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Thursday 3 October 2019

Fertility

Kinder eggs

Egg donation is on the rise, so why is the process still cloaked in silence and secrecy?

By Genevieve Roberts

Beth Pedersen is eight months pregnant and it has been a long and bumpy journey to get there. The excitement she feels as her son kicks in her belly is accompanied by a daily sense of relief after three years of fertility treatment. Now 42, she finally got pregnant using an egg that had been donated from another, younger, woman.

Beth went through seven rounds of IVF using her own eggs, which resulted in a chemical pregnancy, and ran up more than £40,000 in bills to fertility clinics, before she accepted that her chances of a successful pregnancy without the help of another woman were slim. After extensive counselling, she felt proud of her decision to carry a child who isn’t genetically related to her. Using donated eggs, Beth became pregnant first time.

She has chosen to be open with family and friends about the origins of her soon-to-be-born son and the egg donor who shares Beth’s colouring, height, build and background. “I feel a responsibility to other people,” she explains. “If not, I would be an example of another woman over 40 who got pregnant. I want people to know that it’s not easy and to take it into consideration when planning their future. Yes, some women do get pregnant with ease over 40 but so many do not and we need to make sure people are properly educated about fertility.”

Beth Pedersen in Balham, London.

Beth, who is single and lives in London, conceived her baby using donor sperm as well as a donor egg. The sperm donor is Danish and the egg donor British, to match Beth’s half-Danish, half-English heritage. She believes there is a silence surrounding egg donation because infertility remains hard for people to handle. “You may feel the donor is replacing you, essentially.”

While sperm donation may be ‘hushed up’ when used by heterosexual couples, it becomes harder to conceal by people who are desperate to have children but are not in traditional nuclear families. “Solo mums and same sex couples can’t hide it,” says Beth, “and in these situations using a donor is often a sign of empowerment and bravery for taking the step to become a family. I thought I would feel threatened by my egg donor in some way, but I am just so grateful and feel nothing but warmth towards her.”

A desire for privacy also means that egg donation, and sperm donation within straight relationships, is rarely talked about. Dr Susan Imrie, Research Associate at the Centre for Family Research, University of Cambridge, is working on a study comprising 85 families with children conceived through egg donation. The majority of families had told just one person, or a couple of people, about their use of donor eggs, because they were looking for emotional support. Dr Imrie has also met families where the parents choose not to tell anyone and see egg donation as completely private or as confidential information for their child to hold alone. A minority of families are very open and will happily educate people about egg donation, while others believe there is a cultural stigma around not having genetically related children. To women like Beth, it can feel if there is a silence surrounding egg donation which is rarely mentioned in popular culture, the media or in school playgrounds.

Beth’s son may not even be born yet, but already she is creating a story book about the process – she is determined to be open with him so his origins are something he feels pride in.

She is one of a growing number of women in Britain who are turning to egg donors to become parents. In 2017, there were almost 4,000 IVF cycles using donor eggs in the UK, up from 2,500 in 2011, according to the Human Fertilisation and Embryo Authority. Many more people go abroad for treatment, where figures are not recorded. “The majority of people undergoing IVF treatment use their own eggs and their partner’s sperm. However, use of donor eggs and/or sperm has been increasing each year and made up 13 per cent of treatment cycles,” said a spokesperson for the HFEA. In America, meanwhile, figures from 2000 to 2010 – the latest published – follow the same pattern with a rise from 10,801 donor oocyte cycles to 18,306. The number of cycles has almost certainly continued to increase.

The first egg donation happened in the US in 1983 but it wasn’t until the 1990s that it became commonplace in the UK. It follows a similar process to that of women going through IVF with their own eggs. A donor’s normal menstrual cycle is suppressed, usually with drugs, which mimic the menopause. Hot flushes and fatigue are common side effects. Then, she will have her ovaries stimulated with hormones to encourage multiple eggs to grow. Some women will produce dozens of eggs. When they are ripe, they will be harvested from the ovaries under sedation. While in regular IVF, these would be fertilised to go back into the woman’s body, in the case of egg donation they will be used for someone else’s IVF treatment. A minority of donors undergo their own fertility treatment and donate half their eggs while the other half are used for their own treatment.

