Are you considering donor egg or sperm? When should you consider these options? What choices do you have and what are some of the psychological hurdles you need to consider? We talk with Dr. Angela Leung, a reproductive endocrinologist at Reproductive Medicine Associates of New Jersey; and Dr. Poonam Sharma, a Licensed Psychologist specializing in reproductive issues.
In this episode, we cover:
American Society of Reproductive Medicine Guidance Regarding Gamete and Embryo Donation
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Welcome everyone to Creating a Family talk about infertility. Today we're going to be talking about when to consider sperm or egg donation. We will be talking with Dr. Angela Leung. She is an reproductive endocrinologist at Reproductive Medicine Associates of New Jersey who specializes in helping men, women and couples who want to start their family preserve their fertility or take care of their reproductive health issues. We will also be speaking with Dr. Poonam Sharma. She is a licensed psychologist specializing in reproductive issues. She is a longtime member of the mental health provider professional group at the American Society of Reproductive Medicine. Welcome Dr. Leung and Dr. Sharma to Creating a Family. We are glad you're here to talk to us today about gamete donation. Thank you glad to be here. All right. We're gonna start by talking. We are going to be talking about gamete donation which of course means egg and sperm donation. But we're we will also include a discussion about donated embryos at the end. And we're going to be following the following order. We're going to start with sperm donation, then go to egg donation, and then talk about some issues that are relevant to both just for donor selection. And then we will talk about embryo donation. So let's start with sperm donation. Dr. Leung, what are the possibilities of getting pregnant when the male partner has an abnormal semen analysis? And and does it depend on how it is abnormal? Whether it's the sperm count, the motility or the morphology? Yeah, so
it definitely depends on the degree of abnormality. So remember, most of the tests that we do with infertility, especially in assessing eggs and sperm falls on a spectrum, there is no like 100% This is amazing, or, you know, 0%, this is absolutely nothing there. There are cases obviously were a man might have no sperm at all, and that's called a azoospermia. In those cases, then it is impossible to get autologous sperm from that male partner. So then you have to look for a donor sperm. However, in many cases, short of absolute Aizu sperm yet as long as there is some sperm available at tempting conception with that male partners own sperm is feasible, obviously, depending on if there are any other issues among the couple as well. And that's one of the big benefits of the progression of IVF as a technology is that you know, with IVF, we only need very, very few numbers of sperm in order to fertilize eggs and create embryos. So as long as the man has a couple and it may be the case we're a urologist has to go in and surgically extract sperm from the male partner. But there's at least the ability to attempt conception through IUI or IVF. And then if that has failed for various reasons, then that might be another reason to consider sperm donation.
When you do medical sperm extraction does is the sperm often normal? I mean, obviously you're you're seeking out you're only getting very few but are is the how common is it for the morphology or the motility to be impaired on the sperm that you have to extract medically? Yeah,
so if it's extracted directly from the testicles and motility is for sure impaired,
it doesn't so much matter, though. Because you're you're taking care of if you're using IVF you're taking care of the sperm does not have to work its way to the egg or
the correct Exactly. So surgically extracted sperm has to be used in IVF. You cannot use it for IUI. exactly for that reason. So again, the motility doesn't really matter in that sense. And
sperm count doesn't really matter. Because at that point, you've taken out the numbers game and you're just so and they're often the morphology is often normal.
Well, so no, most sperm is actually abnormal. And if you look at a semen analysis for men, usually 4% Only is normal morphology and it's even analysis. So you know, a lot of the sperm that you extract may also be morphologically abnormal. But if you can get you know, even like 50 100 sperm in this surgically extracted sample, you only need the same number of normal sperm as you have eggs. You know, again, it's not typically a very high count that you need.
Okay, so when should a patient consider sperm donation from a medical standpoint?
