The Daisy Network
PO Box 183
Infertility can be a devastating consequence of premature menopause. The loss of the possibility of having your own biological child can be very hard to come to terms with.
The Daisy Network considers this to be a grieving process and offers support on that basis.
For many couples they face a number of choices:
It is also important to remember that in spontaneous premature ovarian failure natural pregnancy can occur. It is estimated to happen in around 5% of women at some time after the diagnosis, although it is more common in the early years. Unfortunately there is nothing to predict which women this will happen to. If you are hoping for a pregnancy, then HRT is not considered to stop this and is therefore suitable to take, but you should not take the contraceptive pill as oestrogen replacement because this would prevent a pregnancy.
On the other side of the fence, if you do not want a pregnancy you must continue to use contraception as pregnancy can occur in POF. HRT is not a contraceptive.
Adoption is a rewarding way of building a family, but it is not always easy. Adoption agencies would expect you to have ended any fertility treatment before you apply. They will check with your GP and with any clinic s/he has referred you to, to confirm that your treatment has ended. This is to ensure that you have come to terms with your own infertility.
Getting approved for adoption is an intrusive and lengthy process; once a child is found and placed with you, further challenges may come to light. Many children placed with adoptive parents have had traumatic experiences and these can cause behavioral difficulties. Despite this, many adoptive parents are living proof that it was worth it.
All adoptions (domestic and overseas) can only go ahead after a Home Study has been completed by a social worker and you have been formally approved to adopt. A home study can only be undertaken in respect of either a domestic or overseas adoption, and not both. Overseas adoption home studies are often given a low priority by social services.
For more information contact your local social services department and the British Agencies for Adoption and Fostering (BAAF) for a list of independent agencies.
Many couples consider adopting a child from overseas.
Although the child will be brought up as a British citizen, it is important to give her or him a sense of cultural heritage, and your views and plans for this will be of interest to both the officials in the child's country and your social worker. The process for applying to adopt an overseas child varies depending on the country of origin and can be complex, bureaucratic and subject to delay. Some countries have very young children available, although whether you are allocated a young child may depend on your own ages. Some overseas countries are 'designated countries' which means that you have only to adopt the child in her/his own country. In non-designated countries you must adopt the child there and then apply to adopt it in the British courts on your return.
Overseas adoption will involve some expense - the cost of the home study and the cost of travel, accommodation etc. and the use of a local guide will account for most of your costs. It is impossible to give a general figure as there are so many variables.
Do get in touch with the specialist adoption information groups listed below, as they can give you good, up-to-date information and advice.
The Association for Families who have Adopted from Abroad (AFAA) (formerly STORK)
Adoption UK (formerly PPIAS)
In Vitro Fertilisation (IVF)
Egg Donation IVF
Egg donation IVF is the type of fertility treatment offered to most women who have suffered a premature menopause.
In women who still have their uterus (womb) it is possible to achieve pregnancy using eggs donated by an egg donor and fertilised in a test tube (in vitro fertilisation or IVF) with their partner’s sperm.
Children born as a result of this treatment are not biologically the mother's children but she is their legal mother and her name will appear on the birth certificates.
From April 2005, children born as a result of this treatment will have the right to identifiable information about their donor at the age of 18.
This hopefully produces embryos, and a maximum of two can be placed in the womb. Any spare embryos of good quality can be frozen. The success of Egg Donation / IVF treatment is variable. For up to date information on the clinics’ success rates contact The Human Fertilisation and Embryology Authority (HFEA) .
In some areas of the country this treatment is available on the NHS. From April 2005, all NHS regions should offer a single cycle of IVF. Private treatment is widely available and in 2005 typically cost £3,500-£4,000 per treatment cycle.
Finding a donor is difficult, and there is no national register of donors. If you cannot find a donor you will be put on your clinic’s waiting list – these vary in length from a few months to over two years in some of the larger centres. You can get information about this treatment and finding a clinic from The Human Fertilisation and Embryology Authority (HFEA) .
Questions To Consider
Before embarking on egg donation IVF there are a number of questions you might like to consider:
- If it’s successful, what will you tell the child and at what age?
- Who else would you tell about undergoing this type of treatment and at what stage?
- Do you have a support network if it’s unsuccessful?
- How many cycles would you be prepared to undergo?
- If successful, who would you tell about how the child was conceived?
- Also, in light of recent cases you should discuss the implications of your relationship breaking down and your partner’s right to withdraw consent for the use of any frozen embryos.
These are just a few questions to think about. However, these and many more questions should be aired when you see a counsellor before undergoing treatment.
Choosing A Clinic
If you decide to try egg donation IVF treatment you will need to decide which clinic to go to. Some clinics have waiting lists of 2-3 years, others of 6-9 months. Many couples decide to become patients at several clinics in order to increase their chances of getting a donor and being treated. You should also expect to pay to go on a waiting list if you are using a private clinic, in some cases this is refundable against treatment. Remember that you are paying for your treatment - you are the customer - and have the right to make an informed decision based on full information.
