The Risks and Perils of Overseas Egg Donation - Singaporean IVF Patients Beware !

[Angelica Cheng]

Translated into English from original Chinese article,
also highly-relevant to Singaporean patients seeking egg donors abroad:

中国不孕妇女在国外寻求卵子捐赠面临的风险和危害

Also adapted from:

Egg Donation In Malaysia: Pitfalls That IVF Patients Should Avoid – Dr Alexis Heng Boon Chin - CodeBlue

Patients often have to navigate a complex web of marketing gimmicks, misleading information, and ethical pitfalls.

codeblue.galencentre.org

The risks and harms faced by Chinese infertile women seeking egg donation abroad

At present, the trend of late marriage and late pregnancy has become increasingly obvious, and the incidence of female infertility in China is on the rise. As a result, the demand for donated eggs for assisted reproductive treatment continues to increase. However, in China, commercial transaction for egg donation is strictly prohibited. According to the relevant legislation "Health Science Education [2006] No. 44" promulgated in 2006, donated eggs can only be obtained from patients receiving assisted reproductive treatment, and it is explicitly prohibited to seek egg donation from non-patients. In addition, out of the more than 20 mature eggs retrieved from the patient, at least 15 eggs must be reserved for the patient's own use, and the remaining eggs can be donated.

Such strict Chinese legislation on egg donation have led to a continuous shortage of donated eggs and a long waiting list for local patients. In addition, Chinese women are prohibited from freezing eggs when they were younger. It is also difficult to find egg donors in other parts of China, such as Hong Kong, Macau and Taiwan. Commercial transactions of egg donation are prohibited in Hong Kong and Macau. In Taiwan, egg donors can receive payment, but the eggs they donate can only give rise to one baby. After that, they are no longer allowed to donate. Therefore, many older and infertile Chinese women have no choice but to resort to overseas egg donation to conceive children. In fact, many countries with large overseas Chinese populations, such as the United States and Malaysia, allow commercial transactions for egg donation. Although Thailand also has a large overseas Chinese population, commercialization of egg donation is prohibited. Therefore, overseas Chinese donors in Thailand often travel to assisted reproductive clinics in Cambodia and Laos for egg donation. These countries are popular destinations for Chinese infertile women seeking egg donations.

However, due to lax regulation of fertility treatment in some countries, Chinese patients may face various marketing gimmicks and misleading information about the egg donation procedure. Therefore, before Chinese patients go abroad to receive egg donations, it is important to emphasize what they should pay attention to and be wary of.

Chinese patients should be particularly careful not to be duped into performing unnecessary genetic testing on IVF embryos, such as preimplantation genetic screening (PGS/PGT-A). This procedure is very expensive and often increases the total medical expenses by 50%. Many foreign assisted reproductive clinics often exploit the fear of infertile patients about unknown genetic diseases carried by egg donors, to hard-sell genetic testing (PGS / PGT-A). They often hide from patients the fact that similar genetic tests on egg donor blood samples or oral swabs, are much cheaper than embryo genetic tests. A blood or oral swab sample contains hundreds to thousands of cells, from which a large amount of genetic material (DNA) can be extracted. In contrast, only a small amount of DNA can be extracted from the embryo. Therefore, compared with PGS / PGT-A (Genetic Testing of Embryos), genetic testing of blood samples or oral swabs from egg donors is technically simpler and more economical. The cost of screening for genetic diseases through WeGene oral swab samples is about a few hundred yuan, while the price of embryo genetic testing (PGS/PGT-A) is usually tens of thousands of yuan. In addition, patients should also consider more economical birth defect screening techniques after pregnancy, such as the new generation of non-invasive prenatal testing (NIPT), which can screen fetal DNA extracted from pregnant women’s blood samples to detect genetic defects in the fetus.

Patients need to understand that more expensive testing methods are not necessarily better. Despite the high cost of PGS, it is not a foolproof screening method for genetic defects. This technology only detects common genetic diseases, not rare genetic disorders. It is also not used for detecting more complex genetic conditions caused by multiple interactions of multiple genes with the birth environment, for example, autism. In addition, if the egg donor is very young, there is no need to use PGS technology to screen embryos for Down syndrome, which usually stems from genetic abnormalities in older women’s eggs. Although many foreign fertility clinics claim that PGS can improve the success rate of IVF among older women, this only refers to older women who use their own eggs and will not increase the success rate of older women using young egg donors. It must also be pointed out that PGS is not completely risk-free. Because this process is very delicate and involves drilling the embryo's outer shell (Zona Pellucida) and extracting cells for genetic testing, there is an inherent risk of damaging the embryo.