Louise Brown, the first baby born using IVF, ahead of her 40th birthday in 2018.

The main reason for these rising numbers is that more women are getting pregnant in their 40s, when their fertility is waning. Professor Simon Fishel, founder of Care fertility and part of the team who worked on the first successful IVF treatment that led to the birth of Louise Brown more than 40 years ago, explains: “It’s not a deliberate attempt to have children later. But for many social and personal reasons – a woman might have a partner but they require two incomes to live or it might be that they haven’t met the right partner – they just can’t consider it younger. This creates problems: we’re seeing a rise in secondary fertility and declining birth rates in society with every single economically advanced nation below the replacement birth rate for that population.”

Professor Fishel, who recently started offering surgery to delay the menopause for up to 15 years through his company ProFam, feels that there needs to be a huge amount of education so people understand the biology of fertility. “Beyond 35, the egg pool decreases and the number of eggs with abnormal chromosomes increases, making successful conception more difficult, increasing miscarriage rates and the incidence of abnormal pregnancies and babies,” he says. “People don’t realise that the chances of a woman conceiving at 52 is one in 10,000. Men have a biological clock too: their sperm can fertilise and produce a baby, but the health of that baby is much more at risk in an older man.”

Olivia Montuschi, founder of the Donor Conception Network, agrees that there is a lot of misunderstanding about fertility, and feels that unacknowledged use of egg donation – frequently by women in the public eye – gives the impression that people are able to have babies into their 50s. “People will talk about IVF but not egg donation, which becomes enormously misleading to the general public,” she says. “It is rare but not impossible for a woman to conceive her first child after 43 or 44.”

In the UK, a woman has to be under the age of 36 to donate eggs, according to Human Fertilisation and Embryology Authority governance. In the UK, the NHS will offer IVF for couples where the woman is 42 and under, while most private fertility clinics won’t treat women over the age of 50. This doesn’t stop women going abroad for treatment: one British woman conceived her first child at 57 at a Russian clinic.

But it’s not simply age that leads women to seek donor eggs. Medical conditions, such as chemotherapy for childhood cancer and premature menopause, also leave women unable to conceive with their own eggs. Approximately 1 per cent of women – 1 million in the UK – have a premature menopause, so will see their periods stop anytime between their teenage years and 40.

Amanda Lewis with her new born son

Amanda Lewis, 31, from Warwickshire, had her first period aged 10. She had a total of six periods, and then they stopped. By 11, she was menopausal. Two years later, she started on hormone replacement therapy, or HRT, which is more often used by women in their fifties. She was told at the age of 13 that her only hope of becoming pregnant was through egg donation. “I was way too young to take in the information,” she says. “But I felt pressure to save up thousands of pounds. I focused on my career in my 20s because I knew I’d someday have to spend a lot of money on fertility treatment.” Although Amanda should qualify for NHS-funded treatment, a waiting list of more than two years meant that she used her savings. The egg donor matched her mixed race background, which was her preference but didn’t feel crucial to her. Montuschi says that most women hope to find a donor who matches their ethnicity to save the family being questioned regularly.

Amanda’s son has just turned one. “When I found out I was pregnant I struggled to believe it was true,” she remembers. “I thought I was going to lose him. I had a mental battle until the second trimester, and I booked a private scan almost every week from six weeks to 16 weeks because I was so worried.” Her partner, Tom Hill, helped to keep her calm as her body was taken out of the menopause to carry her son, and then as she went back through the menopause – with its associated hot sweats and headaches – after he was born.

She firmly believes that “it just doesn’t matter that they’re not my eggs” – there is no question of her parental love. When she sees women go through multiple failed rounds of IVF she wishes for them that they’d explore using an egg donor to try to become pregnant. “I’m very open about my experience,” says Amanda, and talks about her experiences on her YouTube channel. “The only time I’m quiet is when people say my son looks nothing like me, and I don’t want them to feel bad.” She will also be open with her son about using a donor, and believes this is important because their DNA is different.

