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Your Questions Answered on Donor Conception and IVF

Republished from The Conversation Your questions answered on donor conception and IVF August 11, 2015 6.12am AEST

Please note these answers may be specific to existing Australian conditions.

Authors

Thanks to IVF and donor conception, infertile couples, single women and lesbian couples now have a better chance of starting families. But while you might know someone who has gone through the process, it’s rarely openly discussed.

Last month, you submitted your questions about donor conception and IVF and we put them – and some of our own – to The Conversation’s experts in law, embryology, sociology, psychology and donor conception. Here are your questions answered (scroll down or click on the links below):

Questions

How much are men compensated for donating sperm and women for donating eggs?
Where do donors come from?
What sort of identifying information is filed about open donors on the information register?
When and how should you tell children they’re donor-conceived?
What kind of contact can donors expect when their offspring are adults?
What are the options for gay men to start a family?
What logistical barriers do lesbian couples face when starting a family?
Who goes on the birth certificate when using a sperm or egg donor? And what about if the couple is same-sex?
How much does IVF cost?
What are the success rates for IVF?
11. Is sex selection legal in Australia? Should it be?
12. How long can donor eggs and sperm stay in the freezer?
13. How difficult is it to obtain information about overseas donors/surrogates?
14. How are donor eggs and sperm transported interstate and overseas?
15. What barriers do donor-conceived people face in obtaining information about their biological mother or father?
16. Can donor-conceived people access information about their donor if they were conceived before anonymity was abolished?
17. Will using donor eggs from a younger woman increase my chances?
18. What motivates men to donate sperm, and women to donate eggs?
19. Why do I need ICSI (sperm injections) if I use donor sperm?

Q1. How much are men compensated for donating sperm and women for donating eggs?

A. Deborah Dempsey, sociologist:

In Australia, human eggs and sperm cannot be treated as goods that are bought or sold. It’s permissible to pay egg and sperm donors “reasonable expenses” (such as travel and parking) and medical costs incurred in the process of making their donation. Although the actual sum paid varies, for sperm donors it is generally around A$250 per donation.

For egg donors, it is substantially more as it’s a much more invasive medical procedure. Women are required to self-inject drugs for several days to hyper-stimulate their ovaries and need to be monitored to ensure there are no serious side effects. Eggs must be extracted by a medical practitioner, and this usually requires an anaesthetic and a half-day stay in hospital.

If there is too great a financial gain attached to providing eggs and sperm, one concern is that people will be motivated by money rather than a desire to help infertile men or women, and this could cause harm. Potential donors, for instance, may be more likely to conceal a health condition that could be passed on to intended parents or children because they wanted to receive the fee.

The issue of compensation is currently a hot topic due to a national shortage of both egg and sperm donors in Australia. In April, one group of fertility clinics made headlines for offering A$5,000 payments to cover egg donors’ expenses. Debate centred around whether this flat fee could be considered an “inducement” to participate, just as it did several years ago when a different clinic offered A$7,000 to Canadian students willing to come to Australia for a working holiday and to donate sperm.

I agree with a number of other scholars who argue it’s time we looked seriously at whether the principle of “reasonable expenses” is useful in taking into account the actual risks, costs and inconveniences incurred by egg and sperm donors, and the interests of children born from such donation.

Q2. Where do donors come from?

A. Loretta Houlahan, embryology lecturer:

Clinic-recruited donation is probably the most well-known method of donation.

Because of the critical shortage of donor eggs and sperm in Australia, some clinics are now recruiting from overseas. This is generally permitted if it complies with local laws.

Patients can also ask someone they know to donate to them. This is commonly a friend or family member, however, some people may find their donor through online forums as well. Advertising online is subject to many legal restrictions, so be careful if you go down this route.

Sperm donation can also occur outside the clinic environment. Private insemination with donor sperm is not necessarily illegal, but potential medical and legal issues can arise from these arrangements. Unlike clinic-recruited donors, private donors are not screened for infectious diseases and donors often advertise online without their true identities being confirmed.

There are also no restrictions on the number of children that can be fathered from a single donor in a private donation scenario. One Sydney “freelance sperm donor” claims to have fathered 18 children. In contrast, clinic-recruited donors are only allowed to produce a limited number of families. They can also be removed from use if abnormalities are detected in the offspring.

There are pros and cons to both clinic and private donation, however, patients should seek medical and legal advice if they choose the latter.

Q3. What sort of identifying information is filed about open donors on the information register?

A. Fiona Kelly, legal scholar:

Under Australian guidelines, all donors in Australia are required to be “open donors”. Anonymous donors ceased to be available across the country in 2005, though some states abolished anonymity earlier.

The guidelines require fertility clinics in Australia to collect the following information from sperm and egg donors:

name, any previous name, date of birth and most recent address
details of medical history, family history, and any genetic test results that are relevant to the future health of the person conceived by egg or sperm donation (or any subsequent offspring of that person) or the recipient of the donation
details of physical characteristics.

Clinics are also obliged to tell egg and sperm donors that it is their ethical responsibility to keep the clinic informed about any changes to their health that may be relevant to the persons born or the recipients of their donation, and about changes to their contact details.

Clinics are not required to proactively gather additional health information or change of address details. So it’s possible that the information a donor-conceived person receives when they turn 18 is not up to date.

In some states and territories, such as Victoria and New South Wales, donor information is held in a central register, while other states and territories require the clinics to maintain the data.

Q4. When and how should you tell children they’re donor-conceived?

A. Damian Adams, donor conception researcher:

Discovering you’re donor-conceived later in life can potentially lead to confusion, anger and distrust of the family members who kept the secret from you.

Some researchers argue that telling children earlier in life causes less harm. Associate Professor Ken Daniels, a sociological researcher into donor conception, writes that “a child should never be able to remember a time when he/she did not know”. Others suggest it should at least occur before the identity construct window of adolescence occurs.

As there is currently no evidence that more problems arise by telling early, doing so while young has the least potential to create problems.

There are numerous books on the market that can assist parents in how to tell, as well as numerous online resources. One of the better ones is run by the Victorian Assisted Reproductive Treatment Authority (VARTA) which has been running very successful “Time to Tell” campaigns for many years and has numerous informative pages on their website dealing with this.

Q5. What kind of contact can donors expect when their offspring are adults?

A. Roger Cook, psychology scholar:

When offspring reach adulthood it’s possible for them to initiate contact with their donor, the outcome of which is varied. Some offspring reach strong relationships with their donor parent and some do not. There are, of course, some offspring who do not want to make contact.

Typically, however, if both the donor and the offspring are enthusiastic and prepared for contact, an on-going relationship can emerge but it’s not usually a parenting relationship. Often, the young adult can develop and maintain positive relationships with his or her biological father or mother but retain affection for the parents who raised them.

Q6. What are the options for gay men to start a family?

A. Deborah Dempsey, sociologist:

Australian gay men’s pathways to creating families with children are diverse, although relatively limited compared to men in the United States.

Australian gay men’s history of involvement in known sperm donation for lesbian and single heterosexual friends and acquaintances dates from at least the 1980s. Some men are able to negotiate “donor dad” or parental relationships with children conceived in this way.

Since the early 2000s, it has become popular for Australian gay men to form families through surrogacy, particularly commercial surrogacy arrangements abroad.

For gay men who are US residents, adoption is a well-documented path to parenthood. Though laws in some Australian states do not permit gay men or lesbians to adopt. And relatively few children are available for adoption in Australia.

La Trobe University researcher Jennifer Power and her colleagues investigated family make up in the 2012 Work, Love and Play study. Of the 88 gay and bisexual men who described themselves as “actively involved” in parenting a child:

39% had become parents in a previous heterosexual relationship
23% were parenting children conceived through surrogacy
19% had become parents through known sperm donation to lesbian couples or single women
11% were foster parents or permanent carers.

Q7. What logistical barriers do lesbian couples face when starting a family?

A. Deborah Dempsey, sociologist:

Lesbian couples using clinical donor insemination, known donor insemination or IVF to form families with children must navigate a complex range of logistical, social and emotional issues.

Finding a suitable known donor can be difficult because of the need for compatible expectations about parenthood. Men may want more or less involvement than the lesbian parents feel comfortable with; they may feel awkward or uncertain about the responsibilities attached to giving sperm; or their partners may not approve of the idea.

For some lesbian couples, deciding who will become pregnant and whose eggs will be used will be straightforward and for others, it will be emotionally difficult. It really depends on how the women view the issue of being genetically related to the child, and their feelings about how important it is to become pregnant and give birth.

In some US states, a procedure called “reciprocal IVF” is offered so both women can have a biological relationship to the child. One woman provides the egg, while the other becomes pregnant and gives birth. However this procedure is currently only possible in Australia if the couple has fertility problems.

Q8. Who goes on the birth certificate when using a sperm or egg donor? And what about if the couple is same-sex?

A. Fiona Kelly, legal scholar:

Where a couple or single woman has used assisted reproduction (ART) to conceive, the donor is not named on the birth certificate. Rather, the recipient parent(s), who are the legal parents of the child, are named, provided they were married or in a de facto relationship at the time of conception.

In all states and territories, the woman who gives birth to a child born as a result of ART is the “mother” of that child. When a married woman or a woman in a de facto relationship with a man becomes pregnant as a result of assisted reproduction her partner is presumed to be the father, provided he consented to the procedure.

All Australian jurisdictions also presume the same-sex partner of a birth mother who has used ART to conceive is a legal parent of a child born. In other words, same sex couples and opposite sex couples are treated identically.

The language that is used on birth certificates may vary. For example, in Western Australia, the partners may register as “mother” and “parent”; “mother” and “mother”; or “parent” and “parent”. In the ACT, a person may be registered as “mother”, “father” or “parent”.

Several states make a notation on the child’s birth certificate, indicating that further information is available about the child’s birth. The notation ensures the child can determine that he or she is donor conceived, particularly in the event of the child not having been informed by their parents of the nature of their conception.