So, like I mentioned before, one if the male partner does testing and there's absolutely no sperm in the sample, and that would obviously need to be confirmed on more than one occasion. And typically these patients get sent to a male fertility specialist as well, to identify an underlying reason for why this might be the case. There is reasons why men might have no sperm, you know, men with prior cancer diagnoses, who have had surgery or chemo or radiation would be one of them. Are there are other genetic abnormalities that cause abnormal or no sperm production? Or if the couple has done, you know, fertility treatment with the male partner sperm, and based on how the fertility treatment has gone? You know, the, we think that there is a sperm issue contributing to their failures, then we might talk about, well, let's think about maybe trying it with donor sperm, and seeing if that actually increases your likelihood of success. In that sense. It's both a diagnostic and therapeutic test, essentially, because if they have better success, then we can say for sure that the issue was on the sperm side, and not so much on the egg side. Okay,
that makes sense. So how do you how I guess how and when should a medical provider bring up the possibility of using donated sperm? And it seems like it's somewhat, your patient is usually the female partner. And so how do you bring it up? And how do you make certain that the male partner is included? If there is a male partner, obviously,
right, right. So often, you know, you're right, and that the female partners is typically the primary person that we're treating, because they're the one typically going under going through all the medical treatment, but we always encourage both partners to attend all of the consultations. And for the most part, I think patients do, you know, kind of adhere to that. And certainly, if we're at the point where we're talking about donor sperm, I would want the male partner to be there. Because that shouldn't be something that is kind of passed along. Yeah, through an intermediary. So you know, I would want to ensure that both couples are there, because this is more, it's more than just a medical recommendation, right? There's a lot of other emotional psychological considerations to go into this, which I'm sure Dr. Sharma will touch on as well. And I think it is primarily the responsibility of the doctor to have this discussion. A lot of the times the patient's already aware, or has an inkling that that's going to be discussed, though.
And I should mention that obviously, we're this that from the medical standpoint, we're talking about where there is a male partner involved. If there, were not a male partner, or a single woman or a lesbian couple, then this is the medical aspects would not be taught or would not be relevant. So Dr. Sharma, what are some of the the psychological issues that arrive? And I'm going to divide it let's because I think the psychological issues are different between the female partner and the male partner. So what are some of the psychological issues that may arise for the female partner, when using are considering using donor sperm? Well,
I think in any situation where you are potentially using a donor, grief always pops up, especially if the infertility journey has been shorter, you'll see more acute grief and people have been at it a while, sometimes, you know, the nature of that grief will be a little bit different because they've been absorbing things as they go along. But I think that when one partner is the primary one that is having the fertility issue, it's very common to see that the other one is you know, feels that you know, some worry about that partner, like are they going to be okay, if we use a donor that they can be able to bond with the child? Okay. I think there can also be definitely just some sadness as a couple that they're not able to conceive using their own genetic material. And, you know, just worry that that if their marriage going to be okay if their marriage right, and there's a relationship and be able to handle this, and can they come out of this on the back end, really feeling okay about the decisions that they've made? And so I think there's just a lot of you know, just concern and worry wanting to make sure that the partner is on board really okay with that and not just kind of faking it.
And I think there in certain cultures, there are added implications because of of The importance of bloodline, the importance of the male bloodline, and the fear of how extended family might accept this child. Do you see that as well?
Yes, that can definitely be a factor. I mean, I think telling family and friends in general, people do have concerns about that often, especially if you have family members that aren't so safe. But one of the situations where we do and first people he was cautious about telling you, if there are significant cultural factors that might lead to the child being ostracized. So we did have to look at that broader social context as well, in terms of who do you tell, you know, I often say, you know, talking to the child about it is different from talking to everybody else about it, we'll get more into that. That distinction becomes important here.
Right? When we talk about our general issues, exactly. So what are some of the feelings that male partners commonly experience when they when it has been brought up that it is not to their genetic material that's going to be passed on to the child.
