Third-party reproduction is a reproductive option when a couple or person cannot conceive with their own gametes (eggs and sperm) or is unable to carry a pregnancy to term and give birth to a baby. It includes the following options: egg donation, sperm donation, embryo adoption, and surrogacy. Nevertheless, it is subject to many ethical considerations due to the number of parties involved and the potential risks associated.
The various sections of this article are assembled in the following table of contents.
What is third-party reproduction?
Third-party reproduction, also referred to as donor-assisted reproduction, is defined as an alternative human reproduction technique in which DNA or pregnancy is provided by a third party, that is, a person other than the prospective parents, who will raise the resulting baby.
The ASRM (American Society for Reproductive Medicine) defines it as follows:
Arrangements in which intended parents collaborate with gamete donors and/or GCs [gestational carriers] is referred to as «third-party reproduction».
There exist 4 different types of third-party reproduction arrangements, which at the same time allow combinations between them:
- Egg donation
- An egg donor provides eggs. It is indicated for women with a poor ovarian reserve or low egg quality.
- Sperm donation
- A sperm donor provides spermatozoa. It is an option for women without a male partner, as well as heterosexual couples in which the male has low or zero sperm count (azoospermia).
- Embryo donation/adoption
- A couple donates their unused embryos, either created with their gametes or by egg and/or sperm donation, for the use of a third party.
- An embryo created with the gametes of the intended parents or egg and/or sperm donors is transferred to another woman, who will carry the pregnancy and deliver the baby. It allows all family types to start a family, especially gay males, single men, and straight couples where the woman is unable to carry a pregnancy.
In the words of the ASRM, assisted reproductive technology (ART) third parties can be divided into three categories: physicians and collaborators participating in the medical process, gamete donors and/or GCs who help in another’s reproduction, and agents and attorneys who formalize and monitor formal legal relationships between the parties.
The laws regarding third-party arrangements vary greatly from country to country. In this sense, we distinguish three different groups of countries according to how permissive the policies governing third-party reproduction are there:
- Non-permissive countries
- Surrogacy and donor conception are not permitted by law or, if allowed, with a great number of restrictions. Italy, France, Germany, Norway, Sweden and some Latin American countries are some examples.
- Semi-permissive countries
- We use this terminology to refer to those countries where the law permits some third-party reproductive procedures such as gamete and embryo donation but bans surrogacy, as in the case of Spain.
- Permissive countries
- Where the prevailing law allows all kinds of third-party conception arrangements. It is the case of the United States, Canada, Ukraine, Russia, the UK, etc.
The most common reasons behind the prohibition of these treatments or some of them include religious beliefs, ethical considerations, or historical background, among others.
Donor-assisted reproduction means giving up on your own genetic material, either totally, in case you use both donor eggs and sperm or embryo donation, or partially, if one of the two gametes has been delivered by one of the commissioning parents.
The fact that the children do not share the genetic material of both parents is seen as a challenge for the society in general. In fact, many couples need psychological support before, during, and/or even after treatment to cope with the fact that they need to use donor gametes.
Groups such as the Indian Society for Third Party Assisted Reproduction (INSTAR) work to promote ethical third-party arrangements. One of the aims to be pursued by the INSTAR is «to spread public awareness that surrogacy is a boon to mankind».
For that matter, it is important to expand the concepts of motherhood and fatherhood. Everyone having or about to have a child via donor-assisted reproduction should understand that, given their situation, maternity and paternity refer to the desire of bringing up, educating, and being responsible of a child, and are not dependent on any genetic links.
Who can use it to start a family?
Fertility problems may be caused either by female or male alterations. Likewise, sometimes both members of the couple have their fertilizing capacity affected due to anatomical or genetic problems or because their gamete production system does not work properly.
In those cases where infertility is caused by the absence or poor quality of the gametes, donor conception can be the only chance for intended parents to have a child. A couple may turn to reproductive medicine due to a wide range of fertility problems. The following, however, are the most common causes of infertility in humans:
- Anatomical abnormalities
- Genetic alterations
- Husband-wife reproductive compatibility problems
- Poor gamete (egg and sperm) quality
- Diseases and disorders that affect the human reproductive system
- Unhealthy lifestyle
- Medical or surgical procedures such as cancer treatments.
Infertility is not the unique reason why many patients use donor eggs and sperm, and/or donated embryos: new family types resulting from today’s society are also possible thanks to ART in combination with gamete donation and/or surrogacy.
In this sense, single females or lesbian couples are now able to have a child thanks to donor insemination or donor-sperm in vitro fertilization (IVF). Also, single men and male homosexual couples need not only an egg donor to become parents, but also a gestational carrier that bears the pregnancy and delivers the baby.
