– It’s really cool, says Camilla Kleveland. The senior doctor at the Fertility Section at St. Olav’s hospital in Trondheim has many times had to turn away women who need donor eggs to fulfill their dream of having children. Because with only 11 approved donors, Norway’s only public offer for egg donation is struggling to cover the need. – We have had to set fairly strict requirements for who we even accept on the waiting list for donation, says Kleveland. Both eggs and sperm are stored in liquid nitrogen at St. Olav’s hospital. There are far more sperm than eggs in the tank. Photo: Hanne Bernhardsen Nordvåg / news They only give priority to childless women under the age of 40 who cannot have children for genetic reasons or as a result of medical treatment for a serious illness. Everyone else gets a no. And those who are actually put on a waiting list do not know how long they will have to wait. “Amalie” is one of them. – They say that it depends on when and how many donors they get. It is demanding to wait, and the waiting time has already been long, says the 38-year-old. Amalie is a name news has given her. In order to ensure complete anonymity between donor and recipient, she does not wish to provide her own name and photo. – Worthy of criticism Seven years ago, Amalie went through intense cancer treatment which destroyed her egg reserves. Therefore, it was a lucky day when the Storting in June 2020 decided to make egg donation legal in Norway, from 1 January 2021. Egg donation Egg donation was allowed in Norway from 1 January 2021, after the Storting decided to amend the Biotechnology Act in June 2020. Per today there are one public and four private clinics that are approved for egg donation. Who can donate eggs? Egg donors must be aged 25-35, be registered with the population and have a permanent connection to Norway. She must be physically and mentally healthy, and not have any known hereditary disease. She cannot abuse drugs. The egg donor must have good egg production, have normal egg reserves, normal hormone status and no abnormalities on ultrasound examination that could indicate reduced fertility. The donor must also have thought through what it will mean for herself and her family to be a donor, and be in agreement that she can be contacted after the child has turned 15. The clinics are obliged to provide guidance on this. The donation will not affect the donor’s fertility and opportunities to have their own children. How does an egg donation take place? The donor receives hormone treatment in the form of daily injections to increase the number of eggs that can be retrieved, usually for 10-12 days. During this period, she must attend an ultrasound one or more times to monitor the development of the eggs. One or two days before the eggs are to be retrieved, the donor takes a hormone injection or nasal spray to trigger ovulation. The eggs are retrieved via the vaginal wall, through a thin needle. The donor will then receive painkillers, anesthesia and a mild sedative. The actual harvesting lasts about half an hour. After the eggs are retrieved, they belong to the recipient, and they will be fertilized with the recipient’s partner’s sperm before being inserted into the recipient’s uterus. The donor has no right to know who will receive the egg or whether it will produce a child at all. One donor can donate eggs up to three times, and 10-12 eggs are usually retrieved each time. Usually, one egg donor can be used for 1-2 families. Is the donor compensated? The donor will be paid approximately NOK 5,000 for each time she donates eggs, as compensation for the stress and time the treatment entails. Medicines and any travel and accommodation expenses are also covered, and the donor receives sick leave if she has to be away from work. Who can be the recipient of eggs? Those who receive eggs are women who have challenges in having children on their own. Reasons for this can be early menopause, genetics, illness, old age, or complications after medical treatments for e.g. cancer. A prerequisite for being able to get a donor egg is also that you have a partner who can donate sperm. The Biotechnology Act requires one of the parents to be known in the case of assisted fertilization. Sources: Helsenorge.no, Directorate of Health, senior physician Sigrun Kjøtrød – Cancer at a young age makes you vulnerable in so many ways. This is one of the most painful things. Egg donation is my only possibility to have children with my partner. Although she waits in uncertainty, she is incredibly grateful that she has come through the eye of the needle at St. Olav. At the same time, Amalie thinks it hurts to know that there are so many people who don’t even get a place in the queue. – It is objectionable that more than two years after egg donation was adopted, there is only one hospital that offers the treatment, and that they offer it to such a small extent as they do, she says. – In principle, I believe that involuntary childlessness triggers public health care, and it is help that today is not there for many of us who need it. Camilla Kleveland is impressed by those who have chosen to become egg donors. She points out that it is, after all, a bit more manageable than being a sperm donor. Photo: Hanne Bernhardsen Nordvåg / news Camilla Kleveland at St. Olav would also like to see that things were different. – We would like there to be a large influx of donors, so that more people can be helped. But those who cannot get a place with us, we encourage them to go privately. Animal treatment In addition to St. Olav’s hospital, there are four private clinics that are approved for egg donation in Norway. news has been in contact with all of these. They can confirm that it has also been a challenge for them to find donors in Norway, but they still have better capacity than at St. Olav. One clinic has chosen to exclusively buy eggs from Finland, while the other three together have approved more than 100 donors. There is great variation in the number of clinics between them. The egg is fertilized with sperm in the laboratory, before the embryo is eventually inserted into the uterus. Photo: Hanne