The majority of women in the UK who donate eggs do so altruistically, according to Professor Fishel. They receive a regulatory-controlled compensatory fee of £750. In contrast to this, egg donation in America can be a lucrative business with some agencies paying women $50,000 per cycle. In the UK, both egg donors and recipients receive counselling to ensure that they are making the right choice, for the right reasons. Some will be family members; frequently younger sisters or cousins to a woman who can’t get pregnant. When relatives are donating eggs, these counselling sessions also ensure that no one feels coerced into donating. There are egg-share patients too, who receive IVF at a reduced rate: half of the eggs harvested will be donated, the other half used for their own treatment.

Charlotte Hunt, left, her wife Jess and their child Quinn, at their home in Northampton.

Charlotte Hunt, 36, from Northampton, donated her eggs when her wife, Jess, was going through IVF using a sperm donor so they could become a family. The couple had their treatment through Care Fertility. “It felt like good karma: we were reliant on someone doing the same with sperm. And it was a nice way of being part of the treatment,” she says. “I helped to fulfil a dream for parents and appreciated that I got to write a letter that their children can read.”

Meanwhile, Charlotte Birch, 36, a social worker living in Bristol, donated her eggs last year in an egg-sharing arrangement, reducing the cost of her IVF treatment. She felt that donating her eggs was an opportunity to empathise with her child, who will also be conceived with donor sperm. “I liked the idea of being able to say I understood any difficult emotions they may have about having half siblings they may never know from donor sperm, and that I wondered about the children created from my eggs too,” she says. She also saw a friend struggle with fertility issues. “To be able to offer someone the chance to still be able to grow their own baby with a bit of DNA to start them off is an amazing opportunity,” she says. “I would find it too hard to donate to someone I knew, so I wanted to be that stranger for someone else.”

Charlotte Birch is now waiting to hear if her eggs have resulted in a pregnancy for the woman who received them. “I truly don’t consider them as my children,” she explains. “They are very separate to me, but I am anxious that my donation is successful as I want my gift to mean something, not cause more despair.”

Children conceived using donor sperm or eggs since 2005 in the UK can get in touch with the egg or sperm donor if they wish to understand their genetic background at 18. Laws vary between countries, so a child conceived in Spain, for example, will never get this information about their donor.

Dr Imrie has found that three quarters of parents plan to tell their children, and some have started this process by the time their child is five. But a quarter decided not to tell their child, or remain uncertain as to whether they will do. Even so, her research has shown that outcomes for children conceived through egg donation are very good. “Egg donation mum and dads were warm, emotionally connected and sensitive parents with high quality relationships. In our research at the Centre for Family Research we talk to parents (and children) in many different types of families, and what we find is really consistent. What matters for children’s wellbeing is the quality of family relationships, not what the family looks like or how the family was made. Children are most likely to flourish in families that provide love, security and support, and the families through egg donation in our studies are providing this environment for their children.”

Charlotte Birch thinks it would be “really special” if, in decades to come, a young adult who she helped to make gets in touch with her. If it doesn’t happen, she would take it as a sign of security in their relationship with their mother. But she will always have some curiosity about the children that she has helped to create. “I do wonder whether I might end up thinking every child with blue eyes and brown hair is the result of my donation,” she says, with a smile.

Portraits Tom Pilston for Tortoise, all other photographs Getty Images

Further reading

Going Solo: My choice to become a single mother using a donor by Genevieve Roberts, about becoming a solo mother using a sperm donor

– AmandaDawn – YouTube channel; Amanda Lewis shares her experiences of an early menopause and using egg donation to become a mother.

An Insider’s Guide to Egg Donation: A Compassionate and Comprehensive Guide for All Parents-to-be by Wendie Wilson-Miller and Erika Napoletano. A concise guidebook for intended parents that explains the basics of egg donation, how to choose a reproductive clinic and how to pick a donor

Genevieve Roberts headshot

Genevieve Roberts

A journalist and author of ‘Going Solo: My choice to become a single mother using a donor’. She is a mother of two children and lives on the Sussex coast.