Q9. How much does IVF cost?

A. Loretta Houlahan, embryology lecturer:

Back in 1987, the cost of IVF treatment was about A$3,500 to A$4,500 and the pregnancy rate was around 40-50% after three attempts. At the time, Professor Carl Wood, one of the pioneers of Australian fertility treatment, said:

as the test-tube procedure has been developed only recently, it is reasonable to assume that with further improvements the cost may be reduced and the success rate increased.

Arguably, the reverse has occurred with live birth rates reported to be as low as 4% at one IVF clinic. Further, despite a large proportion of IVF now being subsided by Medicare, the going rate for a fresh IVF cycle is around A$10,000, with out-of-pocket expenses commonly over A$4,000 before private health insurance rebates.

Using donor sperm or eggs costs more again, with clinic-recruited donor sperm usually costing around A$1,000 per treatment. Although, actually paying a donor for their eggs or sperm remains illegal.

Q10. What are the success rates for IVF?

A. Loretta Houlahan, embryology lecturer:

Fitness guru Michelle Bridges recently caused a stir when she suggested her ability to conceive naturally at 44 was because of her and her partner’s healthy lifestyle.

While lifestyle factors such a smoking and weight will play a role, the biggest contributing factor to infertility is the woman’s age. So while Michelle Bridges’ 12-week body challenge may reduce your body mass index, drinking protein shakes and running on the treadmill cannot turn back the clock.

The highest success rates are reported in women under 30 who have an around a 26% change of a having a baby with IVF. Women over 40 have around a 6% chance, and as for women 44 or older such as Michelle, the chances of going home with a baby is less than 1%. Michelle was lucky. Most women her age would need donor eggs.

There is also a wide discrepancy between the success rates of IVF providers. The last report showed overall results ranged from 4% and one clinic to 30.9% at another.

There is also evidence to suggest having a younger male partner may improve IVF outcomes in women. This doesn’t necessarily mean women should go out looking for a young male sperm donor, it just shows there are many factors at play, many of which are out of patients’ control.

Q11. Is sex selection legal in Australia? Should it be?

A. Deborah Dempsey, sociologist:

Sex selection using assisted reproductive technology is only legal in Australia to reduce the risk of transmission of a serious genetic conditions, such as duchenne muscular dystrophy.

Sex selection of embryos created through IVF is done using a technique called pre-implantation genetic diagnosis (PGD). This technique enables the removal of one or more cells from an embryo so it can be tested for genetic abnormalities prior to implantation.

Clinics providing PGD must be accredited by the Fertility Society of Australia, which requires them to comply with National Health and Medical Research Council ethical guidelines.

Some Australians would like to use PGD for “family balancing” reasons. Australians often consider it ideal to have at least “one of each” in their family, although in many parts of the world there is a cultural preference for sons. Australians are known to travel overseas to obtain sex selection services in countries where clinicians will perform PGD for non-medical reasons.

While I understand that some parents have a very strong desire to have children of both sexes, my personal view is the practice is undesirable and discriminatory. If we take the “family balancing” idea seriously enough to legally facilitate it, we are perpetuating the view that boys and girls are so different from each other that families with children of one sex are “unbalanced” and somehow deficient.

There would also be no impediment to using the procedure to support more extreme forms of gender discrimination, for example, in cases where families favour having sons.

Q12. How long can donor eggs and sperm stay in the freezer?

A. Loretta Houlahan, embryology lecturer:

Donor eggs and sperm are often frozen before they’re given to recipients. This allows donors to be tested for infectious diseases and genetic abnormalities, transported interstate or overseas, if needed, and to be readily available for patients who need them.

Some people express concerns about the survival rates of donor eggs or sperm that were frozen many years ago. But as long as they’re stored correctly, there is no biological limit on the amount of time eggs or sperm can remain in frozen. Just like Elsa in the movie Frozen, the cold never bothered them anyway, and staying frozen doesn’t reduce their thaw survival rates.

The main problem with eggs and sperm that were frozen many years ago is that the older freezing methods were not as good as the new ones. Eggs frozen using the now-outdated “slow frozen” method have poorer survival rates than those that have been vitrified (“snap frozen”).

There is also limited information about the success of egg freezing in general. So while we know eggs can survive the thaw process, we don’t know the how many babies are being born from this process.

Sperm isn’t usually vitrified like eggs are, but advances in sperm freezing technology have also improved success rates over time.

So, to sum it up, donor eggs and sperm can theoretically remain frozen indefinitely – although there are legal restrictions on this.

Q13. How difficult is it to obtain information about overseas donors/surrogates?

A. Damian Adams, donor conception researcher:

Australian clinics are mandated to follow National Health and Medical Research Council’s guidelines which stipulate that all donor-conceived people (since the guidelines came into effect in 2005) are entitled to know identifying information on the donor once they reach 18 years of age. Subsequently, if clinics are sourcing eggs or sperm from overseas, the information available must meet our guidelines.

We are yet to see whether any donor-conceived people have trouble accessing this information as those conceived under these guidelines as they’re yet to turn 18. Those conceived prior to this will be at the mercy of whatever agreement the Australian clinic and the overseas clinic had in the supply of those gametes and associated information. The donor-conceived are then also reliant on a foreign business maintaining and looking after those records.

Anecdotal evidence from older donor-conceived people overseas does not paint a rosy picture of possible outcomes from seeking information, although it is hoped that their practices have also changed for the better as has been the case in Australia.

Q14. How are donor eggs and sperm transported interstate and overseas?

A. Loretta Houlahan, embryology lecturer:

After eggs and sperm are frozen, they need to be kept in liquid nitrogen, which is about minus 196 degrees Celsius. This can make transportation tricky, as liquid nitrogen is really dangerous, and if it was to leak it could easily kill the courier or the any one else around at the time.

Luckily, scientists have come up with a special device called a “dry shipper” which allows frozen embryos, eggs and sperm to be transported safely while keeping everyone safe. Dry shippers absorb the liquid nitrogen in the walls so it doesn’t leak, but it still keeps everything cold.

Very occasionally, this process can fail, but most transportation occurs successfully without any damage to patient material.

Q15. What barriers do donor-conceived people face in obtaining information about their biological mother or father?

A. Damian Adams, donor conception researcher:

This is highly dependent on when the person was born and which state they were born in. Those conceived from 2005 onwards around Australia, and 1998 onwards in Victoria, are entitled to access identifying information. Prior to those dates, donations were primarily anonymous.

For those conceived under anonymous conditions there are, however, voluntary registers in Victoria, Western Australia and New South Wales which offspring can put their details on in the hope that the donor will also place their details on the register. If the donor is not on the register – or if they were conceived in another state – the offspring will be reliant on assistance from the clinic.

Research my colleagues and I published in 2012 on accessing information in Australia showed some people found dealing with the clinics quite difficult (others have found them helpful), and if information was available that there was no national consistency on what information was recorded.

In some instances, records had been destroyed or redacted. We have also seen instances of registers failing to match people who were later matched through DNA testing.

So, some younger offspring may find it easy, while older offspring may find it difficult or even impossible.

Q16. Can donor-conceived people access information about their donor if they were conceived before anonymity was abolished?

A. Fiona Kelly, legal scholar:

The only state in which donor records have been opened retrospectively is Victoria. As of June 2015, all donor-conceived people who were conceived in Victoria may apply for access to their donor’s identifying information, with the donor’s consent.

In other states, there is no right of retrospective access. However, in a number of states, such as NSW and WA, donor-conceived people may place their names on a voluntary registry. If both the donor-conceived person and the donor register, access is permitted by mutual consent.

Q17. Will using donor eggs from a younger woman increase my chances?

A. Loretta Houlahan, embryology lecturer:

Women over 40 are the main recipients of donor eggs. Using donor eggs from a younger woman significantly increases the chances of success.

However, using donor eggs doesn’t eliminate all complications. Women who use donated eggs have a higher risk of developing serious complications, specifically high blood pressure and pre-eclampsia. Although it was thought these dangers may have been linked to the age of the birth mother and not the egg donor, the real reason remains unknown.

There is also a difference between fresh and frozen eggs to consider. Fresh is best because the success rate with thawed eggs remains unclear. However, this option is not always available where donor eggs are involved. Until only recently, egg freezing was considered experimental so we are still learning a lot about this process.

Q18. What motivates men to donate sperm, and women to donate eggs?

A. Roger Cook, psychology scholar:

Both sexes are motivated, at least in part, by a sense of altruism.

In the past, some men were enticed to donate by payments, albeit very low amounts. This became less common through the 1980s and now some clinics provide some reimbursement but no inducement payments. The Human Tissue Act of 1982 prohibits commercial profiting from semen donation. Financial reward is not a current motivation.

The motivation for men to donate sperm changed somewhat after laws were introduced prohibiting anonymous donation. Donors must now be prepared to be identified and allow contact with their donor children. This has reduced the number of men donating, as the necessity of identification is incompatible with their sense of privacy.

Another motivation for some men is a desire to be biological fathers, particularly when they’re unlikely to form a parenting relationship with a woman.

Women are usually more reluctant than men to give away their DNA, except when they have had their own experience of IVF. This is likely related to the significance of pregnancy and child birth experience, which men experience in a different way.

Women who donate their eggs are have been through infertility treatments such as IVF, and therefore have some understanding of the distress that follows such circumstances. Their motivation is to help other women who are not able to produce their own viable eggs.

Q19. Why do I need ICSI (sperm injections) if I use donor sperm?

A. Loretta Houlahan, embryology lecturer:

A common source of confusion for patients is why they need to use intra-cytoplasmic sperm injection (ICSI) when using donor sperm. ICSI is usually preserved for treatment where the male partner has a low sperm count and costs a lot more than a standard IVF treatment.