The person that, you know, has the fertility issue often feel shame often feels guilt, I think that's magnified for men because we so much associated with them, being able to kind of father a child as a part of who's you know, what being male means. So some of them really have a deep sense of shame. And I think that's reflected in how few males I actually see my practice, and we just don't see a whole lot of men coming in for counseling around having infertility issues, predominantly, it's women or women bringing their partners in. So you know, but for men, and I think so much of how confident they feel very much depends on how their partner is handling it, if she's happy, she's okay. She's saying, You know what, this is not a big deal. Sure, I'm sad that, you know, we can't use your sperm, but I'm really okay with this, then often, that'll give him a jumping off point to, you know, really absorb it and be okay with it, too. And, you know, I think the other factor is to what you mentioned earlier, the whole thing about passing on your genes, I think that often still falls on on men, you know, in a patriarchal society. And so I think that can be another factor for men, if they're not able to pass on their genes. Sometimes that's an issue within a family, you know, some families are very proud of their genes, and others don't care so much. But if that is, you know, something of importance to them, then that can also be an emotional issue,
too. And it's all tied into with masculinity in our society. And I think really, in many societies, and that's, that adds the feeling of lack of being a man, because you aren't, you're, there's something wrong with your sperm, therefore, you're not the same. You're not, you're not a real man type of thing. Or that feeling that concern that fear there of what about the the impact of asymmetry of parenthood where you've got the mom who is a biological mom, and the dad, who is a social, social dad out there, there are different ways to say it, he is a father in every sense of the word, because in my opinion, the one who does the act of fathering or the act of mothering is the mother or the father, but not everyone feels that way. So how does asymmetrical parenthood? Or what are the potentials of impact for that and things that people that that we should be thinking about before someone embarks on sperm donation?
Yes, that's a good question, I think is very linked to what we've been talking about, you know, I think the emotional experience of the couple, to me as as we're looking at one partner, having more of a genetic link, and the other one not having as much, I would tell people, you know, we share 99.9% of our DNA with everybody. So, you know, it is really, really important that, that both of them really grieve and have their heart open to the child they're about to conceive. I often say, you know, this isn't the child you were going to have together without anybody else being involved. This is a different child, and you have to really grieve that loss. If you're feeling you know, sense of loss. And then you have to open your heart open to the child here, he or she conceiving and who's going to be coming into your life because every child deserves that right to have their parents really open to them. So think so much of the addressing the asymmetry issues is during the brief work. And I think the brief work is absolutely critical to the connection you can have with the child once once they're born. When you
follow the creating a family.org podcast, you also gain access to our extensive archive on the topic of infertility and all related content we've created over the years and we have created quite a few because we're now going on almost 15 years worth of shows so you have a lot to choose from. So please follow or subscribe to the creating a family.org podcast. Alright, let's move on to Talk about egg donation and see if there are different issues. And certainly medical medically there, obviously. So Dr. Leon, when should patients consider egg donation from a medical standpoint? All right. And the corollary corollary to that is what medical conditions, make egg donation, appropriate or appropriate for consideration.
Right. So nowadays, to be honest, the most common reason that we see women needing egg donation is advanced age, more and more women are starting to think about building their families at an older age. And so, you know, frequently we have patients in their 40s, mid 40s, even, you know, in their late 40s, coming to us, either having had prior biological children or never having had prior biological children and wanting to conceive, and there's varying degrees of understanding and patients about the impact of age on their eggs, or oocytes. And so first of all, it's a lot of education for these patients about you know, the fact that, especially as you get to your mid 40s, it's going to be highly, highly unlikely that you will conceive with your own eggs. And so a lot of different clinics have actual age cut offs of where we will actually even attempt fertility treatment with a patient's own eggs are example for us here in New Jersey, if you are over the age of 45, you're automatically recommended for donor egg. And so and that's because, you know, when you look at the data, the success of conceiving with your own eggs at that age is essentially zero. So it you know, it is not kind of financially ethically really medically recommended to even attempt to that. So in terms of age, older women, that's kind of an automatic recommendation. Now, there are younger women who say have low egg numbers for various reasons. And often times these patients may attempt fertility treatment with their own eggs at first. But either because of poor egg numbers or poor a quality, they're unable to be successful after multiple attempts, especially when they attempt IVF multiple times. And depending on how, you know, unsuccessful that treatment has been, we may bring up the discussion of using donor eggs in a younger woman as well. There are other medical conditions that are certainly far more rare, but we do see that can lead to even very young women to not have any viable eggs. And a couple of these conditions, for example, are premature ovarian insufficiency, essentially early menopause, and I'm diagnose this condition as in as young a woman as 17, where, you know, she just went through puberty, and then stopped getting periods and as essentially, hormonally in menopause. And it's this, these are always really difficult patients to counsel because it's a very early kind of process of grief that they have to go through. Oftentimes these women haven't even thought about having children yet. And then to be told that having biological children will essentially never be a possibility for them. And donor egg is the primary recommended treatment if they want to conceive a child
that will I'm wondering, it seems like are you finding that when women in their 40s are coming in? You said that there was diversity in their understanding when women come in in their 40s 4142 43? Is the discussion different? Do most of them have an idea when coming in and have already started doing the grief work that Dr. Sharma had mentioned and and have started preparing psychologically, for the egg donation conversation? Are you having to start from ground zero with them?