The Daisy Network does not recommend any clinics, however below are some questions that you may wish to ask when deciding where to have your treatment:
- How long will I have to wait for treatment?
- Do the clinic specialists have any expertise or research interests in any particular area?
- What are the live birth rates for people with my condition and my age? (Ask for the latest year and the one before for a good comparison.)
- How many egg donation treatment cycles did the clinic carry out last year?
- How many embryos do they implant?
- What is the cancellation rate for treatment cycles?
- Are freezing facilities available for unused embryos?
- Is there a dedicated counsellor available at all times and will I have to pay for this?
- How much do treatments cost?
- What is the cost to go on the waiting list? Is this refundable against treatment?
- What other costs are likely to be involved? (e.g. drugs)
- Will the clinic accept results from investigations carried out elsewhere? (Your GP may agree to organise blood tests and semen analysis on the NHS)
- Will I have to buy drugs from the clinic? (You may be able to get them cheaper from your GP - it’s always worth asking, or from private drug companies.)
- How will I be expected to pay and does the clinic have any payment plans to help spread the cost?
- Will I be able to see the same Doctor every time?
- Does the clinic actively recruit donors and how do they do this?
- Does the clinic offer egg share treatment?
- Do the clinic offer known donor treatments?
Owing to the lack of egg donors some clinics now offer the opportunity to share eggs. This is when a woman undergoing a 'normal' IVF cycle offers to share her eggs in order to reduce the cost of her treatment. How this is managed varies from clinic to clinic.
This is when a friend or relative agrees to donate eggs on your behalf. If blood type and CMV match then this means you will be the recipient of your known donors eggs. Although at first the idea of a known donor seems very attractive there may be more implications down the line than if an unknown donor is used. It is something which requires very careful consideration. If a match does not occur, what normally happens is that your known donor’s eggs are offered to another couple and you will automatically go to the top of the waiting list and be offered the next suitable donor. Not all clinics offer known donor treatment and will offer the latter option.
Be aware that donors do sometimes withdraw from treatment for many reasons and this can put good friendships or relationships under a considerable strain.
A woman that has decided to donate her eggs out of the goodness of her heart.
What Does The HFEA Say About Donors?
The HFEA guidelines say that a donor should be an altruistic and preferably anonymous volunteer, between the ages of 18 and 35, who has completed her family. She should not receive any financial compensation for her donation save for the fixed sum stated in the HFEA regulations, but may be reimbursed her travel expenses. Recruiting a donor is stressful. Do not expect your female friends and relatives to donate - many people are deeply sympathetic to you but will stop short of offering to donate, for practical, moral or health reasons. The media may be interested in your story and this can increase your chances of finding a donor - be aware that they may also want photographs. Think carefully about how much exposure you want.
What Does Egg Donation IVF Treatment Involve?
For Your Partner
Your partner will have his sperm analysed before a treatment cycle takes place to make sure that his sperm are OK. His role in the treatment cycle is to produce a semen sample on the day of egg collection. The sperm are then treated in the laboratory so that only the best ones are used. A quantity of sperm is put with each of the eggs collected from the donor, and you will usually know the next day how many have fertilised.
For the Recipient
If you have no natural cycle, you will be scanned at the start of the treatment cycle to make sure that the lining of the uterus is minimal. If you still have a cycle, you may be given a single injection or a drug inhale which you use continuously, to suppress it. Then you will take oestrogen tablets to build up your uterine lining. The development of your lining will be monitored by trans-vaginal ultrasound scans over the next 2 weeks. The lining should ideally be between 9 and 12 millimetres thick when transfer takes place. On the day of egg collection you will be given progesterone pessaries to take each day. If there are embryos to transfer, this will usually occur 2 days after egg collection.
Transfer itself is not an uncomfortable procedure and takes no more than 10 minutes. The embryos are sucked into a narrow, tube-like catheter which is then inserted through the vagina into the entrance of the uterus. The embryos are them released and the instrument withdrawn. You may be asked to come with a full bladder as this makes it easier to insert the instrument. Some clinics like you to remain lying down for a while after the transfer. You will continue to take progesterone pessaries and oestrogen tablets until the result of your transfer is known, usually 12 days later. If you are pregnant, you will continue to take both oestrogen and progesterone for the first 3 months of pregnancy. If you are not pregnant, you should be advised by the clinic about your medication.
For The Donor
The donor will have been screened for hepatitis B and HIV and a full medical history will have been taken. There are a number of ways of treating the donor in order to stimulate the development of a number of eggs. There are two elements to the treatment; the first is to suppress the donor's own cycle, and can be done by single injection or using a 'sniffer' drug throughout the cycle. The second element, usually injections and/or tablets, gives hormones so that the ovaries are stimulated to produce many eggs, rather than the usual one.