The main reason ICSI is used is because of the critical shortage of donor sperm. To enable supply to meet demand, the donor sperm sample may be diluted. This way it can be used in more patient treatments. The downside to this is that because diluted samples contain such a low volume of sperm, ICSI is required for the insemination procedure.

ICSI is also required to inseminate frozen-thawed eggs. In order to freeze eggs, the “cumulus cells” that surround them need to be removed. In natural conception, as well as standard IVF, the cumulus cells act like a maze and the sperm are required find their way through these cells to get to the egg.

It also acts like a barrier to limit the number of sperm that reach the end point. Without the cumulus cells in-tact, the risk of more than one sperm fertilising the egg is too high, so ICSI is used to avoid an abnormal fertilisation. With ICSI, the embryologist can ensure only one sperm enters the egg.

About the Authors

Damian Adams is PhD candidate at Flinders University.
Deborah Dempsey is Senior Lecturer - Sociology at Swinburne University of Technology.
Fiona Kelly is Senior Lecturer in Law at La Trobe University.
Loretta Houlahan is Casual Lecturer, Master of Clinical Embryology, Department of Obstetrics and Gynaecology at Monash University.
Roger Cook is Associate Professor; Director, Psychology Clinic at Swinburne University of Technology.

This article was originally published on The Conversation. Read the original article.

Cite this page: Hill, M.A. (2024, April 23) Embryology In Vitro Fertilization. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/In_Vitro_Fertilization

What Links Here?