When infertility shows up due to poor gamete quality or even when the woman is unable to produce eggs, either due to natural or acquired reasons, egg and/or sperm donation are generally the best reproductive solutions to achieve pregnancy.
According to what is causing infertility, any of the following combinations will be indicated:
- Donor eggs with own sperm
- Own eggs with donor sperm
- Both egg and sperm being from third parties
- Embryo donation and adoption
In the first three cases, it should be clear that it consists of a gamete donation for the purpose of later creating the embryos. Conversely, in the case of embryo donation, the recipients use the excess embryos from another couple’s previous IVF cycle to become parents. Embryo donation is the process by which another couple decides to donate the unused embryos from their own IVF cycle.
Egg donation, also known as ovum donation, egg cell donation or oocyte donation, is a fertility treatment which demand has grown considerably in recent years. Its popularity is due to the phenomenon of delayed motherhood, as it is a fact that nowadays women start planning motherhood later.
Over the years, and especially from age 35 onwards, a woman’s ovarian reserve keeps on diminishing, and egg quality becomes poorer. In fact, from age 40 onwards, the oocytes are more likely to develop a genetic abnormality.
While this is the main reason why donor conception may be required, it is not the only one. The following are also motives that lead a couple to use donor eggs:
- Genetic alterations or history of genetic diseases.
- Premature ovarian failure (POF), which leads to low ovarian reserve or even a lack of egg production.
- Loss of ovarian function due to cancer treatments.
- Surgical interventions such as having one ovary removed (unilateral or bilateral oophorectomy, also called ovariectomy), voluntary sterilization (tubal ligation), etc.
Contrary to what happens in the case of women, sperm quality and quantity do not change over the years so dramatically. Thus, delayed fatherhood is not a major reason when it comes to diagnosing male infertility.
Nevertheless, today’s lifestyle habits do contribute greatly to the production of poor-quality sperm. Damaged sperm parameters, i.e. sperm motility, sperm count and/or sperm morphology are the main causes behind the most common causes of male infertility.
Donor sperm can be used in the following cases as well:
- Genetic diseases or anomalies
- Medical and/or surgical procedures (cancer treatments, vasectomy…)
- Absence of a male partner
Over the last few years, new family types are possible thanks to reproductive medicine to a large extent. Lesbian couples or single women who wish to start a family are now able to make their dreams come true without a man. Sperm donation in combination with fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF) are options available for these families to have children.
About 30% of all infertility cases are caused by female infertility, and another 30% by male factors. The remaining percentage corresponds to couples where both members have developed a fertility issue. Cases of unexplained infertility are also included in the latter group.
When the gamete production system is damaged both in the male and the female, using both donor eggs and donor sperm (double-donor IVF), or receiving donated embryos, is usually the solution.
These treatments are indicated in those cases where neither the eggs nor the sperm from the members of the couple is viable to produce healthy embryos. However, the difference between these two methods should be clear:
- Embryo donation
- In this case, there are two couples involved, being the former couple who donate their leftover embryos after an IVF cycle to the latter couple.
- Double-donor IVF
- The embryos are produced from anonymous egg and sperm donors in order to be transferred later to the woman’s womb so that she can get pregnant.
Surrogacy, also known as surrogate motherhood, is a fertility treatment in which a woman other than the intended mother carries the pregnancy to term and delivers the baby for the intended parents. This technique is the one involving a greater degree of complexity from the ethical and technical points of view.
There exist two types of surrogacy:
- Partial, straight, or traditional surrogacy
- The surrogate contributes the eggs, and therefore is the genetic mother of the resulting child. It is done via intrauterine insemination (IUI), using the sperm of the intended father or from a donor.
- Full, host, or gestational surrogacy
- The surrogate, in this case named gestational carrier, just carries the pregnancy, which means her oocytes are not used, and therefore she is not the biological mother of the child. The eggs are contributed by the intended mother or an egg donor.
It should be noted that traditional surrogacy arrangements are falling into disuse nowadays, given the level of involvement required to the surrogate. Gestational surrogacy arrangements are more common today, preferably using the intended mother’s eggs or, if not possible, donated eggs.
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Fertility treatment options
Depending on the fertility problem, some infertility treatments may be more adequate than others. Carrying a pregnancy to term and subsequently delivering a healthy baby is the sole purpose of everyone getting involved in third-party reproduction agreements.
Every time we talk about egg donation, the technique used is in vitro fertilization (IVF), since it is necessary for fertilization to occur in the laboratory. Once fertilized, the embryos will be transferred to the uterus of the intended mother.
Different alternatives can be found if donor sperm is used, though. In this case, we can choose between artificial insemination or IVF according to the woman’s age and depending on whether she is infertile too or not.
Nonetheless, with embryo donation, the embryo has to be transferred to the uterus, which means that the embryos have been previously obtained through IVF and then stored by means of embryo cryopreservation.
