Pitfalls for patients to avoid when donating eggs

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I READ with interest the article entitled “Earn money quickly with “eggs”(June 16, 2022, the sun), which described the ethical issues surrounding the rampant commercialization of egg donation in Malaysia.

Indeed, many foreign patients often travel to Malaysia for in vitro fertilization (IVF) egg donation treatment, due to the ready availability of paid egg donors. Nevertheless, due to lax regulation of egg donation, patients often have to navigate a complex web of marketing gimmicks, misleading information, and ethical traps. Therefore, it is imperative to point out what they should pay attention to and be wary of.

Above all, patients should be especially careful not to be duped into performing unnecessary genetic testing on IVF embryos, a technique known as preimplantation genetic screening (PGS) or preimplantation genetic testing – aneuploidy (PGT-A). . This procedure is very expensive and often increases total medical costs by up to 50%.

Many Malaysian fertility clinics often exploit IVF patients’ fear of unknown genetic diseases transmitted by egg donors to sell embryo genetic testing (PGS/PGT-A). They often hide from patients the fact that similar genetic testing on blood samples or oral swabs from the egg donor is much cheaper than genetic testing on IVF embryos.

A blood or oral swab sample contains 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 to PGS/PGT-A, genetic testing of blood samples or oral swabs from egg donors is technically simpler and much cheaper.

Additionally, patients can also consider more cost-effective prenatal screening options after becoming pregnant, such as the new generation of non-invasive prenatal tests, which can screen fetal DNA extracted from blood samples of pregnant women for defects. genetics.

Patients should understand that more expensive testing methods are not necessarily better. Despite the high cost of PGS/PGT-A, it is not a foolproof screening method for genetic defects. This technique only detects common genetic diseases, not rare genetic diseases. It is also useless for detecting more complex genetic conditions caused by interactions of several genes with the birth environment, for example, autism spectrum disorders.

Also, if the egg donor is young, there is no need to use PGS/PGT-A to screen the embryos for Down syndrome, which usually results from genetic abnormalities in the eggs of older women. .

Although many Malaysian fertility clinics claim that PGS can improve IVF success rates in older women, this only applies to older women using their own eggs, and it will not improve women’s success rates. elderly using young egg donors.

It should also be noted that PGS is not completely risk free. Since this delicate technique involves piercing the outer envelope of the embryo (Zona Pellucida) to extract cells for genetic testing, there is an inherent risk of damaging the embryo.

The success of this technique often depends heavily on the skill and training of the laboratory staff (embryologist). Even with high levels of training and accreditation, there is always the possibility of human error, especially in a busy lab that handles multiple such cases per day.

Finally, patients should also be wary of fertility clinics manipulating their biased preference for a boy or a girl, to persuade them to undertake very expensive embryonic genetic testing for gender selection.

Some Malaysian fertility clinics may offer frozen egg donation as a cheaper alternative to fresh egg donation. This has simpler logistics as there is no need to synchronize donor and recipient hormone stimulation cycles, and saves the cost of transportation and hotel accommodation required for fresh egg donation .

However, the success rate of frozen egg donation is significantly lower than that of fresh egg donation, which is often understated and overlooked.

Patients should also avoid using frozen eggs transferred from an egg bank to the IVF lab. Because human eggs are very sensitive, the thawing technique must be compatible with the freezing technique, which is similar to the relationship between a lock and a key. Only IVF labs that perform both freezing and thawing procedures can generally achieve good success rates from IVF with frozen eggs.

Some Malaysian fertility clinics use traveling egg donors from out of town or out of state. The overwhelming majority of egg donor agencies and agents in Malaysia are based in Greater Kuala Lumpur and Penang, and IVF clinics in other parts of Malaysia (such as Johor and Malacca) often rely on these agencies and agents to find egg donors for their patients. . This is not good for recipient patients because it is difficult to monitor the hormonal stimulation cycle of egg donors traveling to and from out of town.

Some doctors may hand over expensive hormone drugs (requiring refrigeration) directly to out-of-town donors to inject themselves under the supervision of their agents. They will return to the clinic for an ultrasound of the ovaries at a designated time or perform the final egg retrieval operation. Since IVF clinic supervision is not at hand, the egg donor may not be bothered to strictly adhere to such a painful and time-consuming self-injection routine.

If careless, expensive hormonal drugs may not be stored properly in the refrigerator, which leads to deterioration and reduced potency. Without strict adherence to the injection protocol and proper refrigeration of hormonal medications, the number and quality of eggs obtained from the donor will be severely compromised.

Therefore, it is preferable that patients use egg donors residing in the same city as the fertility clinic, and it is also preferable that the egg donor regularly receives registered hormone injections from the fertility clinic herself, rather than self-injecting.

Additionally, foreign patients should beware that it may be cheaper to contact Malaysian egg donation agencies directly and undergo treatment at their affiliated fertility clinics.

If unaffiliated fertility clinics are asked to find egg donors, they often charge unscrupulous additional fees.

Normally, when you ask an unaffiliated fertility clinic to find you an egg donor, they contact many different outside agencies and get several matching egg donor profiles.

You choose an egg donor and the clinic will coordinate with that specific egg donor agency. You do not 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 significant portion of your payment for themselves as additional profit.

Finally, overseas patients should note that in Malaysia, recipient patients often lack the support of fertility counselors. In contrast, in most Western countries, beneficiary patients are often required to submit to compulsory counselling.

A strict counseling regime will ensure that both spouses agree to egg donation, without any emotional blackmail from either spouse and without undue pressure from parents and in-laws .

In traditional Asian culture, the transmission of the family line is considered the most important responsibility of the wife towards the husband and his family. Therefore, childless women may be pressured by their husbands and in-laws to accept egg donation in order to conceive a child.

As an old saying goes, “A happy and successful marriage requires two hands to clap.” This also applies to raising children. Innocent donor-conceived children may be negatively affected by the reluctant spouse.

Beneficiary patients will miss valuable advice on whether to tell the truth to their children in the future. Most experienced fertility counselors will advise them to tell the child the truth when they are old enough to go to school.

Numerous psychological studies and news reports have documented the emotional trauma and identity crisis experienced by donor-conceived adolescents and adults when they accidentally learn the truth about their conception, for example during a family dispute.

In many cases, this often leads to the estrangement of parent-child relationships. Additionally, readily available and inexpensive home DNA testing kits and related genealogy websites (such as ancestry.com and 23andme.com) have made it more difficult to conceal the truth from donor-conceived offspring.

It is possible for donor-conceived offspring to come into contact with relatives via DNA matching through these websites and inadvertently learn the truth about their conception.

With rapid advances in medical technology, it is expected that DNA testing will one day become standard practice in healthcare. Ultimately, it is up to the patient beneficiaries to decide whether or not to tell their child the truth. Telling the truth will reduce their psychological burden and give them peace of mind.

Dr. Alexis Heng Boon Chin is a citizen of Singapore, who works as an Associate Professor of Biomedical Sciences at Peking University, China. He had previously worked in the field of clinical research on human assisted reproduction in Singapore and has authored 50 publications in international journals on ethical and legal issues related to new reproductive technologies, in addition to having also published more than 270 articles in scientific journals. Comments: [email protected]


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