eggs or sperm (or both) may be from a partner, and thus may not have been required to meet the standards that would be required for an egg or sperm donor. Donor screening standards typically include: genetic screening, family history screening, age limitations, STDs, psycho-educational evaluation, etc. However, there are also sometimes embryos that were from screened donors (egg or sperm or both). Anecdotal evidence suggests families built through egg or sperm donation may be more inclined to be willing to donate their remaining embryos – thus we are seeing those embryos more frequently. Occasionally, but less often, available embryos may also have passed genetic testing (such as PGD/PGS/CCS) that screen embryos for genetic or chromosomal abnormalities or the sex of the embryo, and typically that information will be shared if available. Even for anonymous donations, most US clinics will provide a minimum amount of information about the quality of embryos and type of freezing, ethnicity and ages of the persons providing the eggs & sperm, and in some cases they will share whether the other embryos from the same cycle resulted in a pregnancy (this is often the case). However, some US clinics decline to provide any information about the embryos citing the privacy of the family donating the embryos.

Costs for US fertility clinic programs typically range from $3500 - $12,000. Generally, a recipient can expect to pay the clinic’s frozen embryo transfer fee (maybe with an added management fee for handling the case), plus psycho-educational evaluation or any other STD testing fees from the donors, as well as the recipient’s own required ultrasounds or tests prior to being cleared for treatment. They may also require reimbursement of cryopreservation or storage fees the family may have incurred prior to donation. The recipient of donor embryos also is generally responsible for the legal fees (for the donating family if necessary and the contracts for the recipient), the recipient’s medications for the cycle, and any travel (if the embryos are not at your local clinic). Most clinic programs do not allow you to transfer the embryos to another clinic, you must go to the clinic who is storing the embryos and the transfer will take place there.

There is generally no fee for the actual embryos (aside from the associated costs for treatment listed above). Most clinics consider it unethical for the donating family to receive any compensation other than reimbursement for cryopreservation along with any fees related to the relinquishment of the embryos.

Fertility Clinic Donor Embryo Programs Abroad

There are some distinct differences in the programs from countries where all genetic donations (eggs and sperm) are mandated by law to be anonymous. These countries include The Czech Republic, Spain, South Africa, Russia, the Ukraine, Greece, Cyprus, etc.

Due to strict human tissue testing requirements in many countries, it is very difficult - if not impossible - for families who have embryos from their own genetics (either male partner, female partner or both) to make them available for anonymous donation. As a result, most of these programs offer primarily frozen embryos that were from cycles using both donor eggs and donor sperm. In that case, the recipients can be assured that both donors passed the strictly required screening guidelines for egg or sperm donation which limits age, genetic screening, and family health history, etc. Most clinics are using the ASRM guidelines for donation as a minimum and often adding their own additional restrictions or requirements that may be mandated by the laws of their country.

Not all clinics offer donor embryos – and the wait list can vary from no wait to a few months at clinics that offer a program. Donated embryos are typically matched based on phenotype details such as ethnicity, hair or eye color, and sometimes (but more rarely) blood group. Recipients typically must meet age criteria and sometimes marital status criteria and must be deemed healthy enough to carry a pregnancy. Otherwise, wait lists are typically on a first come, first served basis based on embryos matching the recipients required criteria (skin, hair or eye color, blood group, etc.). In some clinics, when there are no donated embryos that meet the recipient criteria, clinics may offer options under their donor embryo program for two prospective recipients with similar donor requests to “share” a fresh donor cycle, where the donors oocytes are retrieved, fertilized and frozen for a transfer to the intended recipient in a future FET cycle. This satisfies the requirements that embryos be designated for a specific intended recipient. However, many would argue that those are not “donated embryos” they are in fact just double donor frozen embryos. There is also some concern that embryos may in those cases be “owned” by the clinics prior to distribution which is an issue expected to be reviewed by the ASRM’s ethics committee in 2013.

Because the embryo donation is mandated by law to be anonymous, there can be no directed donation (where the donating family would select the recipients). Further, the recipient family will never have the opportunity for contact with any other families who have children from that same batch of embryos (and are genetically related). Typically the embryos are offered on a price per embryo transfer basis with 1 or 2 embryos offered to the recipient, and any others offered to another recipient family.

Costs can range widely by clinic, but typically this is one of the lower cost options available with treatment costs often ranging between $1500 - $5000 per transfer cycle. The treatment fee is typically between $1500 - $3500, and then the recipient is also responsible for her medications, local monitoring/ultrasounds, travel to the clinic for 1 – 2 days, and possibly consultant fees for matching you with a clinic and embryos or coordinating treatment if desired. One benefit to the foreign programs is that they often guarantee a certain number of quality embryos to transfer or you don’t pay for the cycle. Rarely, clinics will also offer a program that if a recipient does not achieve clinical pregnancy within 2 cycles, the 3rd donor embryo cycle is free.

Embryo Adoption Programs

Many traditional adoption agencies and some new organizations are now creating “embryo adoption” programs to offer donating families more control over the screening requirements and selection criteria used for selecting the recipient families. In these programs, rather than relinquishing the embryos to a clinic for matching, the donating families select an embryo adoption agency to facilitate the screening and selection of a suitable recipient family.

Typically in these programs the donating family can specify what, if any, future contact they may be willing to have with the recipient family, and may be able to make that part of their mandated matching criteria. In more open arrangements, the donors may be willing to provide full details and health histories of the genetic parents to the recipient parents.