Often I find it's from ground zero or close to ground zero. You know, I'd say most people have an idea that there is some impact of age on their eggs, but most don't understand to quite the degree of which that is. And so it certainly varies depending on what age they specifically are. So I would say if they're on the younger side of 40 There's definitely still a lot of optimism. You know that I can do it and a lot of it comes from like, oh, I have a friend who got pregnant at this age, or I see these people on social media or these famous women who have conceived when they're 50, you know, and so some of that is re educating these women that you don't know the whole story of what went into that conception that that person had. And oftentimes, especially for those older women that, you know, they will share anecdotal stories of those were likely donor egg consumptions as well, that they just simply didn't know about. And so there certainly there certainly are women who have much more realistic expectations, and have already come to me with the knowledge that donor egg might be in their future. But I would say that's the minority of patients,
that it's interesting to me and a little depressing, it means that we still have so much more work to do on the on the educating and we know just when we think we've made progress, and there's certainly more emphasis now on considering egg freezing for women who are waiting, but there, we still have a ways to go clearly. Dr. Sharma, what are some of the psychological considerations for the female partner, be they a young woman who has no reason to be expecting this other than sometimes she's had health reasons that you know, infrequent periods, or whatever that might have given her an indication, or an older woman who just simply hasn't? Hasn't wasn't understanding that the impact of waiting? What are some of the psychological issues? And do they differ with those people? Are they all suffering from grief and trying to figure it out?
Yes, I think that anyone who is surprised by what's going on medically, is typically going to be at least dealing with some shock, sometimes a little numbness. And if they really, really wanted that genetic connection, then in their grief, becomes much more intense. And so I think the surprise element is, does add to the mix, I think when people have been going through the processor, they're still maybe a little surprised that they got to this door, and they have to open this door. But it's the qualitative is a little bit different, they're further down the road, but in my experience, they've already
been processing it, you know, they've been thinking about it that even if not seriously, in the back of their mind. It's it's been it's been percolating
back me, certainly, it's a great way to put it. And, you know, I do think that for women who want to carry and I'll say this, you know, I'm qualifying This is not every woman actually is into carrying their baby, for women who define themselves as a woman, by the act of carrying a baby and having a baby. For them, there's actually some relief, at least they can still carry, the egg donor option is there, they really do find comfort in that. And so then they're grieving the loss of their full genetic connection with the baby, but they are still hanging on to well, at least I can still, you know, have have a child with my partner. And I think there's often some guilt to you know, just, you know, we're not able to have a child that's fully genetically ours. And so I'm the one that failed to so this is such a failure that creeps into all of this,
I think it goes more than just use the word carry more than just the act of being pregnant. We hear it's number one, being able to control the prenatal environment, not that we ever have complete control. But we do have it when when a person is a woman is carrying a pregnancy, she can make choices that at least increase the odds of controlling the prenatal environment. And it's also not that necessarily we're wanting to go through the birth experience. But I do think, you know, having the war stories and having that part of it is a bonding experience for a lot of women, and then the whole act of breastfeeding it which it's it is possible, but it's not easy to do if you have not carried a pregnancy. So I think carry brings with it, when you use the word carry our pregnancy brings with it a lot of other things. Whereas you may not care so much about being pregnant, but you really did want to control the prenatal environment or you really want to breastfeed or, or something like that, that can play or play a role as well. So how does it differ from the psychological and consideration of male partners? Do you find that for them? It is an easier because it's for whatever reason, they haven't given a well I guess the genetics could still be what are some of the psychological considerations you see that are common with the male partner when egg donation is now on the table?