@@ Line 1: / Line 1: @@
 #REDIRECT [[Assisted_Reproductive_Technology]]
-==Introduction==
+==Your Questions Answered on Donor Conception and IVF==
-[[File:IVF-Louise Brown.jpg|thumb|Louise Brown, the first IVF baby as an adult.]]
+Republished from [http://theconversation.com '''The Conversation'''] [http://theconversation.com/your-questions-answered-on-donor-conception-and-ivf-45715 Your questions answered on donor conception and IVF] August 11, 2015 6.12am AEST
-In vitro fertilization covers the aided fertilization process, in contrast with in vivo fertilization which is the normal uterine occuring fertilization process. The first successful IVF was carried out in the UK in 1978 by Edwards RG, et al.<ref name="PMID6775685"><pubmed>6775685</pubmed></ref>, receiver of the 2010 Nobel Prize in Medicine. The now many different reproductive options are know as '''[[Assisted Reproductive Technology|Assisted Reproductive Technologies]]''' (ART) and this technique continues to grow worldwide with development of new medical technologies.
-The Latin, ''In vitro'' = "in glass" meaning in essence a test tube as apposed to ''in vivo'' (in life or a living body). Note that even in vivo fertilization can also now be assisted through some fertility drug treatments. Both processes have the same biological outcome, fusion of male and female gametes to form a diploid zygote.
+Please note these answers may be specific to existing Australian conditions.
-In Australia, the first successful IVF occurred in 1980.<ref name="PMID7353686"><pubmed>7353686</pubmed></ref> and during 2005 1,596 IVF babies were born. In the same year in Australia and New Zealand 51,017 treatment cycles were reported, an increase of 13.7% of ART treatment cycles from 2004. In all countries using Assisted Reproductive Technologies (ART), pregnancy rates vary for the different methods of treatment and also between individual IVF or GIFT units. In Australia best clinical pregnancy rate (per 100 oocyte retrieval cycles) by most successful 25% of all clinics increased from 24.9% (1998) to 34.4% (2001) (NPSU data - ART 2002 report)
+===Authors===
+* [http://heconversation.com/profiles/damian-adams-181102 Damian Adams] [http://heconversation.com/institutions/flinders-university Flinders University]
+* [http://heconversation.com/profiles/deborah-dempsey-178116 Deborah Dempsey] [http://heconversation.com/institutions/swinburne-university-of-technology Swinburne University of Technology]
+* [http://heconversation.com/profiles/fiona-kelly-154513 Fiona Kelly] [http://heconversation.com/institutions/la-trobe-university La Trobe University]
+* [http://heconversation.com/profiles/loretta-houlahan-173190 Loretta Houlahan] [http://heconversation.com/institutions/monash-university Monash University]
+* [http://heconversation.com/profiles/roger-cook-180930 Roger Cook] [http://heconversation.com/institutions/swinburne-university-of-technology Swinburne University of Technology]
-:{{Template:Fertilization Links}}
+Thanks to IVF and donor conception, infertile couples, single women and lesbian couples now have a better chance of starting families. But while you might know someone who has gone through the process, it’s rarely openly discussed.
-{| class="wikitable collapsible collapsed"
+Last month, you submitted your questions about donor conception and IVF and we put them – and some of our own – to The Conversation’s experts in law, embryology, sociology, psychology and donor conception. Here are your questions answered (scroll down or click on the links below):
-! Author Comments
-|-
-| [[File:Mark_Hill_icon.jpg|50px]]
-| Please not this is an Embryology educational site and does not provide any specific clinical or therapeutic information.
-|}
-==Some Recent Findings==
+===Questions===
-[[File:Intracytoplasmic_sperm_insemination.jpg|thumb|Intracytoplasmic sperm insemination]]
+# [[#Q1. How much are men compensated for donating sperm and women for donating eggs?|How much are men compensated for donating sperm and women for donating eggs?]]
-{|
+# [[#Q2. Where do donors come from?|Where do donors come from?]]
-|-bgcolor="F5FAFF"
+# [[#Q3. What sort of identifying information is filed about open donors on the information register?|What sort of identifying information is filed about open donors on the information register?]]
-|
+# [[#Q4. When and how should you tell children they’re donor-conceived?|When and how should you tell children they’re donor-conceived?]]
-* '''The Nobel Prize in Physiology or Medicine 2010 was awarded to Robert G. Edwards "for the development of in vitro fertilization".''' <ref name="PMID6775685" /> [http://nobelprize.org/nobel_prizes/medicine/laureates/2010/ Nobel Prize 2010]
+# [[#Q5. What kind of contact can donors expect when their offspring are adults?|What kind of contact can donors expect when their offspring are adults?]]
+# [[#Q6. What are the options for gay men to start a family?|What are the options for gay men to start a family?]]
+# [[#Q7. What logistical barriers do lesbian couples face when starting a family?|What logistical barriers do lesbian couples face when starting a family?]]
+# [[#Q8. Who goes on the birth certificate when using a sperm or egg donor? And what about if the couple is same-sex?|Who goes on the birth certificate when using a sperm or egg donor? And what about if the couple is same-sex?]]
+# [[#Q9. How much does IVF cost?|How much does IVF cost?]]
+# [[#Q10. What are the success rates for IVF?|What are the success rates for IVF?]]
+# [[#Q11. Is sex selection legal in Australia? Should it be?|11. Is sex selection legal in Australia? Should it be?]]
+# [[#Q12. How long can donor eggs and sperm stay in the freezer?|12. How long can donor eggs and sperm stay in the freezer?]]
+# [[#Q13. How difficult is it to obtain information about overseas donors/surrogates?|13. How difficult is it to obtain information about overseas donors/surrogates?]]
+# [[#Q14. How are donor eggs and sperm transported interstate and overseas?|14. How are donor eggs and sperm transported interstate and overseas?]]
+# [[#Q15. What barriers do donor-conceived people face in obtaining information about their biological mother or father?|15. What barriers do donor-conceived people face in obtaining information about their biological mother or father?]]
+# [[#Q16. Can donor-conceived people access information about their donor if they were conceived before anonymity was abolished?|16. Can donor-conceived people access information about their donor if they were conceived before anonymity was abolished?]]
+# [[#Q17. Will using donor eggs from a younger woman increase my chances?|17. Will using donor eggs from a younger woman increase my chances?]]
+# [[#Q18. What motivates men to donate sperm, and women to donate eggs?|18. What motivates men to donate sperm, and women to donate eggs?]]
+# [[#Q19. Why do I need ICSI (sperm injections) if I use donor sperm?|19. Why do I need ICSI (sperm injections) if I use donor sperm?]]
-* '''Use of zona pellucida-bound sperm for intracytoplasmic sperm injection produces higher embryo quality and implantation than conventional intracytoplasmic sperm injection'''<ref><pubmed>20971463</pubmed></ref> "The proportion of high-quality embryos (grades 1 and 2) and implantation rate were significantly higher in the test group than in the control group, but the difference in fetal heart pregnancy rate was not significant despite seven more pregnancies being obtained in the test group (26 pregnancies) versus the control group (19 pregnancies) following fresh embryo transfers."
+==Q1. How much are men compensated for donating sperm and women for donating eggs?==
+'''A. Deborah Dempsey, sociologist:'''
-* '''Assisted Reproductive Technologies (ART) With Baboons'''<ref><pubmed>20631291</pubmed></ref> A Nonhuman Primate Model for ART and Reproductive Sciences "The first ART baboons produced by ICSI, a pair of male twins, were delivered naturally at 165 days postgestation. Genetic testing of these twins confirmed their ART parental origins and demonstrated that they are unrelated fraternal twins not identicals."
+In Australia, human eggs and sperm cannot be treated as goods that are bought or sold. It’s permissible to pay egg and sperm donors “reasonable expenses” (such as travel and parking) and medical costs incurred in the process of making their donation. Although the actual sum paid varies, for sperm donors it is generally around A$250 per donation.
-* '''Trends in delivery and neonatal outcome after in vitro fertilization in Sweden: data for 25 years.'''<ref><pubmed>20139431</pubmed></ref> "The decrease in unwanted outcomes can, to a large extent, be explained by the reduced rate of multiple births but was seen also among singletons. Other explanations can be sought in changes in the characteristics of patients undergoing IVF."
-|}
+For egg donors, it is substantially more as it’s a much more invasive medical procedure. Women are required to self-inject drugs for several days to hyper-stimulate their ovaries and need to be monitored to ensure there are no serious side effects. Eggs must be extracted by a medical practitioner, and this usually requires an anaesthetic and a half-day stay in hospital.
-==18 Ways to Make a Baby==
+If there is too great a financial gain attached to providing eggs and sperm, one concern is that people will be motivated by money rather than a desire to help infertile men or women, and this could cause harm. Potential donors, for instance, may be more likely to conceal a health condition that could be passed on to intended parents or children because they wanted to receive the fee.
-[[File:USA_assisted_reproductive_technology_1996.jpg|right|400px]]
-# Natural sex
-# Artificial insemination - of mother with father's sperm
-# Artificial insemination - of mother with donor sperm
-# Artificial insemination - with egg and sperm donors, using surrogate mother
-# In vitro fertilization (IVF) - using egg and sperm of parents
-#  IVF - with Intra-Cytoplasmic Sperm Injection (ICSI)
-#  IVF - with frozen embryos
-#  IVF - with Preimplantation Genetic Diagnosis (PGD)
-#  IVF - with egg donor
-#  IVF - with sperm donor
-#  IVF - with egg and sperm donor
-#  IVF - with surrogate using parents' egg and sperm
-#  IVF - with surrogate and egg donor
-#  IVF - with surrogate and sperm donor
-#  IVF - with surrogate using her egg, sperm from baby's father
-# IVF - with surrogate using egg and sperm donors*
-# Cytoplasmic transfer**
-# Nuclear transfer and cloning
-==First IVF Baby==
+The issue of compensation is currently a hot topic due to a national shortage of both egg and sperm donors in Australia. In April, one group of fertility clinics [http://www.smh.com.au/national/egg-donor-money-fertility-clinic-offers-women-5000-20150411-1miw9h.html made headlines] for offering A$5,000 payments to cover egg donors’ expenses. Debate centred around whether this flat fee could be considered an “inducement” to participate, just as it did several years ago when a different clinic offered A$7,000 to Canadian students willing to come to Australia for a working holiday and to donate sperm.
-Louise Brown was born at 1147 BST on 25 July, 1978, in Oldham, United Kingdom.
+I agree with a number of other scholars who argue it’s time we looked seriously at whether the principle of “reasonable expenses” is useful in taking into account the actual risks, costs and inconveniences incurred by egg and sperm donors, and the interests of children born from such donation.
-== Blastocyst Formation (in vitro) ==
+==Q2. Where do donors come from?==
-The table below shows human blastocyst ''in vitro'' changes during week 1 development.<ref><pubmed>10221713</pubmed></ref>
-[[File:Human blastocyst formation-in vitro.jpg]]
+'''A. Loretta Houlahan, embryology lecturer:'''
-:'''Links:''' [[Week 1]] | [[Blastocyst]]
+Clinic-recruited donation is probably the most well-known method of donation.
-==Embryo Culture Milestones==
+Because of the critical shortage of donor eggs and sperm in Australia, some clinics are [http://www.smh.com.au/nsw/genea-partners-with-world-egg-bank-to-provide-donor-eggs-20140815-104kh6 now recruiting] from overseas. This is generally permitted if it complies with local laws.
-* 1949 8 cell mouse embryo -> blastocyst (in saline and egg yolk)
-* 1956 8 cell mouse embryo -> blastocyst (first embryo culture medium)
-* 1957 2 cell mouse embryo -> blastocyst
-* 1958 8 cell mouse embryo -> blastocyst, then transferred to pregnant recipient
-* 1960's development of culture requirements for mouse mebryos