Many of these programs tend to also be the most restrictive in defining who can “adopt” the embryos. Often there are restrictions based on marital status, religion, as well as requirements for home studies (including fingerprinting, background checks, etc.), adoption classes, and in some cases psychological counselling, a full psychological evaluation or simply a psycho-educational session.

As of early 2013, there are no federal or state laws governing the adoption of embryos. There is only one US state with laws that would allow the parents to officially finalize their embryo adoption in the court system. Otherwise, the federal and state law typically considers embryos property, so the legal process consists of transfer of ownership and rights through contract law. Once the embryos are transferred, the recipients are fully recognized as the legal parents of any children who are born from those embryos without any adoption proceedings required. The donating family does not have any parental or property rights once the embryos are relinquished.

The embryo adoption agencies typically require traditional adoption screening and home studies from potential recipient families to qualify them as recipients. Once a recipient family is matched and approved and all legal paperwork for transfer is completed, the embryos can typically be transferred to the fertility clinic of choice for the frozen embryo transfer.

These “adoption” programs often have the highest fees – sometimes as high as $15,000 - $18,000, because in addition to the typical clinic and legal fees, there are adoption agency fees, fees for home studies, clearances, etc. As a result, many of these programs have either very short or no wait lists. Since donor embryos are often utilized by families who would otherwise be doing a fresh donor egg or donor sperm treatment, they may find that the cost of the embryo adoption programs is a roadblock since it is on par or exceeds costs for other options of fertility treatments that may have higher success rates than available with frozen transfers of remaining embryos.

ASRM Statement On Embryo Adoption

There has been some controversy over the use of the term Embryo Adoption. Although some families created from donated embryos prefer to use the term Embryo Adoption, the professional association, The American Society of Reproductive Medicine (ASRM), issued an Ethics Committee Report with opinion about the use of the term as follows:

“Requiring infertile patients who need donor gametes or patients who need donor embryos to suffer the imposition of unnecessary administrative and legal trappings of adoption and the costs that accompany them is not ethically justifiable. The donation of embryos for reproductive purposes is fundamentally a medical procedure intended to result in pregnancy and should be treated as such.”

The full ASRM report is available at: http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Ethics_Committee_Reports_and_Statements/DefiningEmbryoDonation.pdf

Private Matching

The last common option for donor embryos is not a program at all. There are several online services (including PVED) that are available for low or no fee that allow donating families to either post available embryos with their desired recipient criteria or read profiles of potential recipient families and then select a suitable match. In some cases, the donating families can request the matching service do the matching on their behalf, or to assist them in screening the prospective recipients.

In this private matching scenario, there are no limits to the criteria or preferences that can be requested. It may be done anonymously or through a known donation and any level of future contact may be mutually agreed. Once match details are mutually agreed between a potential donor and recipient, the recipient family is typically financially responsible for any additional testing, securing legal representation for both parties to legally transfer the embryos, paying to have embryos shipped to their home clinic (or paying to have the transfer at the clinic storing the embryos), as well as typically reimbursing cryopreservation and embryo storage fees incurred by the donating family.
Typically speaking, the pricing for treatment with donor embryos through private matching tends to be on par with or slightly lower than the typical US fertility clinic programs – depending on whether embryos need to be shipped and any testing or reimbursement to the donating families for expenses incurred. As with any fertility clinic program or embryo adoption agency program, even though this is a private match, it should ALWAYS be handled legally by a reproductive law specialist that is familiar with the nuances of embryo donation and transfer. Typically clinics will require confirmation from the attorney(s) prior to moving forward with any shipping or frozen embryo transfer protocol.

Donor Embryo Success Rates

Currently the two organizations reporting IVF success data (CDC and SART) do not separately report embryo donation live birth statistics. We can only rely on data from other frozen embryo transfers, and this varies widely based on the quality and number of embryos, the age of embryos and type of freezing, and the age of the genetic parents.

Statistically speaking, based on the CDC IVF success rates for US clinics in 2010, the average live birth rate from a typical frozen embryo transfer is between 13 – 38.4% from an own egg FET cycle, and 34.9% from a donor egg FET cycle. Anecdotal evidence suggests the donor embryo success rates likely align similarly to the age group based on the age of the woman undergoing IVF at the time the embryos were created – with typical success rates of 25 – 35% being routinely quoted.

Most Reproductive Endocrinologists will provide their patients an estimate of the likely success rate based on the recipient’s fertility history and the details about the embryo quality and the infertility diagnosis and age of the woman providing the egg at the time of freezing.

Conclusion

Overall, there are many details and nuances to explore when comparing programs for available embryo donation or embryo adoption. Donor embryos provide many families an affordable alternative option to traditional IVF and donor IVF treatments, and allow them to fulfil their dreams of having a baby.

**Sue Taylor is an experienced IVF consultant with a passion for helping others on their journey to parenthood. With over 27 years experience in the healthcare industry, she now assists patients with selecting a clinic, or going abroad for more affordable IVF and donor egg IVF treatments. Ms. Taylor can provide assistance for prospective patients deciding if IVF treatment abroad is a good choice for them, assist with clinic selection, and has provided full facilitation services (including cycle & travel coordination). She has assisted hundreds of donor IVF patients seeking treatment abroad. Her blog, www.ivftraveler.com/blog, offers practical details for patients traveling for IVF services or an IVF vacation. Sue Taylor can be reached at sue@ivftraveler.com.