I often see male partners in these situations as being protective if they have a good bond with their partner. And our friendship is feeling protective and worried about their partner. And so there's a sense of if she's okay with it, and I'm okay with it and and they often want her to make the decision. about whether to move forward or not. And so I think it's more as sensitive just watching over and, and wanting her to be okay. And so she finds her emotionally hard time. He's often really struggling to, and may not know how to comfort her through that as well, especially if she's feeling like she's failed him. But, you know, I'll tell you nine times I hear men say, you know, well, she's okay with it. And yeah, I'm fine. I'm fine. And, you know, that's, that's often the stance,
that we see that as well, just for the what for the record that that it seems to be less of an issue as long as she's doing okay with it? How does the asymmetry of parenthood play out when it is the mother who is not genetically connected, but on the other hand, she has the connection of a pregnancy and breastfeeding if she chooses? So how does the is it as big of a deal? Is there as much of a worry of the partners that there will be? A I think the asymmetry, the concern, generally is that the non genetically connected parent will be less involved will feel less connected, less bonded, less attached to the child, I think that's ultimately the the greater fear, do you see any difference than when it's egg donation versus sperm donation?
I do think that that donation because she's caring, at least for the female partner, she's typically more confident that she can bond with the child during the pregnancy, sometimes there's a bit of a fear of like, you know, Will I have a different kind of connection with the baby once they see it. And, you know, I often tell people, a lot of those fears tend to take care of themselves once you actually start the process. But, you know, I'll just tie it back. Again, it all is about resolving the grief on the on the front end, as much as you can before you move forward. If if that's been properly addressed, then what we see is that people are just more open to the child, they're actually about to have the bonding process during the pregnancy open to the child once it's born. And so, yeah.
And the first step is also acknowledging that there is grief because I think that so often, unfortunately, infertility treatment, can we call it the escalator, where you come into it, and the next option is simply presented. And you take that step, because it's coming at you as in the escalator. And I, I worry, oftentimes, with gamete donation, that it's the next step, and we don't take the pause. We're actually getting on a different escalator to butcher this analogy here. And so it's important to acknowledge that there is grief that needs to be thought through that you're leaving the escalator, you're on and you're you're trying, you're on a different one now. And I worry sometimes, that the we're not set up for that, because there's always the there's the biological clock, although if you're moving into donor egg, it does take some of the biological clock pressure off. But at this point people have been trying in there for usually, not everyone, but many have been trying for a while, and they're anxious to get started. How do you slow people down? Dr. Sharma, I'm the speed bump. I often know, there you go, you own it, okay.
By the time people see me often, you know, the physicians also recognize something's up with this patient, and they're needing some support. But often will say I mean, fact that we just says, you know, medical process is coming along and into Doctor job to kind of make sure they're looking at what your options are, and educating you. And, you know, we also need to just pause and make sure you're actually keeping up with that journey, too, right? Because there's the human being on that journey. And, and we sometimes just need to get off the train, we need to get off the train station, just take a breath for a bit, and decide when we're ready to get back on. And I do think it's important just that these points where we have other options open up to us to the point where we should pause and say, Okay, this options opened up. Where am I going? Am I ready to start this leg of the journey? Do I need a little bit of a break or not? Because this is I mean, for some people, this is a really long marathon for others. It's quick and fast, you know, so their turn is going to be a little bit different, but absolutely important to pause and ask this question. Everybody on the medical team,
Dr. Leon, from a medical standpoint, a medical professional standpoint, is there a recognition or an end and of that need for many people to pause, to reflect to grieve? And how can we work that into the medical process so that they that this is encouraged?
