Egg and sperm donations
In some cases a couple’s own genetic material is used, while in other cases genetic material from other people is required. It is illegal to buy or sell human gametes (eggs and sperm) or embryos in New Zealand, but they can be donated.
Fertility clinics prefer to use eggs from donors of proven fertility, and who have completed their own family. Sperm and egg donors are medically screened and undergo counselling. If donors are known to the intended parents, then both undergo joint counselling. Donors are not legally responsible for any children produced from their donated eggs or sperm.
Donor insemination (DI) is a low-tech fertility procedure. It involves the simple transfer of sperm into a woman’s uterus. This can be done by medical professionals, or may be done by the woman herself using a device like a syringe. DI is only suitable if fertile sperm is all that is required to achieve conception. It is a common way for fertile single women or lesbian couples to have children.
The first in-vitro fertilisation (IVF) treatment in New Zealand took place at National Women’s Hospital, in Auckland, in 1983. IVF is a response to both male and female infertility. It involves the fertilisation of ovarian egg cells by sperm outside the womb by a medical professional. One to two fertilised eggs are then transferred to the woman’s uterus. Conception is not guaranteed.
Related treatments include intracytoplasmic sperm injection (ICSI) which involves the injection of one sperm into an egg. This is used when the sperm is of poor quality and not suitable for IVF.
Pre-implantation genetic diagnosis
Pre-implantation genetic diagnosis (PGD) is used to test embryos for inherited diseases and chromosomal abnormalities before transfer into the womb. It can be used to select an embryo in cases where an older sibling suffers from an inherited disease and the only possible treatment is using the cord blood of a healthy sibling. Approval from the Ethics Committee on Assisted Reproductive Technology (ECART) is required in these cases. PGD cannot be used for social reasons such as selecting the sex.
Embryo and egg freezing
In the 21st century the freezing of embryos (eggs fertilised with sperm) and eggs or ova increased. Embryo freezing has been available in New Zealand since late 2005. Frozen embryos were most likely to be embryos created during IVF processes that were not inserted into the womb. They were frozen to be used if the in-vitro fertilization process did not result in conception. Frozen embryos can be stored for up to 10 years. After that, people must apply to the Advisory Committee on Assisted Reproductive Technology (ACART) if they want to extend storage or decide whether to discard or donate their surplus embryos to another infertile couple or person.
Ovarian egg freezing started in New Zealand in 2003 and in 2009 women could thaw their eggs for use legally. Sometimes women decide to freeze some of their ovarian eggs because they want to be sure that they have eggs to use through in-vitro fertilisation in the future. This may happen because a woman is about to have medical treatment that could damage their eggs. Some women choose to have eggs harvested and frozen because they want to have eggs available when they are older and choose to have children. The quality and number of women’s eggs decline as she gets older and the storage of frozen eggs can increase the chances of women conceiving if they want to delay childbearing.
The harvesting of eggs for freezing requires hyper-stimulation of the ovaries so that more eggs are available for retrieval. Mature eggs retrieved from the ovaries are frozen. They are thawed and injected with sperm when a woman wants to use them to become pregnant.
Hyper-stimulation, egg retrieval and egg freezing for social reasons is not publicly funded. Funding is available for women whose eggs may be damaged by medical treatment, such as some treatment for cancer.
Women become surrogate mothers for personal as well as altruistic reasons. In a 2008 study one woman said she wanted to be a surrogate, ‘Because I saw what my mother went through with her infertility. I always knew that I wanted to help somebody who may be in a similar position … Although nine months is quite a long time I have relatively easy pregnancies and deliveries. I guess the whole idea of nine months out of my life [is] giving somebody else a lifetime of joy and the opportunity to be a parent … Really, what greater gift is there?’1
In traditional surrogacy a woman carries a baby that is her genetic child for a couple where the woman cannot carry a child – for example, she may have had a hysterectomy. The prospective father provides the sperm. Low-tech self-insemination methods are often used. Some people may use a fertility clinic to screen sperm for sexually transmitted diseases and genetic disorders. To guarantee paternity, traditional surrogate mothers may be asked to refrain from sex for two months prior to insemination and for one month afterwards.
In a gestational surrogate pregnancy a birth mother carries the baby, but the eggs and sperm are provided by others (usually the intended parents) through IVF. Ethics approval must be sought for any surrogacy arrangements involving a fertility clinic. Gestational surrogacy was available from 2002.
Commercial surrogacy is illegal in New Zealand. Birth mothers cannot be paid, but can be reimbursed for ovulation and pregnancy testing, vitamins, legal and counselling fees, and transport to and from inseminations. The parents have to adopt the child after birth.