The landscape of family building, pregnancy and conception has changed dramatically in this century. Over the past 30 years, the number of births from gamete donation is increasing exponentially. It is estimated that more than 8 million children worldwide have been born as a result of assisted reproductive technologies (ART), many of whom have been conceived with the help of gamete donation.
Gamete donation is giving sperm, eggs, or both, or embryos to another person or couple struggling in their fertility journey towards parenthood. When only sperm or eggs are donated, it allows patients to have children that will have a genetic link to one of the partners. It can also permit the patients to experience the pregnancy and birthing event.
The three major aspects of any type of donation are Medical, Legal and Psychological. Thorough screening should be performed including many types of tests. Legal agreements should be drawn up so that both donors and recipients understand their obligations, roles, and expectations. Last but not least, since donation can be an emotional experience for everyone involved; preparing for this experience with counselling can be very helpful – for the wellbeing of the child, the recipients, and the donors.
Egg donation in Greece
In recent years, more and more couples that are struggling towards parenthood, resort to egg donation in order to succeed in becoming parents. The widespread use of the third party in ART and the success of infertility treatment following its use, has led to an increased number of women volunteers who enter the oocyte donation process, mainly for altruism reasons. Although egg donation has become a widely accepted method, it took several years of skepticism and ethical dilemmas in order to be adopted as a common conception solution for infertile couples, or even as the ‘’gold standard‘’ for some cases.
Egg donation is permitted in Greece, in accordance with the recently updated provisions of the law 4958/2022, and is now less restrictive. Egg donation is anonymous or eponymous (by choice of the donor and the recipient) and voluntary. Financial compensation for egg donation is not allowed, but the donor is compensated for medication, as well as travel expenses, loss of income due to absence from her work, etc. Gamete Donation of tissues are voluntary, and it is not permitted to be paid except for the expenses and compensation provided, according to the article 12 par.1 in Law 4272/2014 and in Law no. 54/2014.
Thus, large numbers of donors are available, eliminating long waiting lists for Medically Assisted Reproduction treatment. The primary benefit to every woman who donates eggs should be the outmost gesture of altruism and selfless act of helping another person or couple achieve pregnancy.
Greek egg donors are described as young women – the law sets the age limit at 35 years anyway – with an average age of 25 years, a good level of education, who usually live in large urban centers like Athens or Thessaloniki. They usually join an egg donation program, having been informed about it by another person in their community, usually an acquaintance or a friend who has been a donor herself. The candidates are Greeks but also foreigners – after all, the law is not restrictive in terms of nationality, it only requires that the donor to be a Greek resident. The ratio of Greek women to foreign women is 40-60 %, and only those deemed perfectly healthy and meeting the legal requirements, are accepted.
Moreover, all donors undergo meticulous clinical testing. Special screening includes sexually transmitted diseases, HIV, Syphilis, Hepatitis B and C, CMV, Chlamydia, Cystic fibrosis (up to 99% of CFTR gene mutations), hereditary genetic diseases such as fragile X syndrome, alpha/beta thalassemia, delta/beta thalassemia, proximal spinal muscular atrophy (exons 7 and 8), non-syndromic hearing loss (35delG and L90P mutations), karyotyping. Also, it is required her FSH level to be less than 8, her BMI level to be less than 32 and have both of her ovaries.
Egg donation treatment is either anonymous or eponymous (by choice of both the donor and the recipient). In case of eponymy, the child could obtain information about the donor after the age of 18. In anonymous donation, the donor and the patient’s identity are not disclosed in any case. The recipient selects whether to have an anonymous or eponymous donor. Of course, disclosing donor’s information regarding characteristics such as skin, eye and hair color, blood type, weight/height, social and cultural background is permitted.
Sperm donation in Greece
Like blood or organ donation, sperm donation offers the possibility of creating a new life. The contribution of donors to this process is very significant. Without them, a lifetime dream which brings the greatest happiness – parenthood – may never come true for many people. According to Greek legislation, the maximum acceptable number of children derived from the sperm of the same donor amounts to 10. In case the donor has already acquired his own biological children, he is requested to inform the Sperm Bank. After the successful implementation of the assisted reproduction method using donor sperm, the child will have as a legal mother, the wife/partner and as a legal father the husband/partner. The consent of the husband/partner to submit the wife/partner to heterologous artificial insemination excludes the offense of paternity.
Most of the sperm donors in Greece are between 18 and 40 years old, representing the general diversity of society. This essentially means that they come from all walks of life with all kinds of religions, ethnicity, education, work and sexual orientation. They are mentally and physically healthy and have undergone thorough genetic testing to screen for serious inherited genetic diseases. Donors are often people who have met infertile couples. In short, they have witnessed the difficulty and frustration of people who are struggling to become a parent. Sperm donation in Greece is compensated, mainly for donor’s time, effort and dedication to the process. Donors are compensated approximately €50 each time they donate. Based on EU directives, the sperm donor receives compensation for the above reasons, but also for travel costs. The financial cost to the patients for obtaining the donor’s sperm, is approximately 200 EUR. The cost mainly depends on the sperm population needed for the treatment (IUI or IVF). This cost refers to the compensation of the sperm bank for the services necessary for the donor’s sperm to become available for donation to the patients, safely. These services include the costs for the medical examination of the donor and his sperm, the compensation of the donor, the cryopreservation of the sperm, its disposal and transportation.
