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Health implications

Making informed health decisions 

In order to make informed decisions about gamete (egg or sperm) donation and surrogacy, it is vital that you are aware of not only the ethical and legal considerations, the practicalities, and the emotional impact, but the potential risks to your health as well. This is especially true for female donors and surrogates, or those with internal reproductive systems, as the risks are significantly greater. Below is an an outline of the key facts you need to know to make informed choices about your participation in assisted conception and about the medications, procedures and treatments you may need. 

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Sperm donation  

 

Donating sperm has no known health implications, as it does not include any medication or treatment. However, donors should be aware that they will be screened for certain infectious diseases and genetic conditions, which may yield health information that they were previously unaware of.

 

Additionally, if a donor develops a health condition later in life or if the children born from their donations experience health problems related to their genetic inheritance, sharing this information in either direction can be difficult or even impossible due to gatekeeping by the sperm bank or fertility clinic where the donation took place.  

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Egg donation

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Donating eggs is generally very safe and most people experience no complications while undergoing treatment. However, because the process involves taking hormones to stimulate the ovarian follicles and a surgical procedure (usually under general anaesthesia) to retrieve the eggs, there are some risks involved.  

 

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Possible short term side effects during hormone treatment and following egg collection:  

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  • Abdominal swelling 

  • Pain 

  • Bloating 

  • Breast tenderness 

  • Nausea 

  • Headache 

  • Dehydration 

  • Mood swings

Medical risks of egg collection:  

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  • Internal bleeding 

  • Damage to surrounding tissues and organs 

  • Infection 

  • Reaction to general anaesthetic  

The most severe potential complication of egg donation is Ovarian Hyper Stimulation Syndrome (OHSS).

 

Mild OHSS affects around 1 in 3 people undergoing egg collection, causing bloating, discomfort and nausea. This usually resolves quickly on its own and can be treated at home with rest, fluids and painkillers.

 

However, for around 1 percent of those who have had eggs collected, the symptoms are more severe and can become life-threatening, affecting the kidney, liver, heart and lungs. Severe OHSS requires immediate treatment and hospitalisation. In very rare cases, OHSS can cause death.  

The symptoms of severe OHSS include:

 

  • Extreme thirst and dehydration 

  • Passing only small amounts of urine, often dark in colour 

  • Severe abdominal swelling and discomfort 

  • Vomiting 

  • Difficulty breathing 

  • A swollen, tender leg or pain in the chest (signs of thrombosis – a blood clot) 

Long term risks

 

There is very little evidence on the long-term risks of egg donation. This is not because none have been found, but because they have not been adequately studied.

 

At present, there is no requirement for fertility clinics or regulatory authorities to follow up with donors to assess any future complications or side effects. The lack of evidence is sometimes presented to donors as the absence of risk, which is misleading.

 

To facilitate informed decision making, more robust studies on the long-term effects should be prioritised in donor conception research and further regulation should be implemented to protect and support egg donors. 

Surrogacy

 

The risks of surrogacy are much the same as the risks for anyone during pregnancy and birth, and most surrogates go through the process without major complications or lasting health effects. However, like anyone undergoing IVF to conceive, there is a higher chance of ectopic pregnancy and multiple births (twins, triplets or more), which come with significantly increased risks.  

 

If the surrogate is carrying a child conceived with eggs that are not her own (often referred to as a gestational surrogacy), then her chance of developing high blood pressure or pre-eclampsia in pregnancy is higher than if she were genetically related to the fetus. This can lead to serious complications.

  

In many of the countries that operate a commercial surrogacy model, surrogates have higher rates of caesarean section than the national average. In Mexico, for example, nearly all surrogates give birth via planned caesarean section, despite having more associated risks, and with studies showing that their preference is for vaginal birth. This is mainly due to views within the medical profession that women’s bodies (especially those living in poverty) are ‘risky’ and that caesareans are preferable to minimise surrogate-infant bonding, as well as for the convenience of the Intended Parents. This is an example of how a commercial surrogacy model can pose greater health risks to surrogates.  

A final note

 

For anyone who is considering becoming a donor or surrogate, doing thorough research on the risks and benefits is vital. Though altruistic intentions are commendable, an altruistic act can still have undesired consequences. When making any decisions that can impact one’s health, informed decision making is key.  

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