Bernhardsen Nordvåg / news Gynecologist Liv Bente Romundstad runs the Spiren Fertility Clinic in Trondheim, in addition to being a researcher at the Center for Reproduction and Women’s Health at the Institute of Public Health. She, too, calls for a better public offer, preferably through collaboration with the private sector. – At Klinikk Spiren we have no waiting time, and there is room to treat more people in private. If we had been able to work together, we could have helped more people more effectively, says Romundstad. She also points out that egg donation is expensive. At a private clinic, one trial costs just under NOK 100,000. She believes that more people should not have to pay this bill for involuntary childlessness themselves. – There are many different conditions and reasons why egg donation may be the only option, says Romundstad. – We believe it is not right that, for example, a couple in their late 20s should have to go privately and pay dearly because it is the only real offer. Liv Bente Romundstad shows us what an embryo looks like on day four. She says that at Spiren Fertility Clinic, which she runs, they now have no waiting time for egg donation. But she points out that there is a delicate balance between supply and demand. Photo: Hanne Bernhardsen Nordvåg / news Romundstad believes it could have been appropriate to have an arrangement where the state pays the bill for treatments in the private sector, if the women meet given medical criteria. This is supported by several of her colleagues. Gynecologist and clinic manager at Livio Oslo, Nan Birgitte Oldereid, points out that in Sweden, public services in treatment with assisted fertilization are bought from the private sector. – Patients then have several options for test tube treatment. In addition, it frees up resources so that the public sector can carry out other national and regional tasks. However, Oldereid also believes that more hospitals could benefit from creating an offer for egg donation. – Egg donation is not something that all public hospitals should do, but it should be an offer in several health regions, she says. The resources manage Senior doctor Camilla Kleveland at St. Olav would also like more hospitals to establish an offer. She believes this is the best way to strengthen the public offer. – It is much easier for both donors and recipients if the offer is at a hospital closer to them, she says. At the same time, she understands that other hospitals have not applied to start egg donation, as it requires a lot of time and resources. – It is probably the resources that rule. We would probably have received a better offer in other places as well if it had been accompanied by resources for what is decided. Camilla Kleveland finds it extremely rewarding to be able to help people have children. Photo: Hanne Bernhardsen Nordvåg / news Amalie, who is on the waiting list, believes the authorities should come up with guidelines. – They must allocate enough money so that the hospitals can actually offer the treatments they have adopted. There should be a requirement for it to be sufficiently public, she says. The authorities’ responsibility The lack of a solid public offer reflects that this offer is still new, says State Secretary in the Ministry of Health and Care, Karl Kristian Bekeng (Ap). – The public hospitals have large and complex tasks, and it takes time for new offers to enter the hospitals, he says. Bekeng also reminds us that we have just been through a two-year pandemic which has been very stressful for the hospitals. State Secretary Karl Kristian Bekeng (Ap) believes that one can look with optimism to other countries where egg donation has been practiced for longer. The offer is more well-known and established there, and he believes it will be so in Norway as well. Photo: Esten Borgos / Borgos Foto AS According to the state secretary, there are currently no plans to provide additional resources or guidance related to egg donation. – We have to deal with the pandemic and its aftermath first, and when we work with future budgets and our signals to the hospitals going forward, we have to consider what to prioritize, says Bekeng. – But the fact that there is an offer at all is the first and absolutely necessary step. Bekeng further points out that the biggest limitation right now is the lack of donors, and there they can assess whether action should be taken to promote information about the offer. – It can be done both on the part of the national health authorities or the clinics. Perhaps preferably both. Don’t know about the offer Both St. Olav’s hospital and the private clinics stress that you are dependent on more donors and a steady flow of donors over time if you are to have a solid offer. Each donor can only give eggs three times, and it is also not certain that the result will be pregnancy in the first instance. Therefore, it would have been ideal if you had more donors than recipients. But even if they want more donors, this is still not something to be taken lightly. As Liv Bente Romundstad at Spiren Fertility Clinic says: – An egg is not a random cell – it becomes a person. A life is born. Photo: Morten Andersen / news Camilla Kleveland at St. Olav reminds that the child will also have the right to know his biological origin from the age of 15. – So it is important to think through whether it would be okay for someone to potentially come knocking in 15-20 years’ time. Or that no one will come, she says. – You have to be able to live with the fact that you may be lying for the rest of your life. But if you think it’s okay, and want to help others, then this is a very nice way to do it. And for those on the other end, it means everything. – It is an extremely generous act, and we are completely dependent on the kindness of others, says Amalie. – For those of us who have waited for so many years, it appears almost completely surreal; that of daring to hope that one will actually become one of those who have children.
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St. Olav’s hospital is the only public offer for egg donation – struggling to get donors – news Trøndelag