When a woman or couple decide to start a fertility treatment using donated embryos, a frozen embryo transfer (FET) is necessary. In such cases, it is unnecessary for recipients to undergo ovarian stimulation. Instead, the only thing left to do is preparing the endometrial lining, so that the embryos are able to implant.
Cost of third-party reproduction
The cost of turning to third-party reproduction to create a family depends on the treatment of choice as well as on the country and even the clinic where it is performed. However, to get a general overview, we have created a list of treatments in the order of most expensive to least expensive:
- Surrogacy: Given the complexity of the procedure, its overall cost ranges from €35,000 to 150,000. The most expensive country is the USA, although it varies widely depending on the particular needs of the intended parents.
- Egg donation: On average, the price of IVF using donor eggs can be as high as €7,500 in countries such as Spain, or as low as €4,500 in other destinations such as Cyprus, the Czech Republic, or Ukraine. On the other hand, the USA is again the most expensive country: $20,000-40,000 approximately.
- Sperm donation: It depends on the treatment used. While IVF with donor sperm can cost €3,400-4,500, a cycle of donor insemination can be twice as cheap. Should donor eggs be necessary as well (i.e. double-donor IVF), the price will amount to €5,000-8,000.
- Embryo adoption: It is the most cost affordable of all third-party reproduction arrangements, with a cost that usually ranges from €1,500 to €3,500.
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Regulations governing egg and sperm donation as well as embryo donation are not equal worldwide. For this reason, we can find great disparity in the following aspects of the donation process:
- Anonymity of sperm and egg donors
- Donor compensation
- Permitted fertility treatments
- Who can become a recipient of donor eggs and sperm
Due to the wide range of differences that can be found from country to country in this field, we have witnessed the birth of fertility tourism, also known as reproductive tourism. This concept is defined as the process of traveling abroad to undergo a fertility treatment.
Singles and couples who opt for this option are usually forced to do so because of the restrictions they find in their own country, or because the process or part of it does not accommodate their needs.
You can learn more about this phenomenon by visiting the following post: IVF abroad.
FAQs from users
What does the HFEA say about third party agreements?
The UK’s Human Fertilisation and Embryology (HFE) Act 1990 (as amended), in the Code of Practice established by the HFEA (hereinafter the Authority), defines third party agreements as follows:
For the purposes of this Act, a “third party agreement” is an agreement in writing between a person who holds a license and another person which is made in accordance with any licence conditions imposed by the Authority […]
Third-party agreements are required in all cases before starting a fertility treatment using donor gametes or embryos.
Telling a child about donor conception, in favor or against?
There exist many opinions regarding this issue, but the truth is that it depends on each family. Nonetheless, the ASRM considers that disclosure might be beneficial for the child for various reasons, including:
- Knowing your biological origins reinforces your autonomy
- Understanding your identity improves your decision-making skills
- Parents are able to build a relationship with the child based on openness and honesty
- Knowing your genetic heritage allows you to deal more accurately with severe health problems
- It helps protect the child against later inadvertent consanguinity
On the other hand, those who are against disclosure argue that it would subject the child to a psychological turmoil, thereby affecting his long-term capacity of developing social skills. Read more: Donor-conceived children.
How many parents can a child conceived via third-party reproduction have?
The actual parents are always the intended parents, whom will have the parental rights of the child that has been conceived through third-party assisted reproduction. Yet, if we distinguish between social (i.e. non-genetic) and genetic parents, as well as a gestational mother in cases of host surrogacy, up to 5 combinations are possible. To sum up:
- Intended parents = social parents (2)
- Gestational carrier = gestational mother (1)
- Egg donor = genetic mother (1)
- Sperm donor = genetic father (1)
Is donor conception wrong?
There is no reason why donor conception should be wrong. It is a reproductive option for those who would not be able to become parents with their own gamete cells, and have the chance to start a family thanks to the altruism of others. As explained above, having a child should not be understood in terms of DNA and genetic heritage, but in terms of loving, educating, and rearing a child.
What are the ICMR guidelines on third-party reproduction?
The Indian Council of Medical Research (ICMR), on Chapter 3 of their Code of Practice, entitled Ethical Considerations and Legal Issues, establishes the following basic guidelines in relation to third-party reproduction arrangements:
A third party donor of sperm or oocytes must be informed that the offspring will not know his/her identity […]
A third-party donor and a surrogate mother must relinquish in writing all parental rights concerning the offspring and vice versa […]
Suggested for you
Would you like to delve deeper into the third-party reproduction options explained above? You can find detailed information about each one of them in the following guides:
Also, if you want to learn more about the fertility treatments that can be used in any of these procedures, just visit any of these posts:
Or, if you prefer to get a general overview about the most common infertility treatments in addition to IVF and AI, click here: Guide to infertility treatment options.