Yeah, definitely. So I think in the example of the older woman, who, you know, eventually likely won't need egg donation. Some of that is built into the progression of medical treatment already in the sense that you know, unless there kind of like, you know, almost 50 already and you know, I would have never, they would have never attempted IVF with their own eggs to begin with. Most women are in a slightly grayer area, where I may initially counsel them and say, you know, based on your age or egg numbers, I think it's highly unlikely you will be successful with your own eggs. And egg donation is the best course of treatment. However, most women at that point are not ready to jump forward with egg donation, right, because it's a it's a new concept, they need that time for that idea to sink in to go through those stages of grief and processing this. And so part of that processing for a lot of women is actually attempting IVF with their own eggs. And so I think there is actually great benefit, and allowing these women the option to try to conceive with their own eggs. And this is something that, you know, that kind of has a term like doing a closure cycle, a closure IVF cycle. And there are various practitioners that have kind of different opinions about this, some are very against this, some are very foreign, I think I come down on the side that I think there is definitely benefit, not necessarily medically, but from a psychological perspective. Because what I find, why I find it helps is, for example, it's one thing to tell a woman, these are your data points, these are your numbers, you know, this is your likelihood of successful conception. And they may get that in their head. But they may not truly internalize what that means. And for a lot of people who want to hold out hope and be optimistic, they may think I'm going to be that like, less than 1% person, right? Who achieves success. And by allowing them to go through the process of treatment of truly seeing how they do in terms of how many eggs we can get how, you know, the fertilization goes, and and really to be honest, how poorly it goes, it helps them see the real data, that this is not going to work for them. And it can help them work through that process. So I think there's a lot of benefit. Plus it allows them to feel like they did everything they could to make that attempt with their own eggs. And then they tend to not be regretful in the future if they choose to go to a donor egg, because then they can say what gate I gave it my all. And this was the next best option
that makes such good sense giving it at all I've tried. I you know, I this was my choice. It was the only choice. I don't have the regret afterwards of what if, yeah, that makes that makes really good sense to me. Somebody one of our support groups one time was, I think she was 44 and starting this. And she really she said I'm just a lucky person. I always have been I always win at bingo. I remember her saying that. I always want it bingo. I am just a lucky person. And I thought okay, well she she's one of those people who probably really would benefit. And I never found out what happened because I think that the reality became too hard. And, and people were giving her advice that she didn't want, which was that? Yes, you could try. But then there was also a money issue for her and so she was paying for it out of pocket. And anyway, so for all those reasons I never heard but I still remember her saying I always win it bingo. And I thought this is gonna be a hard journey. That so anyway, all right, let us move to talking about some general issues with donor selection and using donor gametes. So let's talk about the starting with the medical. Dr. Liang, what are some of the medical considerations when selecting any type of donor and it makes you do consider an egg bank versus or a sperm bank was a separate law must start with a sperm sperm bank versus a live donor. Often you have somebody in your life who you want to use from a medical consideration standpoint, does it really matter speaking just a sperm then we'll move to egg. Um, medically,
there's probably less consideration. The main one when you talk about using any gametes from someone who you are not in a relationship with is genetics and genetic screening. So having a good understanding of that person's medical history and then also their risk for carrying inherited genetic diseases. And so it's recommended actually that all All gamete donors undergo genetic screening so that the recipient has a good understanding of risk to any future children. But whether that is an an anonymous donor from a bank or a known donor, you know, those requirements and recommendations are similar. The other considerations that lead me to, or I should say lead patients to tend to choose one over the other are more kind of the logistical like one certainly is easier and takes less time than the others.
Everything you just said would apply to both egg or sperm. Is it a standard is genetic screening a standard part of egg and sperm bank?
Yes. Okay. Yes. Although it varies To what degree they are screened.
Alright, so that is something that is a consideration to ask when using a sperm bank. And if using a live donor, someone either you know, or someone you're going to find and someone you find on the internet or whatever, then this is something that patients need to consider on their own and making certain that this is done before, before they utilize those gammie. Correct. All right, excellent. The show you are listening to this show would not happen without the support of our partners. And these are organizations entities that believe in our mission of providing unbiased medically accurate information to the patient community. I want to tell you about two such partners one cryos international sperm and egg bank. They are dedicated to providing a wide selection of high quality extensively screened frozen donor sperm and egg from all races, ethnicities and phenotypes, and they do it for both home insemination as well as fertility treatment. Practice International is the world's largest sperm bank and the first freestanding independent egg bank in the United States are another partner is Reproductive Medicine Associates of New York. They are one of the largest fertility practices in the state of New York and one of the biggest in the country. By combining the latest innovations in reproductive sciences with compassionate and customized treatment plans, RMA of New York is able to provide the very best possible care. So, Dr. Sharma, what some advice you would give intended parents about psychological considerations when selecting a donor. And when we say intended parents, this can be heterosexual couples, it can be LGBTQ plus couples, it can be single women. And so we include all those in your answer from the psychologic. What what they should be considering
what the same thing that Dr. Liang just said, you know, I think psychologically donors should also be screened. I think historically, we've seen egg donors typically have been screened more so than sperm donors, we are now seeing more, you know, everybody being screened more so than in the past, but I often encourage people to just ask, you know, wherever they're getting the donor, so you know, whether it's usually a sperm bank or an you know, egg bank, ask them if that donor underwent a psychological evaluation, you know, I've done many of these and 20 years. And you know, psychological evaluation is really more like a mental health checkup is the way that I describe it, want to make sure that we're looking at any inheritable psychiatric disorders in the family. But also, the other component of it is making sure that the donor has the right kind of mindset to donate. Because the child will have a connection with this person down the road, we want to make sure that, you know, the motivation for the donation is looked at that is not that they're not donating out of desperation, you know, for money or something like that, but they're really getting something out of it. And that they have really the mindset that a blood donor might have that, you know, here I am giving you just donation, and I don't need anything in return. You know, it's really a gift. And so it's very, very important, I think, to look at whether they've been psychologically screened as well.