-* 1965 2 cell mouse embryo -> blastocyst, then transferred into pseudopregnant recipient
-* 1968 zygotes from mouse -> blastocysts
-* 1968,70 2 & 4 cell rabbit embryos -> blastocyst in serum supplemented medium
-* 1970,71 1 & 2 cell rabbit embryos -> blastocyst in defined medium
-* 1970,81 Culture of in vitro fertilized human embryo -> 16 cells -> blastula
-* 1998 Cloning of adult sheep "dolly"
-* 2004 Cloning of human blastocysts
-Data modified from<ref><pubmed>15726768</pubmed></ref>
+Patients can also ask someone they know to donate to them. This is commonly a friend or family member, however, some people may find their donor through online forums as well. Advertising online is subject to many legal restrictions, so be careful if you go down this route.
-==Oldest IVF Mother==
+Sperm donation can also occur outside the clinic environment. Private insemination with donor sperm is not necessarily illegal, but potential medical and legal issues can arise from these arrangements. Unlike clinic-recruited donors, [http://www.news.com.au/lifestyle/real-life/meet-the-men-donating-their-sperm-for-free-online/story-fnq2o7dd-1227469657353 private donors] are not screened for infectious diseases and donors often advertise online without their true identities being confirmed.
-There is still risk, ethical and genetic debate about very old women becoming pregnant by IVF.
-* 2003 India - A 65-year old Indian woman was the oldest in the world to give birth by IVF.
-* 2006 United Kingdom - A 62-year old woman has become the UK's oldest woman to give birth to a child.
-* 2008 Australia - A 54-year old woman was Australia's oldest woman pregnant by IVF (most Australian IVF clinics do not treat women over 50)
-* 2010 Australia - A 57-year old woman is now the oldest mother to give birth in Australia, has delivered IVF twins in Western Australia.
-==IVF Sex Ratios==
+<figure class="align-center <img alt="" src="https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/91129/width668/image-20150807-4384-zq28a4.jpg <figcaption><span class="caption The local shortage of donor sperm and eggs has promoted some clinics to recruit from overseas.</span><span class="attribution <a class="source" href="http://www.shutterstock.com/pic-231503803/stock-photo-specimen-collection-bottle-with-urine.html?src=Amwaah7vueTe3QARNAL5jA-1-33 Gotzila Freedom/Shutterstock]</span></figcaption></figure>
-A recent paper looked at Australian assisted reproductive technology (ART) data (2002-2006) studied the effect on human sex ratio at birth by different procedures. [http://www.ncbi.nlm.nih.gov/pubmed/20875033 PMID:20875033]
+There are also no restrictions on the number of children that can be fathered from a single donor in a private donation scenario. One Sydney “freelance sperm donor” claims to have fathered 18 children. In contrast, clinic-recruited donors are [https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e78.pdf only allowed] to produce a limited number of families. They can also be removed from use if abnormalities are detected in the offspring.
-:"More males were born following in vitro fertilisation single embryo transfer (IVF SET) (53.0%) than intracytoplasmic sperm insemination (ICSI) SET (50.0%), and following blastocyst SET (54.1%) than cleavage-stage SET (49.9%). For a specific ART regimen, IVF blastocyst SET produced more males (56.1%) and ICSI cleavage-stage SET produced fewer males (48.7%). The change in the sex ratio at birth of SET babies is associated with the ART regimen. The mechanism of these effects remains unclear. Fertility clinics and patients should be aware of the bias in the sex ratio at birth when using ART procedures."
+There are pros and cons to both clinic and private donation, however, patients should seek medical and legal advice if they choose the latter.
-== Assisted Reproductive Technology (Australia and New Zealand) ==
+==Q3. What sort of identifying information is filed about open donors on the information register?==
-{| class="prettytable"
+'''A. Fiona Kelly, legal scholar:'''
-| [[File:IVF cycles ANZ 1999-2004.jpg]]
-| '''2005''' - 51,017 treatment cycles reported to ANZARD in Australia and New Zealand in 2005. Of these cycles, 91.1% were from Australian fertility centres and 8.9% from New Zealand's centres. There is an increase of 13.7% of ART treatment cycles from 2004.<ref name="ART2005">Wang YA, Dean JH & Sullivan EA. [http://www.preru.unsw.edu.au/PRERUWeb.nsf/page/art11 Assisted Reproduction Technology in Australia and New Zealand 2005] National Perinatal Statistics Unit (2007) [http://www.aihw.gov.au/publications/index.cfm/title/10469 AIHW Assisted reproduction technology series no. 11]</ref>
-|-
+Under [http://www.nhmrc.gov.au/guidelines-publications/e78 Australian guidelines], all donors in Australia are required to be “open donors”. Anonymous donors ceased to be available across the country in 2005, though some states abolished anonymity earlier.
-| &nbsp;
-| &nbsp;
-|}
+The guidelines require fertility clinics in Australia to collect the following information from sperm and egg donors:<ul><li>
-Average age of women was 35.5 years (35.2 years in 2002). Women aged older than 40 years has increased from 14.3% in 2002 to 15.3% in 2005.
-Since ANZARD was established in 2002 there has been a significant increase in the number of embryos transfer cycles where women received single-embryo transfers (SET). SET cycles accounted for 48.3% of embryos transfer cycles in 2005, compared to 28.4% in 2002. The increase of SET cycles resulted more singleton deliveries. The proportion of singleton deliveries was 85.9% in 2005, the highest proportion ever reported.
+name, any previous name, date of birth and most recent address</li><li>
-Babies born to women who had a single-embryo transfer had better outcomes compared to babies born to women who had a double-embryo transfer (DET). In 2005, there were '''3,681 SET babies and 5,589 DET babies.''' In SET babies, 96.1% were singletons, compared to 61.6% singletons in DET babies. SET babies had a lower proportion of preterm babies (11.7%), compared to 30.6% in DET babies. Similarly, 8.0% of SET liveborn babies were low birthweight, compared to 25.0% in DET liveborn babies.
+details of medical history, family history, and any genetic test results that are relevant to the future health of the person conceived by egg or sperm donation (or any subsequent offspring of that person) or the recipient of the donation</li><li>
-Perinatal mortality rate is a measure of perinatal outcomes. In 2005, for all babies born following ART treatment, the perinatal mortality rate was 14.7 deaths per 1,000 births, a 23.8% decrease from 19.3 deaths per 1,000 births in 2004. The perinatal mortality rate was the lowest among singletons born following SET (7.3 deaths per 1,000 births) in 2005.<ref name="ART2005" />
+details of physical characteristics.</li></ul>
-'''2004''' - 41,904 IVF treatment cycles were started in Australia 92.6% (38,823) and New Zealand 7.4% (3,081). (More? NPSU [http://www.npsu.unsw.edu.au/NPSUweb.nsf/page/Assisted+Reproduction+Technology+Reports Assisted Reproduction Technology Reports])
+Clinics are also obliged to tell egg and sperm donors that it is their ethical responsibility to keep the clinic informed about any changes to their health that may be relevant to the persons born or the recipients of their donation, and about changes to their contact details.
-'''In Vitro Fertilization''' - ABC News [http://www.abc.net.au/am/content/2007/s1857958.htm Baby born from frozen embryo]
+Clinics are not required to proactively gather additional health information or change of address details. So it’s possible that the information a donor-conceived person receives when they turn 18 is not up to date.
-"In what's thought to be a world first, a baby has been born in Melbourne using a woman's frozen egg and a donor's frozen sperm which created an embryo that was also frozen, then thawed and implanted into the mother"
+In some states and territories, such as [http://www.bdm.vic.gov.au/home/births/donor+treatment+registers/central+register.html Victoria] and [http://www.health.nsw.gov.au/art/Pages/The-Central-Register.aspx New South Wales], donor information is held in a central register, while other states and territories require the clinics to maintain the data.
-"JOHN MCBAIN: Oh egg freezing is very difficult. Embryo freezing itself is very well established. We would probably have about 55 per cent of all the babies born from our program, and that's about 1,400 a year, come from frozen embryos. So, that's very well established technology. But even with these embryos, only 70 per cent of the embryos survive the freezing and thawing. With eggs, it's closer to 40 to 50 per cent, and then you have to have the number which don't fertilise following that, and then you have to have those which end up being frozen, possibly not surviving the embryo freezing stage too, and that's a reason we don't promote it."
+==Q4. When and how should you tell children they’re donor-conceived?==
-== Assisted Reproductive Technology (USA) ==
+'''A. Damian Adams, donor conception researcher:'''
-[[File:USA_assisted_reproductive_technology_1996.jpg|right]]
-* '''Centre for Disease Control (USA) 1999 Survey of Assisted Reproductive Technology''': Embryo Laboratory procedures and Practices (January 29, 1999) USA statistics including the survey document.
-Assisted Reproductive Technology Success Rates National Summary and Fertility Clinic Reports
+Discovering you’re donor-conceived later in life [http://www.ncbi.nlm.nih.gov/pubmed/10967012 can potentially lead to] confusion, anger and distrust of the family members who kept the secret from you.
-* The 1996 report of pregnancy success rates is the second to be issued. The report includes a national report that uses information from 300 U.S. fertility clinics to provide an indepth national picture of ART; fertility clinic tables that provide ART success rates for each clinic that submitted and verified its1996 data; and an appendix containing a glossary of terms and lists of reporting and nonreporting clinics in the United States. (See Pie Graph)
-Assisted Reproductive Technology Success Rates National Summary and Fertility Clinic Report.]
+Some researchers argue that telling children earlier in life causes [http://humrep.oxfordjournals.org/content/24/8/1909.abstract less harm]. Associate Professor Ken Daniels, a sociological researcher into donor conception, [http://www.booktopia.com.au/psychoanalytic-perspectives-on-building-a-family-with-donor-conception-katherine-fine/prod9781782202035.html writes] that “a child should never be able to remember a time when he/she did not know”. Others [http://www.ncbi.nlm.nih.gov/pubmed/14512252 suggest] it should at least occur before the identity construct window of adolescence occurs.
-* This report gives consumers and potential assisted reproductive technology (ART) users an idea of a woman's average chances of having a pregnancy and a live birth by using ART. The report includes a national summary that uses the information from all reporting fertility clinics to provide an indepth national picture of ART; fertility clinic reports that provide ART success rates for 259 clinics in the United States; and an appendix containing a glossary of terms used in the national and clinic reports.
-[[File:USA_ART_live_birth_rates_1996.jpg]]
+<figure class="align-center <img alt="" src="https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/91132/width668/image-20150807-27622-b62p2l.jpg <figcaption><span class="caption Telling children early seems to work best.</span><span class="attribution <a class="source" href="https://www.flickr.com/photos/blushingmulberry/4080606133/ Laura Smith/Flickr], <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/ CC BY-NC-ND]</span></figcaption></figure>
-== European Society of Human Reproduction and Embryology ==
+As there is currently no evidence that more problems arise by telling early, doing so while young has the least potential to create problems.
-Reports annually (in the journal ''Human Reproduction'') on the European results of assisted reproductive techniques. Listed below are some statistical information gathered from reporting clinics for the current 2001 report. [http://humrep.oupjournals.org/cgi/content/abstract/20/5/1158 ESHRE Report 2001]
-=== Highlights from the 2001 Report ===
+There are numerous books on the market that can assist parents in how to tell, as well as numerous online resources. One of the better ones is run by the [http://www.varta.org.au Victorian Assisted Reproductive Treatment Authority] (VARTA) which has been running very successful “Time to Tell” campaigns for many years and has numerous informative pages on their website dealing with this.
