An Overview of Embryo Donation in Canada by Angela Krueger - SPRING 2011

AN OVERVIEW OF EMBRYO DONATION IN CANADA

SPRING 2011

by Angela Krueger

After undergoing a successful round of IVF (in vitro fertilization) resulting in the birth of their daughter and then having a second child born without medical intervention, Leah Hendrick* and her husband decided their family was complete. However, they were now faced with a dilemma – what should they do with the 12 frozen embryos they had in storage? “Destroying them was out of the question, and we wanted to know what other options existed,” the Toronto couple recalls. Eventually, they found an organization to work with in the U.S. which helped them donate their embryos. That was almost 10 years ago.

For Canadians faced with this same reality, three options were generally available at the time: donate the embryos to science, destroy them or store them indefinitely for a fee. Fortunately, Canadian couples today can work with fertility clinics across Canada if embryo donation is the option they wish to pursue.

Across Canada, thousands of frozen embryos are currently in storage. Most of these will be available to the very people who created them for subsequent IVF cycles. While couples feel positive about donating their surplus embryos at the beginning of their infertility journey, the reality is that very few embryos are designated for donation to another couple.

For embryo recipients, the possibility of experiencing pregnancy, childbirth and nursing is paramount in the decision to put their names on a waiting list with fertility clinics. For those who have also explored adoption and are uncomfortable with the risks of another woman carrying “their” child, embryo donation allows them to ensure optimal healthful conditions throughout the pregnancy. Embryo donation also gives both parents time for gestational bonding, as they can experience the child in utero despite not being genetically linked.

To embryo donors, this process gives the peace of mind that they are helping others form a new family. Their altruistic donation also reaffirms, for some, the reason for the embryos being created in the first place: to give them the potential for life.

Although not a brand new procedure, embryo donation has evolved in Canada alongside IVF since 1997. Terminology and guidelines were clarified with the creation of the Assisted Human Reproduction Act (2004), but there are no laws currently regulating the process across the country.

“This is where the complexities are,” says Samantha Yee, a social worker at the Centre for Fertility and Reproductive Health at Mount Sinai Hospital who sees patients seeking third-party reproduction on a regular basis. “We must consider how to balance the needs of both donating and recipient couples while protecting their confidentiality and privacy, and recognizing that their needs may be very different and may change over time.”

Ms. Yee emphasizes that although embryo donation is a medically simple procedure, from an administrative and psychological point of view it is extremely complex because a child may be born as a result. Issues that need to be considered are:

will the recipient family tell their child about his or her genetic origins?
how would a child feel having a genetically linked “sibling” raised by another family?
will family members be told about the embryo donation?
will information be disclosed between donor and recipient families?
will the donating couple be informed about the outcome of their donation while the privacy of the recipients is protected?
how does the recipient couple feel about raising a child not genetically linked to them?
does the donor-conceived child have the legal right to know his or her genetic origins?

“In essence, fertility clinics become gatekeepers for information and the donation model is dependent upon the clinic’s embryo donation guidelines,” comments Ms. Yee, recognizing that each of the over 30 IVF clinics across Canada handle embryo donation differently, with some not offering it at all.

At the McGill University Health Centre Reproductive Centre (MUHCRC), for example,
embryo donation is done anonymously. In compliance with the Canadian Assisted Human Reproduction Act, before patients proceed with IVF they sign consent forms
indicating their wishes for unused embryos. If they still wish to donate their
embryos following IVF, then the embryos are given to the next couple on the
clinic's waiting list.

“Patients are do not set out to donate their embryos,” says Dr. Janet Takefman, a
clinical psychologist with MUHCRC. “It is a decision they finalize once their family is complete and they have embryos left in storage.” She adds that patients of McGill's program are only eligible to donate and receive embryos if they have been treated at the clinic, and all patients must see her before finalizing their embryo donation decision. “Donors and recipients working with our clinic undergo psychosocial assessment. And we provide education and counseling to ensure they understand the process and the implications of donating and receiving embryos.”

For some couples considering donating their embryos, the donation is not that straightforward. According to Ms. Yee, it is often hard for the donating couple not to become emotionally attached to their embryos, especially if they have gone through IVF to create these very wanted embryos for their own family. “It boils down to how they conceptualize their embryos; do they look at their embryos as human tissues, genetic materials, children waiting to be born or their genetic children?” Ms. Yee comments. “The most frequent question I hear from patients struggling with embryo donation is ‘how do you assess or screen the recipient couples?’ It’s obvious that most donors want their embryos to go to a “good home” and raised by good people, but they do not necessarily want open contact or disclosure of their identifying information because of unknown future implications.”

