Donor Conception

Who donor conception is for

On the egg side: premature ovarian insufficiency, early menopause, ovaries removed or damaged by surgery or cancer treatment, a heritable condition, and, most commonly, age. The usual route in is repeated IVF cycles that produce few eggs, or embryos that do not survive to blastocyst.

On the sperm side: azoospermia, where no sperm is found even on surgical retrieval. Severe male factor that ICSI has not solved. A heritable condition. And single women and female couples, who between them are the largest group using donor sperm worldwide.

Clinics ask about age, general health and whether the uterus can carry a pregnancy. Most set an upper age limit for the person carrying, often somewhere around the late forties to early fifties. They will also ask whether you have had counselling. In the UK and several other countries the clinic must offer implications counselling before you consent, and I would take it even where it is optional.

It is worth having a clear explanation of why your own eggs or sperm are not working before you move on, and if donor eggs are suggested after a single cycle, ask what led to that advice and what a different protocol might do. A good clinic will be glad to talk it through.

Before your first donor consultation

Talk to your partner separately about the genetic link before you talk to the clinic about it. Couples often arrive having each assumed the other minds more, or less, than they do. The conversation goes better once you have both said the awkward part out loud in private.

Choosing between them

There is one genuine choice between the types of donation, and it arrives when neither side works. Then a donated embryo and a double donation are two routes to the same outcome, which is a child genetically unrelated to either parent.

They differ in control rather than in result. An embryo already exists, so it is cheap and quick, the supply is small, and the donors and the embryo quality are fixed history. A double donation creates embryos from an egg donor and a sperm donor you chose, which means a fresh cohort and usually better odds per attempt, for several times the money. It also means creating embryos rather than receiving them, and people often feel differently about the two, so it is worth noticing which suits you.

What you decide in every other case is everything around the donation: fresh donor or frozen bank, a clinic-recruited donor or someone you know, a country where the child can trace the donor at eighteen or one where they never can. And whether you treat at home or travel for a shorter wait and a lower price.

That last one is where I would spend the most thought, because it is the only decision on the list your child cannot revisit. Countries split roughly two ways. Identity-release systems record the donor's identifying details and release them to the donor-conceived person at eighteen, on request. The UK, Sweden, the Netherlands, Ireland, Australia and New Zealand all work this way.

Anonymous systems do not, and they still cover much of continental Europe and most of the United States outside voluntary open-ID programmes. Treating abroad and coming home does not import your own country's rules. Your child is left with whatever the treating country wrote down.

Waiting times push people towards the anonymous option, and I understand why. Identity-release systems recruit fewer donors, and the wait for a match, especially for donors who are not white, can run to a year or more. But direct-to-consumer DNA testing has already made practical anonymity unreliable, so the main thing an identity-release system adds is a clear, official record for your child if they want it. That is well worth weighing.

Before you agree to a donor match

Ask what the child will be able to find out at eighteen, and get the answer in writing. Having it in writing gives you, and later your child, a clear record that will still exist in two decades.

The donor conception options

The four differ in which half of the genetic material is donated, and in whether it was donated for you or left over from somebody else's treatment. Everything around them is shared. The same screening, the same counselling, the same consent forms, the same conversation about telling.

Read egg donation first even if sperm is what you need. It has the most moving parts, so screening, matching and the law are covered fullest there, and they carry over to the others with small changes.

Donor eggs and embryos

Donor sperm

Donor conception recovery

Recovery is the wrong word for most of this, because people arrive braced for an operation. A recipient of donated eggs or embryos does not stimulate her ovaries or have eggs collected. She takes oestrogen, then progesterone, to build and hold a lining, and has a transfer through the cervix that takes minutes and needs no anaesthetic. Donor sperm by insemination is lighter still. Only the IVF route with donor sperm involves a collection of your own.

What there is instead is the two-week wait, with an extra question about whether the pregnancy will feel like yours. It usually does, and sooner than people expect, which is one of the most reassuring things I can tell you about donor conception.

The longer tail is the family one. Decide how you will tell the child before there is a child. The evidence and the donor-conceived adults who write about this agree on that point more firmly than on anything else. Children told early, as a story that was always there, take it as ordinary.

The difficulties people report come from finding out late, or by accident, which early telling avoids.

Donor conception cost

Donor treatment costs more than a standard IVF cycle, mainly because of the donor. In the United States, a fresh cycle with an exclusive donor commonly lands somewhere around $30,000 to $60,000 all in. Compensation, screening, agency fee and the donor's stimulation all sit on top of the IVF. Frozen donor eggs from a bank cut that substantially, often to roughly half, because you buy a set number of eggs rather than a whole cycle.

The UK is cheaper, broadly £8,000 to £15,000, because the regulator caps what a donor may be paid at a fixed compensation sum rather than a negotiated fee. Donor sperm is far cheaper everywhere. Vials run in the hundreds. The expensive part is the treatment you use them in.

Donor programmes often offer packages and refund plans, and it is worth checking whether the quoted price includes the recipient's medication, storage of surplus embryos and every transfer after the first. Egg donation sets out what to get in writing before you sign.

Where it fits

Donor conception normally comes after your own gametes have been tried. For single women, female couples and men with no sperm at all, it is where treatment starts. There is no rule that it has to be last. Moving earlier, at an age where the answer is already clear, makes the most of your time.

One timing point matters more than the rest. If a donor cycle fails, do not book the next one before somebody has explained why the first one failed. Donor eggs remove the egg question, so a failure points somewhere else. Usually the lining, the uterus or the transfer itself. That is worth investigating before you spend again.

If you might want a second child, ask about keeping embryos from the same donor. A genetic sibling is much easier to arrange while the cohort still exists than to reconstruct three years later.

Eligibility

This is a legal question more than a medical one, and the law differs by country more than in any other area of fertility treatment. Three things vary. Whether donors can be anonymous. Whether they can be paid, and how much. And who counts as the child's legal parent.

Legal parenthood is the one to get right. In a licensed clinic, with the right consent forms signed before treatment, the intended parents are the legal parents and the donor has no rights or obligations. Get that sequence wrong, or arrange a donation privately outside a clinic, and in several countries the man who provided the sperm remains the legal father. That carries obligations as well as rights, for both sides. Home insemination with a known donor is where this most needs care.

Many countries also cap how many families one donor may create, which is one reason imported donor gametes are regulated.

Cross-border treatment does not carry your own country's protections with it. If you treat abroad, check both what the clinic's country records about the donor and what your own country will recognise when you get home. In Thailand, where I work, commercial surrogacy and sex selection are restricted by law for foreigners. Check what is legal for international patients before you travel.

Frequently asked questions

Will the child be able to find out who the donor was?

It depends entirely on where the donation happened, not where you live. Identity-release countries release identifying details at eighteen; anonymous ones do not. See choosing between them.

Are donor egg success rates really the same at any age?

Close to it, for the person receiving them. The odds follow the donor's age rather than the recipient's, which is why donor egg live birth rates stay high and fairly flat through the forties.

Should we tell the child?

Yes, and early. Donor-conceived adults and the research on this are consistent that early, ordinary telling goes well and late or accidental discovery does not. See recovery.

Can we choose what the donor looks like?

Partly. You generally get physical characteristics, blood group, ethnicity and some background. You do not get to select for traits, and what is disclosed varies widely by country.

Is the donor the legal parent?

Not when treatment happens in a licensed clinic with the consent forms signed beforehand. Private arrangements outside a clinic work differently, so take advice first. See eligibility.