An important fact often concealed by foreign fertility clinics is that the age of the recipient of donated eggs is very important. Recent news reports about successful births by elderly women in their 60s and 70s has led to much hype and misunderstanding. In fact, as pregnant women get older, the risk of pregnancy complications increases.

Patients must also beware of a marketing gimmick claiming that a woman receiving egg donation can pass some of her genetic material to the fetus. This misunderstanding arises from news reports a few years ago that the gene expression behavior of embryos is affected by the womb lining (endometrium). This is because the embryo absorbs a molecule called miRNA (originating in the endometrium or womb lining), which is structurally similar to DNA. Because miRNA is closely related to DNA, it can be widely and loosely considered as a genetic material. However, miRNAs are extremely short-lived and fragile, and cannot stably transmit genetic information from parents to children.

 

[Angelica Cheng]

Some foreign fertility clinics may offer frozen eggs as an alternative to fresh eggs. This has simpler logistics, as there is no need to synchronize the hormonal stimulation cycles of donors and recipients, and saves transportation and hotel accommodation costs required for fresh egg donation, so the cost is lower. However, the success rate of frozen eggs is significantly lower than that of fresh eggs, which is often overlooked. Patients should also avoid using frozen eggs transferred from the egg bank to the assisted reproduction clinic, and it is best to use the egg bank directly affiliated with the fertility clinic. Because human eggs are very sensitive, the thawing technique needs to be compatible to the cryopreservation technique, which is similar to the relationship between a lock and a key. Only assisted reproduction laboratories that perform both freezing and thawing techniques can achieve this.

Some foreign fertility clinics often utilize eggs donated by traveling egg donors from out-of-town. This is not good for recipient patients because it is very difficult to monitor the hormonal stimulation cycle of egg donors traveling to and from out-of-town. Some doctors may directly hand over expensive hormone drugs (requiring refrigeration) to out-of-town donors to inject themselves under the supervision of their agents. They will return to the clinic for an ultrasound scan of the ovaries at a designated time or perform the final egg retrieval operation. Without the direct supervision of the fertility clinic, the egg donor or surrogate may not strictly observe the injection schedule and be careless. Expensive hormone drugs can also deteriorate and lose their potency if they are not stored properly at low temperatures. In the absence of strict supervision of hormone injections, the quantity and quality of eggs extracted from donors will be severely impaired. Therefore, it is best for patients to use the eggs of egg donors who reside in the same city as the fertility clinic, and it is best to have the egg donor regularly receive hormone injections (recorded) from the fertility clinic nurse.

In addition, Chinese patients should be aware that it may be cheaper to directly contact foreign egg donation agencies and request treatment at their affiliated fertility clinics. If foreign fertility clinics are asked to source egg donors, they often charge extra fees unscrupulously. Normally, when you ask a foreign fertility clinic to find an egg donor for you, they will contact many different external agencies and obtain several matching egg donor files. You choose an egg donor, and the clinic will coordinate with that specific egg donor agency. You don’t pay directly to the egg donation agency. Instead, you give your money to the fertility clinic. They will pay the egg donation agency and keep a small portion of your payment to themselves as an additional profit.

Finally, Chinese patients should note that in developing countries such as Malaysia, Thailand, Cambodia, and Laos, egg recipients lack the support of fertility counselors. In contrast, the laws of Western developed countries require that patients receiving egg donation must undergo mandatory counseling. A strict counseling regimen will ensure that both spouses agree to egg donation, without any emotional blackmail from either spouses, and without undue pressure by their parents and in-laws. In traditional Chinese culture, passing on the family line is considered the most important responsibility of the wife to the husband and his family. Therefore, childless women may be pressured by their husbands and in-laws to accept egg donations in order to conceive a child. As the old Chinese proverb says, twisted melons are not sweet. This also applies to raising children. Innocent children after birth may be adversely affected by the unwilling spouse.

In addition, egg recipients will miss valuable advice on whether to tell their children the truth in the future. Most experienced fertility counselors will advise them to tell the truth to the child when they are at school-going age. Many psychological studies and news reports have reported the emotional trauma and identity crisis experienced by teenagers and adults born from egg donation when they accidentally learned the truth about their conception. For example, children often accidentally learn the truth when a family quarrel occurred. In many cases, this situation will lead to strains in family relations and even estrangement of parent-child relationships. In addition, recently, convenient, easy-to-obtain and low-cost DNA home testing kits and related genealogy and genetic relationship websites (such as WeGene) have made it more difficult to conceal the truth of conception from the offspring of donors. It is possible that offspring may come into contact with relatives who match their DNA through these websites and unwittingly learn the truth about his/her conception. And with the advancement of medical technology, DNA testing will become a routine practice in the field of healthcare. Ultimately, it is up to egg recipients to decide whether or not tell their children the truth. Telling the truth will reduce their psychological burden and give them peace of mind.