One of the most important reasons for the rise in infertility today is that many couples choose to have children at an older reproductive age. Unfortunately, for women this choice leads to a poor ovarian response. A reduced ovarian response can also be found in a number of younger women. Inevitably, in these situations — as in women with premature ovarian insufficiency, and in women who have had radiotherapy or chemotherapy — the only option may be to use eggs from a donor.
Criteria and screening of donors
To ensure the best possible egg quality, donors have to meet specific criteria. Greek law sets a strict age limit of 18 to 35 for prospective donors, who also undergo a large number of tests before being approved as suitable. At the assisted reproduction unit we work with, every prospective donor is interviewed and a full medical history is taken. Her family, sexual and psychiatric history is also explored, along with any history of substance and medication use. Information is gathered about her level of education, and an assessment is made of the stability of her character and of her motivation for donating eggs. The interview confirms that the donor fully understands the treatment she is about to undergo and the psychological implications of donation. Finally, donors are informed in detail about what Greek law provides for egg donation.
Egg donors undergo a clinical examination at which they must meet specific criteria. Blood tests are also carried out for transmissible diseases such as hepatitis B and C, AIDS and syphilis, along with microbiological testing with cultures from the genital tract. Finally, blood group and Rhesus status are checked, as is carrier status for thalassemia and sickle cell anemia.
Although particular weight is given to looking for genetic abnormalities when the donor's family history is taken, all donors undergo karyotype testing, as well as testing for mutations in the cystic fibrosis gene, the spinal muscular atrophy (SMA) gene and Fragile X.
Egg donation is essentially an altruistic act, but the law provides for compensation for donors' time, effort and physical burden.
How the process works
First, a suitable donor is selected for each recipient couple. The criteria used are the blood groups of the woman or the couple and the recipient's physical characteristics (eye colour, hair colour, height, skin colour). Once a suitable donor meeting the criteria has been found, her hormone treatment begins. The donor takes medication to stimulate her ovaries and then, after about 10 to 15 days, the eggs are collected transvaginally. On the day of egg collection the mature eggs are fertilized with the partner's sperm or with donor sperm, depending on the case, and the fertilized eggs are then cultured for 5 to 6 days, up to the blastocyst stage.
Because it is usually difficult to synchronize the recipient's and the donor's cycles, in most cases the resulting blastocysts are cryopreserved. Blastocyst cryopreservation is a safe method today, with a survival rate after thawing of close to 98%, so it does not affect the success rate of the process as a whole. This gives the opportunity to prepare the recipient's endometrium as well as possible and so to improve the chances of a better outcome.
Greek law on egg donation
Greece has one of the most liberal legal frameworks for assisted reproduction treatments in Europe. Recently, under the new law 4958/2022, there have been significant changes in the field of assisted reproduction, in line with modern social needs. The changes relating to donation are as follows.
- The age limit for the woman receiving treatment has been raised to 54, subject to permission from the National Authority.
- Wider choice of donor. The new law allows three options: full anonymity, full disclosure, or partial disclosure, where the child on reaching adulthood can obtain the personal details of the donor of the genetic material.
- Abolition of the limit on the duration of cryopreservation, which can be extended for 5 years at a time, with no upper limit on extensions.
- Introduction of an upper limit of 6 egg donation cycles for each donor.
- At least 4 months must pass between two consecutive egg collections.
The latest amendments to the legal framework on donation have also opened a window for donations between relatives in the direct line of descent. The condition remains, however, that the relative must pass all the required tests and meet the general criteria that apply to donors under Greek law.
In addition, a register of donors has been created and is in operation, in which all prospective donors are recorded, so that their participation in donation programmes at every IVF centre in Greece can now be checked. This ensures that the number of children per donor set by law is not exceeded.