Vaginal ultrasound scans show how the follicles in the ovaries are developing, and a final injection is given to complete the maturing process for the eggs. The timing of this last injection is crucial - it should be given 34-38 hours before collection so that the eggs are mature but have not yet been released from the follicles.
Egg collection is usually carried out using a needle guided by ultrasound, either through the urethra or vagina. This method can be carried out under light sedation. Egg collection can also be carried out using laparoscopy, for which an anaesthetic is required. In this technique a small hole is made below the navel for a laparoscope to be inserted and a fine hollow needle is inserted separately to remove the eggs.
Surrogacy is when another women becomes pregnant with your partner’s sperm and carries the baby until it is born. She may use her own eggs, or eggs donated by the other woman through the IVF process. At birth the baby should be handed over to the father and his partner. When the child is 6 weeks old, the father and new mother apply to the court for a Parental Order. The Court appoints a guardian ad litem (court welfare officer) to interview the prospective parents and to recommend for or against the parental order being granted. If granted, the child is then legally the child of the marriage.
Childlessness Overcome Through Surrogacy (COTS) is an agency that aims to match surrogates with commissioning couples. COTS stresses the importance of feeling absolutely comfortable with your surrogate before you decide to go ahead and of maintaining good communication throughout the process of trying to conceive and pregnancy. It is important for the commissioning couple and any potential surrogate to express their preferences and requirements about all aspects of their relationship and the pregnancy.
Commissioning couples may feel anxious about receiving the baby at the end of the pregnancy. Do remember the risks and anxieties which the surrogate may have - illness in pregnancy, the commissioning couple abandoning the pregnancy or baby, etc. - the relationship must be built on trust and good communication, and a real appreciation of what the surrogate is doing for you. The commissioning couple are often closely involved with the surrogate during the pregnancy, speaking and visiting with her regularly and attending medical appointments, as well as the birth.
Surrogacy is becoming more common and better understood by the general public, although it can still provoke some hostile responses and concerns about whether the surrogate mother will give up the baby when it is born. In fact, the great majority of surrogate babies are passed to their parents and the court grants a parental order without incident.
The Childlessness Overcome Through Surrogacy (COTS) organisation can give full information about surrogacy, and help you to find a surrogate
If you choose to remain childless from the start, or after unsuccessful IVF treatments, see it as a positive life choice.
Deciding not to have children is an even braver and more unpredictable life choice than choosing to have them because of the ensuing consequences from family/general society. You are not conforming to what society expects of you. You develop your own identity in other ways. You strike your own path.
You may find yourself having to defend this decision, as others will not understand your not choosing to pursue IVF egg donation or adoption. It is very important that you understand why the choice you make is right for you and come to terms with that choice. It is YOUR choice and you do NOT have to explain your decision, or feel guilty about it. Loneliness is often a worry when thinking about being childless. But there are no guarantees that a child will be there for you in later life and you may have had feelings of greater loneliness once children had left home.
Remember that everybody has regrets about some of the life choices they make and that you may get these feelings too from time to time, but they pass. Take pride in your independence and your ability to do what is right for yourself, whatever choice you finally make. Enjoy your freedom and self-reliance.
Note:For more information on this subject a Positively Childless Fact Sheet is available.
The Human Fertilisation and Embryology Authority (HFEA)
The HFEA was set up in 1990 under the Human Fertilisation and Embryology Act to license and regulate clinics which provide IVF treatment (with or without a donor) and storage of sperm or embryos. Clinics can only provide these services if they have a license from the HFEA. In addition to this function the HFEA also:
- Publishes a code of practice for clinics who carry out these activities
- Keeps a confidential register of information about donors, patients and treatments
- Gives advice and information to people seeking fertility treatment.
The HFEA publishes the following information which will be useful for people wanting egg donation IVF:
Considering fertility treatment?
When exploring fertility treatment the HFEA is the first place to go for reliable information. The HFEA has produced a new publication, Getting started: Your guide to fertility treatment aimed at people who are at the beginning of their fertility treatment journey.
Click here to order your free copy or pick up a leaflet with a pre-paid order form at a GP surgery.
Getting Started explains the different fertility treatments available, what to think about before you begin, what to expect when you visit a clinic, funding options, potential risks and where to get support.
Each section of the new guide directs people to the HFEA website for more detailed information and the latest data on licensed clinics. Making sure you have all the information you need means you can be confident that you're making the right choices.
Subscribe to e-updates Service
Have the latest news from the HFEA delivered every month to your inbox by subscribing to our e–update service. Click here to subscribe.
The Patients' Guide To DI and IVF Clinics
This gives information about fertility treatments, the issues involved with these treatments and advice on selecting a clinic. It also comes with a booklet of all centres licensed by the HFEA giving their addresses and phone numbers, treatments offered and success rates.
Leaflets On Egg Donation And Donors And The Law
These leaflets give full information on what treatment is involved and the legal position regarding donors. Many clinics will include a copy of these leaflets in their own literature.