In the psychological screening part, how do we deal with the fact now? Or how do you deal with the fact now, that anonymous donation, the ability how it used to be that no one is going to know, is really a thing of the past? Or perhaps I should ask, do you agree that it is a thing of the past? I'll start with you, Dr. Sharma.
Yes, absolutely. In fact, I say, you know, anonymous donation really doesn't exist anymore. For you look as to what, you know, all the genetic testing was going on 23andme ancestry.com. People are finding all sorts of genetic relatives, they never knew existed. And then, you know, we have age progression software, we have, you know, facial recognition software, we have all this social media. So it's very hard to hide in the modern world. And then, you know, even from a legal standpoint, you know, we're moving towards more openness. So I even when I screen donors, I tell ones that are signing up for anonymous that, you know, you may not be anonymous. And are you okay with that? Because that is the realities of the world that we all live in now,
do medical providers or mental health professionals talk with patients about it, because patients have to make the choice also, about whether they're going to use an anonymous donor versus an identified donor or an open donor. Different banks call it different things. And different banks have different requirements associated with it. But generally, it's when the child has access to identifying information at a certain age, and then the family has access to identifying information for medical reasons. They're just different criteria that go. Dr. Liang, is that something that infertility doctors and nurses discuss with patients? Or is it something Do you think that's something that they should be discussing with patients?
Yeah, in my practice, you know, I do bring it up a little bit to a degree when I talk to them about the various ways they can obtain donor gametes, and the sense of anonymous or what is we're trying to move to the non identified terminology, non identified donor versus a known donor
or an identified donor. So you may not know them, they may just have agreed to be have their information shared at a certain age,
correct. But all of our patients actually are required to meet with a social worker if they use third party gametes. So for our patients, I allow the social worker to have that full breadth of conversation with them. Because to be honest, I think they're better trained to do that than then I or the nurse.
So Dr. Sharma, you are a psychologist, but but also one that is, is is advising patients on their choices. How do you advise patients on the decision of how they choose the ability to have information, contact information, or release name information about donors? Well, I'm
pretty direct in saying that if we're looking from the perspective of being a parent of a child donor conceived, that if they want their child to have the option to potentially know who that donor is, and potentially find out more, once a child turns 18, that really then they opened donor option is open ID option is really more what I would encourage. And you know, and I cashed that in the context of this larger discussions, just how this is the direction we're moving anyway. So even if you have anonymous donor at this point, there's no guarantee that status will remain. So you know, I really tried to tie it in with conversations about talking about the child down the road and how that that's related.
Well, and there's, we also have a long history of research on genetic genetic parenting, to know that through adoption, to know that adoptees having that ability, they're not looking necessarily for a parent, but having the ability to know their genetic history to know they're who they look like it have that information. It may be different from an adoptee from a donor conceived child but but there is such strong evidence in the adoption world and we're getting that evidence now in the sibling in the while the sibling registry, but the the donor can conceive to person community as well. So that's, it's something before I want to talk about telling the child but before we do that I wanted to touch on whether using known are dirt, friends, relatives, directed don't where you know, the person, it's your cousin, or it's, you know, it's your best friend, or whatever that you're using. Dr. Sharma, any thoughts on the psychological issues associated with are things that you need to at least think through if you're using someone who is known to you, and will be in the child's life potentially,
right, that that piece right there will be in the child's life potentially, you know, I think for someone, especially in the family to donate, we really need a very high level of maturity in that individual, but also, once again, a donor mindset that they don't really see this as their child. You know, they see they donated, you know, the eggs or whatever, but, but their mindset, it really is that they're helping their family member or friend to actually conceive their child. And so that's an important distinction. So when we do screenings for Mellon donors, we're looking at also what's what, what are the implications that you know, for how they're going to coexist in the family, you know, and especially with the child being in the mix? It's very important to look at how everyone's proceeding that
I briefly tell us your opinion on telling the child I know that is an issue that many people have to work through. Dr. Sharma.
