Embryo adoption in the US: Any lessons for the UK?

Once a couple or individual has finished their fertility treatment, the question of what to do with any remaining frozen embryos is often perceived as a difficult decision. There are, broadly, four options to choose from: keep the embryos in storage; allow them to be destroyed; make them available for research; or donate them to others to use for family-building. Recently we conducted a study of embryo donors and recipients of donated embryos who had pursued the fourth option through an American embryo adoption agency, Snowflakes. We were interested in exploring what kind of contact they had established with each other both during and after the donation process (Blyth et al, in press; Frith et al, 2017).

Embryo adoption is a form of conditional donation – donors can choose who receives their embryo(s) and contact between the parties can be negotiated. This has been pioneered by private agencies in the USA over the past two decades and, in a different form, New Zealand (Goedeke et al 2015). Embryo adoption agencies such as Snowflakes provide donors with information about potential recipients (ie details about their religious beliefs, education, interests and family life). Also, if the donors and recipients are agreeable, they can arrange to have contact with each other. This offers an alternative to fertility clinic-based, anonymous embryo donation programmes.

We found that the donors felt a sense of responsibility towards their embryos and wanted to make sure they went to a 'good home'. Both donors and recipients thought that being open with their children about their origins was important. One of the defining characteristics of embryo adoption is information exchange and the possibility of ongoing contact between donor and recipient families. Hence, our participants wanted to share information about the children and keep in contact with each other, and some donors and recipient couples had met face-to-face.

Our study showed how donors and recipients can acknowledge each other's role in the lives of their own family and establish meaningful relationships. While developing successful relationships within the context of this novel family form was not necessarily problem-free, most study participants reported mutually satisfactory arrangements and, on the whole, participants were happy with the amount and type of contact they had. All participants expected that existing inter-family communication and contact arrangements would develop. In cases where the contact did not yet involve the children, it was seen as a way of keeping the channels open. In the future, participants expected that the children would take a more participatory role and eventually take responsibility for the contact arrangements themselves. Our study suggests that this model of open embryo donation better addresses the needs of some potential embryo donors and recipients than anonymous embryo donation.

How such a model of donation might be realised in other contexts is an area for further research. For example, currently in the UK, although donor-conceived people may discover the identity of their donors once they reach adulthood, conditional embryo donation is not available. When a couple donate their embryo, they usually have no say in who receives it, and there is no contact between the donors and potential recipients. However, legally, there is nothing preventing clinics from starting such a programme since donation can take place between donors and recipients who know each other. Also, the Human Fertilisation and Embryology Authority, allows donors to put extra conditions on the use of their gametes or embryos, which, theoretically at least, gives the donors some potential say in choosing who gets their embryo(s) (Frith and Blyth, 2013).

Under UK legislation, there are some limitations on the potential extension of conditional donation. For example, the Equality Act prohibits discrimination on certain grounds, such as gender and sexuality. How clinics can and should monitor such choices is a difficult question, but one solution would be to counsel people with embryos to encourage choices that are not discriminatory.

There could also be practical difficulties regarding organisational arrangements and the associated costs involved. However, if there was sufficient demand for a conditional embryo donation programme, such practical difficulties could be overcome.

So should we begin to think about conditional embryo donation in the UK? Without any evidence to suggest that this form of embryo donation is harmful, there is no reason why it should not be offered. Conditional embryo donation could operate alongside, rather than replace, existing embryo donation programmes. This could give those who wanted it the opportunity to choose who they donate to and to have contact with them while the child is growing up.