-* From 23 countries, 579 clinics reported 289,690 cycles
-* IVF 120,946, ICSI 114,378, frozen embryo transfer (FER) 47,195 and egg donation (ED) 7,171 (4% increase since the year 2000)
-* <nowiki>European data on intra-uterine inseminations (IUIs) were reported from 15 countries. A total of 67 124 cycles [IUI husband'sperm (IUI-H) 52 949 and IUI donor sperm (IUI-D) 14 185] were included. </nowiki>
-* In 12 countries where all clinics reported to the register, a total of 108 910 cycles were performed in a population of 131.4 million (829 cycles/million inhabitants).
-* '''IVF'''- clinical pregnancy rate per aspiration and per transfer was 25.1 and 29.0%, respectively.
-* '''ICSI'''- clinical pregnancy rate per aspiration and per transfer was 26.2 and 28.3% (similar to the results from 2000).
-* '''IUI-H'''- clinical pregnancy rate was 12.8% in women less than 40 and 9.7% in women 40 years of age.
-* After IVF and ICSI, the distribution of transfer of one, two, three and 4 embryos was 12.0, 51.7, 30.8 and 5.5%, respectively.
-* Distribution of singleton, twin and triplet deliveries for IVF and ICSI combined was 74.5, 24.0 and 1.5%, respectively.
-* Range of triplet deliveries after IVF and ICSI differed from 0.0 to 8.2% between countries.
-* After IUI-H in women less than 40 years of age, 10.2% were twin and 1.1% were triplet gestations.
-== Human Fertilisation and Embryology Authority UK (HFEA) ==
+==Q5. What kind of contact can donors expect when their offspring are adults?==
-The UK '''Human Fertilisation and Embryology Authority''' (HFEA) was established in August 1991 following the passing of the Human Fertilisation and Embryology Act 1990 (HFE Act).
-The HFEA's principal &nbsp;tasks are to:
+'''A. Roger Cook, psychology scholar:'''
-* License and monitor clinics that carry out in vitro fertilisation (IVF) and donor insemination
+When offspring reach adulthood it’s possible for them to initiate contact with their donor, the outcome of which is [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949499/ varied]. Some offspring reach strong relationships with their donor parent and some do not. There are, of course, some offspring who do not want to make contact.
-* License and monitor research centres undertaking human embryo research
-* Regulate the storage of gametes and embryos
-HFEA also provide a downloadable patient booklet: [http://www.hfea.gov.uk/ForPatients/YourGuidetoInfertility Your Guide to Infertility] and website information on [http://www.hfea.gov.uk/ForPatients/PatientsGuidetoDI Patients' Guide to Donor Insemination (DI)]
+Typically, however, if both the donor and the offspring are enthusiastic and prepared for contact, an on-going relationship can emerge but it’s [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949499/ not usually] a parenting relationship. Often, the young adult can develop and maintain positive relationships with his or her biological father or mother but retain affection for the parents who raised them.
-:'''Links:''' [http://www.hfea.gov.uk/Home Human Fertilisation and Embryology Authority, UK)]
+==Q6. What are the options for gay men to start a family?==
-== Sweden ==
-Sweden had its first child born after in vitro fertilisation 20 years ago. A recent paper in BMJ looks at the change in multiple birthrates since a change in the early 1990s, to reduce the number of embryos transferred in the clinic from three to two.
-"The rate of multiple births after in vitro fertilisation increased to a maximum of 29% in 1991 but fell to 18.5% by 2001, resulting in a 70% reduction of preterm births"
+'''A. Deborah Dempsey, sociologist:'''
-[http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38443.595046.E0v1?ecoll Temporal trends in multiple births after in vitro fertilisation in Sweden, 1982-2001: a register study] Bengt Kallen, Orvar Finnstrom, Karl Gosta Nygren, Petra Otterblad Olausson
+Australian gay men’s pathways to creating families with children are diverse, although relatively limited compared to men in the United States.
-==Spermatozoa Production==
+Australian gay men’s history of involvement in known sperm donation for lesbian and single heterosexual friends and acquaintances dates from at least the 1980s. Some men are able to negotiate “donor dad” or parental relationships with children conceived in this way.
-[[File:Human-spermatozoa.jpg|thumb|Human spermatozoa]]
-* Fertile Male - Spermatozoa are generally collected from the male by ejaculation. These sperm can be used fresh or stored frozen for later use (spermatozoa banking).
+<figure class="align-center <img alt="" src="https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/91134/width668/image-20150807-27622-wsjjw9.jpg <figcaption><span class="caption Gay dads in Australia have fewer pathways to fatherhood than in the US.</span><span class="attribution <a class="source" href="http://www.shutterstock.com/pic-139669156/stock-photo-happy-family-outdoors.html?src=SgZK7jtbST1c7KlI2ZvrOA-1-20 Dubova/Shutterstock]</span></figcaption></figure>
-* Infertile Male - Spermatozoa can also be collected from men who have had a vasectomy or with obstructive azoospermia (OA), by a testicular biopsy. A study has shown that both spermatozoa yield and rate of clinical pregnancy were lower in these male populations.<ref><pubmed>15958397</pubmed></ref>
-==Ovarian Stimulation==
+Since the early 2000s, it has become popular for Australian gay men to form families through surrogacy, particularly commercial surrogacy arrangements abroad.
-A variety of drug based techniques are used to stimulate maternal oocyte development, called ovarian stimulation, for any in vitro fertilization procedure. The recommended for technique will vary for some procedures and also from clinic to clinic and between countries.
-'''An example of ovarian stimulation''' (based on PMID20953827)
+For gay men who are US residents, adoption is a well-documented path to parenthood. Though laws in some Australian states do not permit gay men or lesbians to adopt. And relatively few children are available for adoption in Australia.
-* Gonadotrophin releasing hormone agonist (GnRHa) triptorelin acetate (0.1 mg/day) treatment started on the 22nd day of the preceding menstrual cycle.
-* Human menopausal gonadotrophin (HMG) and/or follicular stimulating hormone (FSH) was carried out daily 12 to 15 days later.
-** Dosage may vary dependent upon patient response and can be monitored by hourmone levels (oestradiol) and transvaginal ultrasound (follicular size).
-* The resulting ovulatory wave generates large follicles (greater than 18 mm in diameter).
-* Human chorionic gonadotrophin (HCG) is then administered (36 to 38 h later)
-* Clinical transvaginal puncture is used to collect from these follicles cumulus-oocyte complexes.
-* Oocytes are then isolated from these cumulus-oocyte complexes.
-:'''Links:''' [[Menstrual Cycle]] | [[Ovary Development]] | [[Oocyte Development]] | [[Endocrine_-_Pituitary_Development|Pituitary]]
+La Trobe University researcher Jennifer Power and her colleagues investigated family make up in the [http://www.bouverie.org.au/images/uploads/2014_Brief_report.pdf 2012 Work, Love and Play study]. Of the 88 gay and bisexual men who described themselves as “actively involved” in parenting a child:<ul><li>39% had become parents in a previous heterosexual relationship</li><li>23% were parenting children conceived through surrogacy</li><li>19% had become parents through known sperm donation to lesbian couples or single women</li><li>11% were foster parents or permanent carers.</li></ul><hr>
-==Gamete Banking==
+==Q7. What logistical barriers do lesbian couples face when starting a family?==
-Women undergoing clinical procedures of chemotherapy and/or radiotherapy (ionizing radiation) can have induced premature ovarian failure. Therefore a growing reproductive option has been the collecting of  oocytes or ovarian tissue before commencing these procedures and storing ("banking") by cryopreservation for later use. One major issue is coordination of the two procedures, as most cancer therapies commence immediately, and most reproductive procedures require substantial preparation time. Currently the cryopreservation techniques required for ovarian tissue preservation are also improving all the time. In a number of clinics women with breast cancer and of reproductive age are being counselled about their reproductive options.<ref><pubmed>20499073</pubmed></ref>
+'''A. Deborah Dempsey, sociologist:'''
-Chemotherapy, alkylating and alkylating-like agents attach to the guanine base of DNA, cross-linking the DNA, preventing replication and cell division. Some examples include: busulfan, carboplatin, chlorambucil, cisplatin, cyclophosphamide, dacarbazine, ifosfamide, thiotepa
+Lesbian couples using clinical donor insemination, known donor insemination or IVF to form families with children must navigate a complex range of logistical, social and emotional issues.
+Finding a suitable known donor can be difficult because of the need for compatible expectations about parenthood. Men may want more or less involvement than the lesbian parents feel comfortable with; they may feel awkward or uncertain about the responsibilities attached to giving sperm; or their partners may not approve of the idea.
-A third potential option that may also in future be available is the transplanting (allografting) of ovarian cortex between individuals, this has recently been carried out between genetically non-identical sisters.<ref><pubmed>20663793</pubmed></ref>
+For some lesbian couples, deciding who will become pregnant and whose eggs will be used will be straightforward and for others, it will be emotionally difficult. It really depends on how the women view the issue of being genetically related to the child, and their feelings about how important it is to become pregnant and give birth.
+<figure class="align-center <img alt="" src="https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/91130/width668/image-20150807-4380-eks6fu.jpg <figcaption><span class="caption Reciprocal IVF is not available in Australia unless the couple has fertility problems.</span><span class="attribution <a class="source" href="https://www.flickr.com/photos/digitalgrace/3036447684/ Danny Hammontree/Flickr], <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/ CC BY-NC-ND]</span></figcaption></figure>
+In some US states, a procedure called “reciprocal IVF” is offered so both women can have a biological relationship to the child. One woman provides the egg, while the other becomes pregnant and gives birth. However this procedure is currently only possible in Australia if the couple has fertility problems.
+==Q8. Who goes on the birth certificate when using a sperm or egg donor? And what about if the couple is same-sex?==
+'''A. Fiona Kelly, legal scholar:'''
-'''Links:''' [[Abnormal Development - Environmental]] | [[Abnormal Development - Drugs]] | [[Abnormal Development - Radiation]]
+Where a couple or single woman has used assisted reproduction (ART) to conceive, the donor is not named on the birth certificate. Rather, the recipient parent(s), who are the legal parents of the child, are named, provided they were married or in a de facto relationship at the time of conception.
-==Ovarian Reserve==
+In all states and territories, the woman who gives birth to a child born as a result of ART is the “mother” of that child. When a married woman or a woman in a de facto relationship with a man becomes pregnant as a result of assisted reproduction her partner is presumed to be the father, provided he consented to the procedure.
-Ovarian reserve is a term referring to the evaluation of ovary oocyte (egg) number and quality. A negative finding has been described as Diminished Ovarian Reserve, or an ovarian insufficiency or premature ovarian failure and may be seen in adult childhood cancer survivors and adult patients undergoing a number of therapies.
+All Australian jurisdictions also presume the same-sex partner of a birth mother who has used ART to conceive is a legal parent of a child born. In other words, same sex couples and opposite sex couples are treated identically.
-The anti-Müllerian hormone (AMH) level is currently the most sensitive marker of ovarian reserve.<ref><pubmed>19153092</pubmed></ref>