I think you should be open um, unless you have, there's two situations where you might not want to see, you know, what I mentioned earlier, there's a cultural issue of the child being ostracized and to if the child has some sort of cognitive issue where they couldn't comprehend. But outside of that, you know, I, I come from the standpoint the child has a right to know who they are, I also think it's impossible to hide that, you know, at this point, given how medicine is even progressing, we're using more and more genetic testing in our treatments. And so that's typically what I encourage people to do, ultimately, it's the parents decision. And I also make that clear, and that there's a process there of getting comfortable with that option of being open. And I do connect it to adoption, you know, we have lots and lots of data on how children benefit, because it's really, you know, knowing more about themselves is really about their own identity. It's not about whether you're my mom or my dad.
And I will tell you having interviewed donor conceived people. Universally, what I heard was, they didn't care so much about the donor conception, that wasn't the issue. But when, and the people I was interviewing had not been told, the lie that that mattered. And that caused a for many of the people back for the panel, I was interviewing for every one of them. It caused a significant rift. And it was not the fact that they were conceived by donor, quite frankly, none of them really cared about that they did care about the fact that the and the not telling doesn't get you I mean, that's the fact that it's not a direct lie, doesn't get you off the hook. Because it's all the omissions that throughout their years. Anyway, so I will I will throw that out there. And our remaining time, let's talk briefly about embryo donation. When Should this option be considered Dr. Lyon from a patient's standpoint, medically I mean,
so to be honest, I don't really bring up embryo donation all that much with patients. And in particular, it's, it's because it's very, very rare to actually even be able to get embryos, donated embryos, it's not as prevalent in terms of the sources of embryos as getting donor eggs or donor sperm. And so often, I will mention it as a possibility, especially more from the other end, when patients are asking, Well, what should I do with my remaining embryos that I don't want? Well, you one option is you can donate it, but But right now, what I currently see as the issue with embryo donation is that we often don't know kind of the provenance of these donated embryos, like where like, where did they come from? And what situation where they created? What is the quality of these embryos, and they come from various locations and different laboratories in the United States. And, you know, what kind of testing have these, the biological parents of this embryo what has been done because they're often they often come from couples who have done fertility treatment versus like one being already a donor a gamete. So it's not most of them have not undergone the same rigorous level of testing as if you go to an egg bank or sperm bank, and obtain gametes that way. So I really think it's kind of a last resort option. For patients who one maybe financially cannot afford the idea of paying for egg donation is especially sperm donation is less of an issue because it's a lot cheaper. But the financial consideration or the other instances where I've seen it happen is they actually know a specific person who has told them I have embryos, I would like to donate specifically to you. And then that's a situation actually that they've worked out already, you know, with just me facilitating the medical side of it.
Any doctor Sharma briefly, any additional psychological issues that are unique to the embryo donation space, we certainly both parents are not genetically connected. So that certainly one of them any thoughts from the psychological that might be different that we need to bring up? Dr. Sharma.
I think in this situation, whether someone's receiving donated embryos, often, I see couples really thinking of it as adoption, but they're controlling prenatal factors, because this child actually will typically have, you know, full siblings somewhere in the world. And so it's psychologically a little bit different. And that, you know, there are really, there's a family out there and then some of the places that people get donate embryos, some actually put them through a process of as if they are adopting, right. And that can be a little bit controversial. We'll get into that right now. But, you know, I often see people who are receiving embryos within a clinic and a clinic may have a program for their patients. And so, you know, like Dr. Lee am sad often is because finances are limited and this is an option that is available to them.
All right, well thank you so much Dr. Angela Leung and Dr. Poonam Sharma for being with us today to talk about gamete donation when to consider and how to discuss with patients. I truly appreciate your time
Transcribed by https://otter.ai