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.

Look elsewhere first if nobody has given you a clear answer on why your own gametes are failing. Be slower still if you are being moved to donor eggs after one disappointing cycle. One poor response is not a diagnosis. Ask what changed the clinic's mind and what a different protocol would be expected to do.

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

The type of donation is rarely a real choice. What you actually decide is everything around it: 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 what an anonymous donation now offers is not privacy for anyone. It is only the absence of a record when your child goes looking. Weigh it knowing that.

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. Clinics abroad in particular describe their rules in reassuring general terms. The written version is the one that will still exist in two decades.

The donor conception procedures

The four arrangements below differ in which half of the genetic material is donated, and almost everything else about them is shared. The same screening, the same counselling, the same legal 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 the sections on screening, matching and law are fullest there. They apply with small changes to the rest.

Donor conception recovery

Recovery is the wrong word for most of this, and it is worth saying so plainly, because people arrive braced for an operation. A recipient does not stimulate her ovaries and does not have eggs collected. She takes oestrogen, then progesterone, to build and hold a lining, with a scan or two to check it. Then a transfer through the cervix with a soft catheter.

It takes minutes and needs no anaesthetic. Most people drive themselves home. Donor sperm treatment by insemination is lighter still.

What there is instead is a wait, and the weight lands emotionally rather than physically. Two weeks to a pregnancy test. Everyone in fertility treatment has that fortnight, but this one carries an extra question about whether the pregnancy will feel like yours.

It usually does, and sooner than people expect. Carrying a pregnancy is an unexpectedly persuasive experience. I have watched that surprise land on plenty of people who had spent months certain it would not.

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 harm reported consistently comes from finding out late, or by accident, or from a DNA test.

Donor conception cost

Donor treatment costs more than a standard IVF cycle, and the gap is 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.

Two honest warnings about the numbers. Donor programmes quote packages more than any other part of fertility care, and the conditions inside a package are where the money is. Multi-cycle and refund plans carry eligibility criteria, cut-off dates and exclusions, and a guarantee that returns your money does not return the year.

The quoted price also leaves things out: the recipient's medication, freezing and storage of surplus embryos, and the second and third transfers. A good donor cohort usually gets used across several.

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, buys back time that is the one thing nobody can add later.

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 people underestimate. 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 goes wrong most often.

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. Arrangements advertised to international patients are not always legal for them to use. Ask before you travel, not after.

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 are a different and riskier picture. See eligibility.