+The language that is used on birth certificates may vary. For example, in Western Australia, the partners may register as “mother” and “parent”; “mother” and “mother”; or “parent” and “parent”. In the ACT, a person may be registered as “mother”, “father” or “parent”.
-==Follicle Growth in vitro==
+Several states make a notation on the child’s birth certificate, indicating that further information is available about the child’s birth. The notation ensures the child can determine that he or she is donor conceived, particularly in the event of the child not having been informed by their parents of the nature of their conception.
-[[File:Ovarian_follicle_growth_in_vitro.jpg|600px]]
-==References==
+==Q9. How much does IVF cost?==
-<references/>
+'''A. Loretta Houlahan, embryology lecturer:'''
+Back in 1987, the [http://trove.nla.gov.au/work/13000621?q&versionId=15393011 cost of IVF treatment] was about A$3,500 to A$4,500 and the pregnancy rate was around 40-50% after three attempts. At the time, Professor Carl Wood, one of the pioneers of Australian fertility treatment, said:<blockquote>
-===Reviews===
+as the test-tube procedure has been developed only recently, it is reasonable  to assume that with further improvements the cost may be reduced and the success rate increased.</blockquote>
-===Articles===
+Arguably, the reverse has occurred with live birth rates reported to be as low as 4% at one IVF clinic. Further, despite a large proportion of IVF now being subsided by Medicare, the [http://monashivf.com/treatment/vic-ivf-costs/ going rate] for a fresh IVF cycle is around A$10,000, with out-of-pocket expenses commonly over A$4,000 before private health insurance rebates.
-<pubmed>20124287</pubmed>
+Using donor sperm or eggs costs more again, with clinic-recruited donor sperm usually costing [http://monashivf.com/treatment/vic-ivf-costs/ around A$1,000] per treatment. Although, actually paying a donor for their eggs or sperm remains illegal.
-<pubmed>19147504</pubmed>
-===Search Pubmed===
+==Q10. What are the success rates for IVF?==
-July 2010 "in vitro fertilization" All (29785) Review (3172) Free Full Text (6189)
-'''Search Pubmed Now:''' [http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=search&term=in%20vitro%20fertilization in vitro fertilization] | [http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=search&term=assisted%20reproduction%20technology assisted reproduction technology]
+'''A. Loretta Houlahan, embryology lecturer:'''
-== External Links ==
+Fitness guru Michelle Bridges [http://www.news.com.au/lifestyle/parenting/michelle-bridges-criticised-for-suggesting-pregnancy-success-is-due-to-good-health/story-fnet08ck-1227448956094 recently caused a stir] when she suggested her ability to conceive naturally at 44 was because of her and her partner’s healthy lifestyle.
-{{Template:External Links}}
-* '''Australia''' [http://www.npsu.unsw.edu.au/art8high.htm Assisted reproductive technology in Australia and New Zealand 2002 Report - Highlights] Has links to the full report online. | [http://www.npsu.unsw.edu.au/ (Australian) National Perinatal Statistics Unit] | (Australian) National Perinatal Statistics Unit [http://www.npsu.unsw.edu.au/NPSUweb.nsf/page/Assisted+Reproduction+Technology+Reports Assisted Reproduction Technology Reports] | [http://www.nor.com.au/community/aisg/ The Australian Infertility Support Group]
+While lifestyle factors such a smoking and weight will play a role, the biggest contributing factor to infertility is the woman’s age. So while Michelle Bridges’ 12-week body challenge may reduce your body mass index, drinking protein shakes and running on the treadmill cannot turn back the clock.
-* '''USA''' [http://www.cdc.gov/ART/ CDC - Assisted Reproductive Technology]
-* '''UK''' | [http://www.hfea.gov.uk/Home Human Fertilisation and Embryology Authority (UK)] | [http://www.hfea.gov.uk/ForPatients/YourGuidetoInfertility Your Guide to Infertility] | [http://www.hfea.gov.uk/ForPatients/PatientsGuidetoDI Patients' Guide to Donor Insemination (DI)] | [http://www.hfea.gov.uk/ForPatients/PatientsFAQs Patients FAQs] | [http://www.hfea.gov.uk/ForPatients/PatientsGuidetoIVFClinics Patients Guide to IVF Clinics (UK)]
-* [http://www.ivf-worldwide.com IVF Directory]
-* '''The Merck Manual''' | [http://www.merck.com/mmhe/sec22/ch254/ch254a.html?qt=infertility&alt=sh The Merck Manual- Infertility | ][http://www.merck.com/mmhe/sec22/ch257/ch257a.html?qt=pregnancy&alt=sh The Merck Manual- Pregnancy] | [http://www.merck.com/mmhe/search.html?qt=infertility&qp=%2Bsite%3Awww.merck.com+%2Burl%3A%2Fmmhe+-url%3Aprint%2F+-url%3Aindex%2F+-url%3Aresources%2Fpronunciations+-url%3Amultimedia%2F&charset=utf8&la=en&start=0 Search The Merck Manual "Infertility"] | [http://www.merck.com/mmhe/search.html?qt=pregnancy&qp=%2Bsite%3Awww.merck.com+%2Burl%3A%2Fmmhe+-url%3Aprint%2F+-url%3Aindex%2F+-url%3Aresources%2Fpronunciations+-url%3Amultimedia%2F&charset=utf8&la=en&start=0 Search The Merck Manual "Pregnancy"]
-* '''Sydney Commercial IVF Sites''' [http://www.sivf.com.au/ Sydney IVF] | [http://www.ivf.com.au/ Citywest IVF] | [http://www.ivfsouth.com.au/ IVF South] | [http://www.nsart.com.au/ North Shore Fertility Pty Ltd]
-==Terms==
+<figure class="align-right <img alt="" src="https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/91135/width237/image-20150807-27573-vib92d.jpg <figcaption><span class="caption Michelle Bridges was lucky; most women her age would need donor eggs.</span><span class="attribution <a class="source" href="http://one.aap.com.au/ AAP/Tracey Nearmy]</span></figcaption></figure>
-* '''empty follicle syndrome''' - (EFS) Term used to describe a condition in which no oocytes are recovered/obtained after an apparently successful ovarian stimulation.
-* '''follicle stimulating hormon'''e - (FSH, gonadotropin) A glycoprotein hormone secreted by [[A#anterior pituitary|anterior pituitary]] (adenohypophysis gonadotrophs, a subgroup of basophilic cells) and acts on [[G#gametogenesis|gametogenesis]] and other systems in both males and females. In females, FSH acts on the [[O#ovary|ovary]] to stimulate [[F#follicle|follicle]] development. Negative feedback by inhibin from the developing [[F#follicle|follicle]] decreases FSH secretion. In males, acts on the testis Sertoli cells to increase androgen-binding protein (ABP) that binds androgens and has a role in spermatogenesis. FSH-defficiency in females results in infertile (block in folliculogenesis prior to [[A#antral_follicle|antral follicle]] formation) and in males does not affect fertility (have small testes but are fertile). FSH protein has a molecular weight 30 kDa and a 3-4 hour half-life in circulation. Gonadotrophins have been used clinically in humans for the treatment of infertility.
+The [http://theconversation.com/five-things-you-need-to-know-before-going-to-an-ivf-clinic-43705 highest success] rates are reported in women under 30 who have an around a 26% change of a having a baby with IVF. Women over 40 have around a 6% chance, and as for women 44 or older such as Michelle, the chances of going home with a baby is less than 1%. Michelle was lucky. Most women her age would need donor eggs.
-* '''human chorionic gonadotropin''' - (hCG, human chorionic gonadotrophin) Placental hormone initially secreted by cells (syncitiotrophoblasts) from the implanting [[C#conceptus|conceptus]] during week two, supporting the ovarian [[C#corpus luteum|corpus luteum]], which in turn supports the endometrial lining and therefore maintains pregnancy. Hormone can be detected in maternal blood and urine and is the basis of many pregnancy tests. Hormone also stimulates the onset of fetal gonadal steroidogenesis, high levels are [[T#teratogen|teratogenic]] to fetal gonadal tissues.
-* '''human menopausal gonadotropin''' - (HMG) A clinical [[H#hormone|hormone]] preparation used in [[A#assisted reproductive technology|assisted reproductive technologies]] (ART). This hormone is collected from the urine of menopausal women and has similar biological activity to that of follicle stimulating hormone (FSH). This is used in an injectable form along with human chorionic gonadotropin (hCG) to induce [[O#ovulation|ovulation]]. Some commercial product names include Menogon or Organon.
+There is also a wide discrepancy between the success rates of IVF providers. The last report showed overall results ranged from 4% and one clinic to 30.9% at another.
-* '''triptorelin acetate''' - A gonadotropin-releasing hormone (GnRH) agonist used clinically in an acetate or pamoate form inreproduction for  [[A#assisted reproductive technology|assisted reproductive technologies]] (ART, in vitro fertilization, IVF). This decapeptide (pGlu-His-Trp-Ser-Tyr-D-Trp-Leu-Arg-Pro-Gly-NH2) agonist stimulates the pituitary to decrease secretion of gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH). Also used for other clinical conditions.
-* '''zona pellucida birefringence''' - (ZPB) Optical property of  the zona pellucida using polarization imaging when viewed microscopically.  Used to qualitatively predict the developmental potential of a in vitro matured metaphase-II (MII) oocytes. High birefringence has been associated with oocytes contributing to conception cycles when compared with those of nonconception cycles and higher implantation, pregnancy, and live birth rates from transferred oocytes. (More? [http://www.ncbi.nlm.nih.gov/pubmed/18284880 PMID18284880] | [http://www.ncbi.nlm.nih.gov/pubmed/20079896 PMID20079896])
+There is also evidence to suggest having a younger male partner may improve IVF outcomes in women. This doesn’t necessarily mean women should go out looking for a young male sperm donor, it just shows there are many factors at play, many of which are out of patients’ control.
-{{Template:Glossary}}
+==Q11. Is sex selection legal in Australia? Should it be?==
-{{Template:Footer}}
+'''A. Deborah Dempsey, sociologist:'''
+Sex selection using assisted reproductive technology is only legal in Australia to reduce the risk of transmission of a serious genetic conditions, such as [http://www.mda.org.au/disorders/dystrophies/dmd-bmd.asp duchenne muscular dystrophy].
+Sex selection of embryos created through IVF is done using a technique called [http://ivf.com.au/fertility-treatment/genetic-testing-pgd pre-implantation genetic diagnosis] (PGD). This technique enables the removal of one or more cells from an embryo so it can be tested for genetic abnormalities prior to implantation.
+Clinics providing PGD must be accredited by the [http://www.fertilitysociety.com.au/ Fertility Society of Australia], which requires them to comply with [https://www.nhmrc.gov.au/guidelines-publications/e78 National Health and Medical Research Council ethical guidelines].
+Some Australians would like to use PGD for “family balancing” reasons. Australians often consider it ideal to have at least “one of each” in their family, although in many parts of the world there is a cultural preference for sons. Australians are known to travel overseas to obtain sex selection services in countries where clinicians will perform PGD for non-medical reasons.
+While I understand that some parents have a very strong desire to have children of both sexes, my personal view is the practice is undesirable and discriminatory. If we take the “family balancing” idea seriously enough to legally facilitate it, we are perpetuating the view that boys and girls are so different from each other that families with children of one sex are “unbalanced” and somehow deficient.
+There would also be no impediment to using the procedure to support more extreme forms of gender discrimination, for example, in cases where families favour having sons.
+==Q12. How long can donor eggs and sperm stay in the freezer?==
+'''A. Loretta Houlahan, embryology lecturer:'''
+Donor eggs and sperm are often frozen before they’re given to recipients. This allows donors to be tested for infectious diseases and genetic abnormalities, transported interstate or overseas, if needed, and to be readily available for patients who need them.
+Some people express concerns about the survival rates of donor eggs or sperm that were frozen many years ago. But as long as they’re stored correctly, there is no biological limit on the amount of time eggs or sperm can remain in frozen. Just like Elsa in the movie Frozen, the cold never bothered them anyway, and staying frozen doesn’t reduce their thaw survival rates.
