ABSTRACT

For patients with ovarian failure, IVF is not a medical option. Nonetheless, these patients have a good chance of achieving pregnancy with oocyte donation. The known time, effort, commitment, discomfort, and minor risks derived from ovarian stimulation and oocyte retrieval continue to limit donor availability.1-3 Egg sharing is a form of egg donation where complete strangers can collaborate anonymously to overcome their involuntary childlessness. Since the Australian team of Trounson and Wood first reported a successful oocyte donation >I 5 years ago,4 the procedure has spread around the world, although in a limited way (small number of patients treated) when compared with sperm donation or with in-vitro fertilization (IVF) (2930 cycles of oocyte donation worldwide in comparison with 119,992 IVF cycles in 1991).5 This modest activity is probably due more to the difficulties of the procedure for the oocyte donor (IVF) than to the lack of medical indications, since it is estimated that >100000 women in the USA present with premature ovarian failure (before the normal age of menopause).6 From a purely rational point of view, oocyte donation is the mirror of sperm donation; it consists of introducing, in the couple, half of the genetic material from a third party donor (a male donor in the case of sperm donation, a female donor in the case of an oocyte donation). However, the similarity stops there; symbolically, sperm donation and oocyte donation are experienced very differently by couples. This was shown by a Californian study on the reaction of recipient couples to the possibility of recruiting the brother (or sister) of the sterile partner as the donor; whilst 86 percent of the women and 66 percent of their partners involved in oocyte donation stated that they would prefer the patient’s sister to an anonymous donor (moreover 80% had asked for it), only 9 percent of the women and 14 percent of the men involved in sperm donation expressed the same preference for the brother of the patient and no one had actually asked for it.7 This difference has its origins in the different perception of feminine and masculine sterility, both by couples and by society; a perception which frequently leads to hiding masculine sterility and to openly accepting feminine sterility.8 Some recipient candidates may also worry about the transmission of infectious or genetic disorders or, in case of non-anonymity, fear the ‘genetic’ donor ringing at the door some years later. However, a comparative examination of the differences and similarities between oocyte and sperm donation shows that this is not the case. In addition, maternity by oocyte donation repairs a double major wound in women not only confronted by the failure to become a mother, but also disturbed in their female identification (absence of a cycle) and even in their sexual identity (Turner’s syndrome, gonadal dysgenesis). All these reasons explain the massive denial observed in pregnant

women or having given birth after an oocyte donation, which can go as far as ‘forgetting’ the distinctive character of their filiation ties.9,10

As far as the future of the children is concerned, the paucity of available data does not indicate real particularities11 in accordance with the studies carried out on children conceived by AID.12,13

Unlike sperm donation, oocyte retrieval is not without risk, either the risk related to ovarian stimulation or to oocyte retrieval, even to anesthetic risk in case of general anesthesia. An informed consent document is therefore all-important, and it must be preceded by the provision of meticulous information to the potential donor on the nonexceptional risks of treatment especially when it concerns non-anonymous donations where the medical risks often appear to be minimized by the potential donor.14 Since this consent is only of value if it is freely given, the discussion, in case of a related donor, must aim at detecting the candidates who may be pressurized by the recipient couple. In this case, it is necessary to act with tact to help the ‘non-candidate’ to get out of a commitment which has not been freely agreed to without compromising her relationship with the recipient couple, whether these relations are effective or professional ties.