The Regional Fertility Program in Calgary works more along the lines of an adoption model. Patients at their clinic are required to complete a home study and receive psychological counseling prior to being eligible as recipients for embryo donation. Donors must complete a medical and genetic questionnaire and also receive counseling from a clinical psychologist.

In the Calgary program, donor couples and recipient families are matched based on ethnic background and physical characteristics – this is what traditionally occurs in adoption. Looking down the road, the clinic may be able to offer donor couples to be involved in the process of choosing prospective parents for their embryos.

“We also have a process called direct embryo donation where the donating couple chooses their recipient,” says Lori McCrae, Director of Nursing and Director of the Embryo Donation Program for the Calgary clinic. “They may be related, may have known each other for a long time or possibly found each other another way.” In the direct embryo donation program, the recipient couple is not required to complete a home study, unless the donor couple requests it. “In addition, all patients must also complete blood work for HIV, HTLV, HBsAg, Hep C, Hep B core AB and Syphilis prior to being eligible to donate or receive embryos,” Ms. McCrae explains.

Recognizing the need to have support available to embryo donors, recipients and children at the centre of the relationship, Beginnings Family Services in Ontario started an open embryo donation program in 2010. Being at the forefront of Canadian adoption, Beginnings’ work focuses on the best interests of the child. “We believe that the psychosocial needs of children born from ART must be considered, and that all parties must be prepared for the lifelong issues associated with their origins,” says Kerry Vandergrift, Executive Director of Beginnings.

From a legal standpoint, embryo donation is not referred to as adoption in Canada. Technically speaking, adoption refers to the transferring of parental rights from the biological parents to the adoptive parents. In the case of embryo donation, there is no termination of rights, just a transfer of tissue from donors to recipients, much like in organ donation.

Beginnings is not a fertility clinic, nor do they store embryos. Their principal role is to enable donors to determine the “best fit” for their embryos’ future and to facilitate the screening of the intended parents. For a fee of about $6300 payable by the recipient couple, Beginnings provides the counseling services, recipient reports and screening similar to the adoption home study process, openness education, presentation of profiles, consultations and inter-family meetings, as well as administration and long term follow-up for all participants in the open embryo donation program.

“It is clear many couples hesitate to make a decision about their stored embryos because they consider them ‘their children’,” says Ms. Vandergrift. “They want to know who they will be placed with, into what conditions, and they want to know how they are doing as they are growing up in another family.”

In the Beginnings program, the embryo transfer takes place at the clinic the embryo donors originally were working with. Embryo recipients are responsible for all medical and legal fees regarding the donation. People who choose to donate their embryos through any clinic in Canada do not receive payment for doing so nor are they responsible for any costs of the donation.

Despite embryo donation being less expensive than other ART (assisted reproductive technology) processes and having higher success rates over other procedures, embryo donation in Canada has not increased over the past few years. However, notwithstanding its many challenges and the lifelong implications of this process, it is a worthwhile option for Canadians. Ms. Yee suggests people interested in both donating and receiving embryos speak to their clinic about the possibility and find out if such a program is being offered. “Most people do not know that embryo donation is a feasible reproductive option such as egg donation, sperm donation and surrogacy.”

As for Leah Hendrick and her husband, one of their donated embryos allowed another couple to fulfill their dream of having a child: their Julia* is now a happy, healthy, spunky nine-year-old.

“There are so many considerations for couples donating embryos that need to be worked through before they decide whether embryo donation is for them,” says Hendrick. “But we are so glad we made the decision to pursue it.”

*names changed upon request to protect privacy

About the author
Angela Krueger is a freelance writer specializing in the areas of adoption and open embryo donation. In addition to being a Feature Writer for www.suite101.com, her articles have appeared in IMPrint (Sick Kids Hospital), Adoptive Families Magazine and several college textbooks.

References:

Assisted Human Reproduction Act, S.C. 2004.

Covington, Sharon N. & Burns, Linda Hammer (eds). Infertility Counseling: A Comprehensive Handbook for Clinicians 2nd ed. Cambridge University Press: 2006.

Ethics Committee of the American Society for Reproductive Medicine. American Society for Reproductive Medicine: defining embryo donation. Fertility and Sterility, Vol. 92, No. 6, December 2009.

Lee, J. & Yap, C. Embryo donation: a review. Acta Obstet Gynecol Scand 2003; 82: 991-996.

Embryo Donation: A History of Unfulfilled Expectations. Presentation to the 2010 Canadian Fertility and Andrology Society Conference by Dr. Chris Newton.