It is obligatory for all sperm donors to undergo a rigorous selection process: medical examination, semen analysis, sexual history assessment and a series of DNA and blood testing. This process ensures they are not carriers of sexually transmitted or infectious diseases, such as HIV, Hepatitis B and C, Syphilis, Cytomegalovirus, Gonorrhea, Chlamydia, various types of Streptococci, Trichomonas, or hereditary diseases. Due to this strict screening process, only 1 in 20 candidates will ultimately become a sperm donor. The donor sperm is stored and frozen in liquid nitrogen. Each sperm donor also undergoes a personality test (Keirsey test) and an individual and family medical history is obtained from the sperm bank. Medical information concerning the sperm donor is kept strictly confidential and encoded in Sperm Cryopreservation Bank and in the National Record of donors and recipients, which must be maintained by the Greek National Authority of Assisted Reproduction. Access to this record is only allowed to the child and strictly only for reasons related to his health. The anonymity of sperm donors in mandatory under Greek legislation. Nevertheless, interested parties are offered sufficient information about each donor, so that they can make their choice based on their personal requirements. This information includes the donor’s physical characteristics (height, weight, eye color, hair color and type, body build), nationality, blood type, psychological profile and some of their interests. In addition, there is access to information regarding the donor’s educational level and professional career. Also, information if the donor already has a family and children of his own, could also be disclosed.
Sperm donor reservation in the context of ensuring a woman’s children will be 100% genetically related as siblings, is possible. However, since there is a chance that the donor’s sperm will be used up by other interested parties, it is advisable, when a woman decides which donor to proceed with, to make a pre-booking on his sperm. Many Greek IVF clinics are collaborating with Sperm and Egg banks across Europe so it is possible to proceed with ART using gametes outside Greece. There is no current legislation or data mentioning if this is possible outside EU.
The use of fresh sperm, or the use of sperm from more than one donor during the same treatment cycle, selling or purchasing sperm is prohibited.
Greece is rapidly becoming a competitive destination for IVF globally, thanks to the combination of excellent standard of care, very short waiting times for treatment and high-quality and innovative services, at reasonable rates. Over the years, more and more couples from USA, Europe, Australia, and Canada are placing their trust in healthcare professionals in Greece to support them in their fertility journey towards parenthood. One of the main reasons that couples choose Greece as a destination for infertility treatments is the country’s progressive IVF legislation. Greece has a fully regulated, comprehensive and transparent Medically Assisted Reproduction legal framework. It is considered as one of the most advanced whilst at the same time liberal. It is no wonder, therefore, that the legal framework in combination with low medical care costs, and high level of services, that Greece has become a top destination of choice for those seeking fertility treatment abroad. The current recently updated Greek law (4958/2022) regulating the framework of medical assistance in human reproduction and ART applications, introduces reforms and offers an updated framework for the application of recent scientific techniques.
One of the important reforms is related with the age limit of women that want to use ART procedures. The 2005 Greek legislation was setting the age limit for women who wish to resort to IVF at 50 years old. The age limit was recently extended to 52 years due to the COVID-19 pandemic. Quite recently, a new extension of the age limit to 54 years was approved. This will facilitate many couples that due to the age restriction had to travel to other countries in order to undertake ART techniques. Now, these couples have the opportunity to choose Greece for their IVF treatment. Some other key-points explaining why Greece is such a desirable destination for ART treatments are:
- Cross-border Medically Assisted Reproduction is permitted in Greece, regulated under 4958/2022 ART law. Access to IVF/ICSI – using donated sperm, donated eggs, donated sperm plus donated eggs or donated embryos – could help heterosexual couples and single women.
- The legal limits of ART access in Greece for females is 18-54 years old, and for males minimum age of 18 years.
- Legal limits in third-party donation, is permitted. For sperm donors maximum age is 40 years old, with maximum number of infants 10. For egg donors, maximum age is 35 years old, with maximum number of infants also 10.
- In regards of the anonymity, anonymous and non-anonymous sperm and egg donation is allowed.
- PGT is also permitted in Greece, when in 11 EU countries it is not allowed.
- Embryo donation is allowed in Greece.
- Surrogacy is allowed in Greece, but it is under law regulations, which is a big step for patients considering this option. According to these regulations, there should be medical grounds and court approval for surrogacy procedure. Both the couple and the surrogate need to be permanent Greek residents by proof. For a non-married couple, the law states that additional notarial deed should be signed. A woman may confirm that she is single or – if there is a partner – he should agree to treatment and claim the future offspring.
- Embryo Sex selection is only allowed for medical reasons. Thus, it is available if there is a significant risk that the offspring may have genetic disorders.