The evolution of egg, sperm and embryo donation

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A sign of a specialty that never stands still
by Julia Chain

The speed at which fertility treatment has evolved over the last 30 years is nothing short of incredible. The rapid scientific and technological advancements achieved in this time has given the 620,000 patients who have had IVF or donor insemination, much-longed-for hope, that one day they will conceive a child of their own.

In 2023, the landscape of egg and sperm donation will change as the first cohort of donor-conceived people affected by the 2005 change to donor anonymity law, will be eligible to access identifying information about their donor. This, along with an analysis of donor treatment numbers, of donor registrations and their changing characteristics, is highlighted in the new Trends in Egg, Sperm and Embryo Donation report, published by the Human Fertilisation & Embryology Authority (HFEA).

The report has shown the dramatic increase in children born through egg, sperm and embryo donation over time. The number of children born with the help of a donor has nearly doubled since the 1990s with over 4100 children born in 2019 compared to around 2500 in 1993. Over 70,000 donor-conceived children have been born since 1991 and egg, sperm and embryo donation accounts for one in 170 of all births and for one in six births using IVF in the UK.

The largest proportion of births are from treatments using donor sperm, followed by egg donation. Births from treatments using donor embryos are least common but have increased from under 50 births in 2010 to over 200 births in 2019.

The number of children born from donor sperm has more than tripled over the last 15 years, from under 900 in 2006, and growing to over 2800 in 2019. This increase is largely due to female same-sex and single people having treatment.

'Offer of hope'

In addition to the change in family type with more single parents and same-sex couples having children, we know that donation can dramatically increase an older patient's chance of success. As birth rates decline with age when women use their own eggs, older women can increase their chances of having a baby by using donor eggs. In 2018/19, the birth rate per embryo transferred for patients aged 18-34 using their own eggs was 33 percent, compared to below five percent for patients aged 43-50. However, birth rates remained above 30 percent for all ages when donor eggs were used; a statistic that means we must question how many older patients are being encouraged to have treatment with their own eggs, when using donor eggs may provide a much higher chance of success. We recognise that this is a very complex and emotionally charged issue.

Disparities

The HFEA's Trends in Egg, Sperm and Embryo Donation report shows that IVF treatments using donated sperm or eggs are less commonly funded through the NHS. From 2016-2020, just 13 percent of donor treatments were funded by the NHS compared to around 40 percent of IVF treatments without donation.

We know that same-sex couples are increasingly using donor IVF treatment and they often can't access NHS funding unless they've had at least six rounds of unsuccessful intra-uterine insemination (IUI). The government published its long-awaited Women's Health Strategy this year which committed to putting a stop to this requirement (see BioNews 1152). This is a really important commitment, and we are engaging with the Department for Health and Social Care about this regularly.

We also know that in recent years sperm imported into the UK has increased; sperm from mixed, other and black ethnicity donors were more likely to be imported than sperm from Asian and white donors.

The availability of donor sperm or eggs depends where in the UK you live and so it is possible that the increase in imported donors is in response to a lack of ethnically diverse donors available in the UK, or a result of patient choice, as well as long waits in some areas. In response to our National Patient Survey 2021, 82 percent of patients who had used donor eggs, sperm or embryos said it was important that the donor's ethnicity matched their own. However, some ethnic minority patients found it difficult to find donors matching their ethnicity.

This shortage of sperm from men from certain ethnic minority backgrounds could relate in part to cultural and/or religious beliefs, as well as stigma around donation in these communities. It could also be due to general lack of awareness around donation in these specific areas.

2023