This is the latest article in a Global News investigation into fertility in Canada, and the emotional and financial impact infertility has on Canadians struggling to conceive.
Cherie Cohen was 40 years old when she first tried to get pregnant naturally. But after four miscarriages in three years – each being more devastating than the last – she knew she had to explore other options.
She sought the help of doctors and specialists, none of which could tell her what was wrong. The problem, she says, wasn’t getting pregnant – it was staying pregnant.
“I was very career-driven and I didn’t even think about having a baby until after I turned 40,” Cohen says. “But because I was able to successfully get pregnant – and with such great ease – no alarm bells really went off in anyone’s mind that perhaps there could have been some problem.”
Then she underwent testing.
Several diagnostic tests later it was determined Cohen had a hypothyroid condition as well as a blood clotting issue. The quality of her eggs was also considered to be poor.
“There was no question that my age was a factor and that my egg viability had diminished because of my age,” Cohen says. “Considering that I was able to conceive, it just seemed like ‘why would we continue to waste time trying to get pregnant naturally when in fact my eggs were not going to change in terms of their poor quality.’”
So Cohen and her husband decided to use egg donation.
“It made logical sense to us,” she says. “It seemed like a really positive way to almost turn the clock back.”
After two tries, Cohen was pregnant with twins. Though one passed away early in her pregnancy, Cohen was able to carry her baby boy Coby Jack to term.
Cohen’s decision to pursue egg and/or sperm donation is one that many Canadian couples grapple with at one point or another in their journey to build a family.
In fact, it’s a route that is growing so steadily in popularity that the Canadian Fertility & Andrology Society (CFAS) has recorded a 30 per cent jump in procedures using both fresh and frozen donor eggs between 2014 and 2015.
In 2014, there were 874 procedures (631 using fresh eggs and 243 using frozen eggs) in Canada; in 2015 that number increased to 1,139 (722 using fresh eggs and 417 using frozen eggs).
(The number of procedures using donated sperm is not available, according to CFAS.)
For some couples – like Cohen and her husband – navigating through the egg and sperm donation process can be overwhelming and a bit confusing.
So Global News spoke with Dr. Arthur Leader of the Ottawa Fertility Centre and professor of obstetrics, gynecology and reproductive medicine, to break down what couples need to know before deciding if egg or sperm donation is the right choice for them.
Who needs a donor?
There are several reasons why women and/or couples require an egg or sperm donor.
For a woman, it may be because the quality of their eggs have diminished, ovarian failure, cancer treatment or genetic causes, among others, according to the Reproductive Centre at McGill University Health Centre.
For women needing sperm donors, it may be because their partner’s sperm quality is considered poor. If they’re single, they’ll need sperm for insemination (artificial or natural).
Same-sex couples also seek donors when eggs or sperm are needed.
The decision to use egg and sperm donation should be made between the patients and their attending physician after tests are able to determine if this would be a viable route.
When it comes to getting a donor, some couples choose to ask people who they already know, says Leader.
By choosing this option, couples will most likely be dealing with fresh eggs and sperm.
(More on why and how people donate eggs and sperm below.)
But for those who choose the anonymous donor route, patients should know that eggs and sperm are stored in banks in the United States. Canada does not have these storing services available.
(More on fresh vs. frozen eggs below.)
Before anything, patients must first choose a donor through an online catalog provided by their bank of choice in the U.S. Each donor has a profile that lists their age, race, physical appearance, education, interest, hobbies and possible medical conditions within the family.
Once the order is place, the eggs or sperm are shipped frozen in liquid nitrogen through delivery services (like FedEx for example). The eggs or sperm are then thawed when they’re ready for use, Leader explains.
The egg or sperm is mixed together in a lab and left in an incubator for up to three days to encourage fertilization and cell division.
The fertilized eggs or embryos are then implanted into the woman’s uterus. According to the McGill Centre, this works best when a number of eggs can be fertilized and transferred, because not every egg will fertilize or result in a pregnancy.
For those using egg donation, the recipient is usually asked to take medications so that the lining of the uterus is prepared for the implantation of the embryos. The medication will vary depending on the treatment plan. (You can read more on treatment plans, here.)
Fresh vs. frozen and success rates
The team studied data from 380 fertility centers in the U.S. in 2013. Of the 11,148 IVF cycles using donor eggs, almost 50 per cent of those using fresh eggs resulted in a live birth, compared to 43 per cent who used frozen eggs.
The reason for the difference was unclear, researchers admitted. They speculate that the egg quality may be affected by the freezing and thawing techniques – or a smaller starting number of frozen eggs results in less opportunity for the proper selection, Medical Daily reports.
It’s important to note, however, that only donated eggs were looked at, not cycles in women who freeze and use their own eggs.
Success rates are also dependent on other factors.
The Reproductive Centre at McGill University Health Centre says the success is often related to egg quality, as well as the age and fertility of the donor. It is not thought to be related to the age of the recipient.
“Because of this, your success with egg donation treatment will be very much higher than it would be if you were undergoing treatment with your own eggs,” the centre states.
When it comes to sperm though, a 2013 study by PLOS ONE found that there is no difference between frozen and fresh sperm in terms of a successful pregnancy through IVF, Medical News Today reports.
Being a donor
Women donating eggs must meet certain criteria in order to be accepted as donors.
They must be between the ages of 21 and 34, fertile and in good health. Egg donors are asked to complete a health history and some diagnostic tests before being accepted, the McGill Centre details.
If accepted, the donor will be asked to take fertility drugs to stimulate their ovaries then have surgery to remove them.
Sperm donors must also go through testing by a clinic and provide a complete medical history, the Government of Canada says.
If the eggs or sperm are being donated to no one in particular, then they will be shipped to a bank in the U.S. for storing.
For more details on how to become a donor in Canada, visit the Government of Canada’s Healthy Canadians website.
As for why someone would choose to donate, Leader says it could come down to a variety of unique reasons.
“If it’s direct donation then it might be because they want to help a friend, relative or colleague – it’s truly altruistic,” says Leader. “Many times when men want to donate their sperm it’s to help other people because they know someone who has suffered infertility – and they’re often mature. For egg donors, they may be doing this to help someone but there may also be financial incentive – especially in the U.S. – and these donors tend to be students.”
(Note: While egg donation itself is legal in Canada, it is illegal in to sell and/or purchase eggs. However, personal expenses may sometimes be covered. More on fertility law at Fertility Law Canada.)
Things to consider
Before women and couples consider egg or sperm donation, Leader says there are a few things couples should keep in mind.
First, consider the baby may have a half-sibling somewhere in the world.
“When a man donates sperm, for example, one sample might donate enough sperm for three, four or five inseminations,” he says. “When a woman donates eggs there might be enough eggs for three or four pregnancies. So people need to be comfortable with that.”
Leader also says that patients need to assure themselves that there may be a chance the child has an illness they weren’t planning on, considering all donors may not be forthcoming with their medical histories.
Because of the possible emotional, physical and psychological effects donors and recipients may go through, they are often asked to meet with a counsellor or psychologist to ensure that they’re ready to go through with their decision.
Doing it all again
Despite the initial frustration and complications of her first experience with egg donation, the now 45-year-old Cohen says she would consider doing it again.
“Coby is our miracle baby,” says Cohen. “For him to be with us today and continue to grow and thrive and bring so much joy to us, he is truly our miracle. He is loved by many and he’s surrounded by a lot of love. I think he knows it – I hope he knows it and can feel it. He is our true joy.”