+<figure class="align-center <img alt="" src="https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/91136/width668/image-20150807-27568-wyuqaq.jpg <figcaption><span class="caption There’s no limit to how long donor eggs and sperm can be frozen.</span><span class="attribution <a class="source" href="http://www.shutterstock.com/downloading_tips.mhtml?code=&id=231112240&size=medium&image_format=jpg&method=download&super_url=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTQzODk1ODQwNywiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMjMxMTEyMjQwIiwiayI6InBob3RvLzIzMTExMjI0MC9tZWRpdW0uanBnIiwibSI6IjEiLCJkIjoic2h1dHRlcnN0b2NrLW1lZGlhIn0sInJNd2t0elpYNnFHWkY0dmQzUVNoMnZCODI2OCJd%2Fshutterstock_231112240.jpg&racksite_id=ny&chosen_subscription=1&license=standard&src=sioMuefciOw7NwB100O3hQ-1-0&el_order_id= nevodka/Shutterstock]</span></figcaption></figure>
+The main problem with eggs and sperm that were frozen many years ago is that the older freezing methods were not as good as the new ones. Eggs frozen using the now-outdated “slow frozen” method have [http://www.sciencedirect.com.ezproxy.lib.monash.edu.au/science/article/pii/S1472648314002478 poorer survival rates] than those that have been vitrified (“snap frozen”).
+There is also limited information about the success of egg freezing in general. So while we know eggs can survive the thaw process, we don’t know the how many babies are being born from this process.
+Sperm isn’t usually vitrified like eggs are, but advances in sperm freezing technology have also improved success rates over time.
+So, to sum it up, donor eggs and sperm can theoretically remain frozen indefinitely – although there are legal restrictions on this.
+==Q13. How difficult is it to obtain information about overseas donors/surrogates?==
+'''A. Damian Adams, donor conception researcher:'''
+Australian clinics are mandated to follow [https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e78.pdf National Health and Medical Research Council’s guidelines] which stipulate that all donor-conceived people (since the guidelines came into effect in 2005) are entitled to know identifying information on the donor once they reach 18 years of age. Subsequently, if clinics are sourcing eggs or sperm from overseas, the information available must meet our guidelines.
+We are yet to see whether any donor-conceived people have trouble accessing this information as those conceived under these guidelines as they’re yet to turn 18. Those conceived prior to this will be at the mercy of whatever agreement the Australian clinic and the overseas clinic had in the supply of those gametes and associated information. The donor-conceived are then also reliant on a foreign business maintaining and looking after those records.
+Anecdotal evidence from older donor-conceived people overseas does not paint a rosy picture of possible outcomes from seeking information, although it is hoped that their practices have also changed for the better as has been the case in Australia.
+==Q14. How are donor eggs and sperm transported interstate and overseas?==
+'''A. Loretta Houlahan, embryology lecturer:'''
+After eggs and sperm are frozen, they need to be kept in liquid nitrogen, which is about minus 196 degrees Celsius. This can make transportation tricky, as liquid nitrogen is really dangerous, and if it was to leak it could easily kill the courier or the any one else around at the time.
+Luckily, scientists have come up with a special device called a “dry shipper” which allows frozen embryos, eggs and sperm to be transported safely while keeping everyone safe. Dry shippers absorb the liquid nitrogen in the walls so it doesn’t leak, but it still keeps everything cold.
+Very occasionally, this process can fail, but most transportation occurs successfully without any damage to patient material.
+==Q15. What barriers do donor-conceived people face in obtaining information about their biological mother or father?==
+'''A. Damian Adams, donor conception researcher:'''
+This is highly dependent on when the person was born and which state they were born in. Those conceived from 2005 onwards around Australia, and 1998 onwards in Victoria, are entitled to access identifying information. Prior to those dates, donations were primarily anonymous.
+<figure class="align-left <img alt="" src="https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/91138/width237/image-20150807-27573-m0j4x.jpg <figcaption><span class="caption In some instances, records had been destroyed or redacted.</span><span class="attribution <a class="source" href="https://www.flickr.com/photos/adrianclarkmbbs/3183890564/ Adrian Clark/Shutterstock]</span></figcaption></figure>
+For those conceived under anonymous conditions there are, however, voluntary registers in Victoria, Western Australia and New South Wales which offspring can put their details on in the hope that the donor will also place their details on the register. If the donor is not on the register – or if they were conceived in another state – the offspring will be reliant on assistance from the clinic.
+Research [http://www.ncbi.nlm.nih.gov/pubmed/22908615 my colleagues and I published] in 2012 on accessing information in Australia showed some people found dealing with the clinics quite difficult (others have found them helpful), and if information <em>was</em> available that there was no national consistency on what information was recorded.
+In some instances, records had been destroyed or redacted. We have also seen instances of registers failing to match people who were later matched through DNA testing.
+So, some younger offspring may find it easy, while older offspring may find it difficult or even impossible.
+==Q16. Can donor-conceived people access information about their donor if they were conceived before anonymity was abolished?==
+'''A. Fiona Kelly, legal scholar:'''
+The only state in which donor records have been opened retrospectively is Victoria. As of June 2015, all donor-conceived people who were conceived in Victoria [http://www5.austlii.edu.au/au/legis/vic/num_act/artfaa201458o2014575/ may apply for access] to their donor’s identifying information, with the donor’s consent.
+In other states, there is no right of retrospective access. However, in a number of states, such as [http://www.health.nsw.gov.au/art/Publications/brochure-voluntary-donor-register.pdf NSW] and [http://www.voluntaryregister.health.wa.gov.au/home/ WA], donor-conceived people may place their names on a voluntary registry. If both the donor-conceived person and the donor register, access is permitted by mutual consent.
+==Q17. Will using donor eggs from a younger woman increase my chances?==
+'''A. Loretta Houlahan, embryology lecturer:'''
+Women over 40 are the main recipients of donor eggs. Using donor eggs from a younger woman [https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20reproductive%20technology%20in%20Australia%20and%20New%20Zealand%202012.pdf significantly increases] the chances of success.
+However, using donor eggs doesn’t eliminate all complications. Women who use donated eggs have a [http://www.telegraph.co.uk/news/health/news/10936458/Risks-of-donor-egg-pregnancies-revealed.html higher risk] of developing serious complications, specifically high blood pressure and pre-eclampsia. Although it was thought these dangers may have been linked to the age of the birth mother and not the egg donor, the real reason remains unknown.
+There is also a difference between fresh and frozen eggs to consider. Fresh is best because the success rate with thawed eggs remains unclear. However, this option is not always available where donor eggs are involved. Until only recently, [http://www.sciencedirect.com/science/article/pii/S1472648314002478 egg freezing] was considered experimental so we are still learning a lot about this process.
+==Q18. What motivates men to donate sperm, and women to donate eggs?==
+'''A. Roger Cook, psychology scholar:'''
+Both sexes are motivated, at least in part, by a sense of altruism.
+In the past, some men were enticed to donate by payments, albeit very low amounts. This became less common through the 1980s and now some clinics provide some reimbursement but no inducement payments. The [http://www.austlii.edu.au/au/legis/vic/consol_act/hta1982160/ Human Tissue Act of 1982] prohibits commercial profiting from semen donation. Financial reward is not a current motivation.
+<figure class="align-center <img alt="" src="https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/91140/width668/image-20150807-27622-aipfn3.jpg <figcaption><span class="caption Some donors are unlikely to have children of their own and want to be fathers.</span><span class="attribution <a class="source" href="https://www.flickr.com/photos/davelawler/6912975586/ Dave Lawler/Flickr], <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/ CC BY-NC-ND]</span></figcaption></figure>
+The motivation for men to donate sperm changed somewhat after laws were introduced prohibiting anonymous donation. Donors must now be prepared to be identified and allow contact with their donor children. This has reduced the number of men donating, as the [http://www.ncbi.nlm.nih.gov/pubmed/18653672 necessity of identification] is incompatible with their sense of privacy.
+Another motivation for some men is a desire to be biological fathers, particularly when they’re unlikely to form a parenting relationship with a woman.
+Women are usually [http://humrep.oxfordjournals.org/content/15/10/2133.full more reluctant] than men to give away their DNA, except when they have had their own experience of IVF. This is likely related to the significance of pregnancy and child birth experience, which men experience in a different way.
+Women who donate their eggs are have been through infertility treatments such as IVF, and therefore have some understanding of the distress that follows such circumstances. Their motivation is to help other women who are not able to produce their own viable eggs.
+==Q19. Why do I need ICSI (sperm injections) if I use donor sperm?==
+'''A. Loretta Houlahan, embryology lecturer:'''
+A common source of confusion for patients is why they need to use intra-cytoplasmic sperm injection (ICSI) when using donor sperm. ICSI is usually preserved for treatment where the male partner has a low sperm count and costs a lot more than a standard IVF treatment.
+The main reason ICSI is used is because of the critical shortage of donor sperm. To enable supply to meet demand, the donor sperm sample may be diluted. This way it can be used in more patient treatments. The downside to this is that because diluted samples contain such a low volume of sperm, ICSI is required for the insemination procedure.
+ICSI is also required to inseminate frozen-thawed eggs. In order to freeze eggs, the “cumulus cells” that surround them need to be removed. In natural conception, as well as standard IVF, the cumulus cells act like a maze and the sperm are required find their way through these cells to get to the egg.
+It also acts like a barrier to limit the number of sperm that reach the end point. Without the cumulus cells in-tact, the risk of more than one sperm fertilising the egg is too high, so ICSI is used to avoid an abnormal fertilisation. With ICSI, the embryologist can ensure only one sperm enters the egg.
+==About the Authors==
+* [http://theconversation.com/profiles/damian-adams-181102 Damian Adams] is PhD candidate at [http://theconversation.com/institutions/flinders-university Flinders University].
+* [http://theconversation.com/profiles/deborah-dempsey-178116 Deborah Dempsey] is Senior Lecturer - Sociology at [http://theconversation.com/institutions/swinburne-university-of-technology Swinburne University of Technology].
+* [http://theconversation.com/profiles/fiona-kelly-154513 Fiona Kelly] is Senior Lecturer in Law at [http://theconversation.com/institutions/la-trobe-university La Trobe University].
+* [http://theconversation.com/profiles/loretta-houlahan-173190 Loretta Houlahan] is  Casual Lecturer, Master of Clinical Embryology, Department of Obstetrics and Gynaecology at [http://theconversation.com/institutions/monash-university Monash University].
+* [http://theconversation.com/profiles/roger-cook-180930 Roger Cook] is Associate Professor; Director, Psychology Clinic at [http://theconversation.com/institutions/swinburne-university-of-technology Swinburne University of Technology].
+This article was originally published on [http://theconversation.com The Conversation]. Read the [http://theconversation.com/your-questions-answered-on-donor-conception-and-ivf-45715 original article].
+{{Footer}}
 [[Category:Human Embryo]] [[Category:Week 1]] [[Category:Fertilization]] [[Category:Oocyte]] [[Category:Spermatozoa]]
 [[Category:In Vitro Fertilization]] [[Category:Assisted Reproductive Technology]]