Balancing Ethics, Emotions, and Science: How Couples from Eastern Europe Approach PGT with Donor Gametes

Medical decisions are rarely purely medical. When you're choosing whether to perform genetic testing on embryos created with donor eggs or sperm, you're navigating a complex intersection of science, personal values, cultural background, religious beliefs, financial realities, and profound emotions about parenthood itself.

For couples from Eastern Europe—where family traditions run deep, religious heritage shapes worldviews, and the path to assisted reproduction carries its own cultural meaning—the decision about PGT in donor cycles involves layers of consideration that clinical studies alone cannot address.

This article explores the ethical, emotional, and cultural dimensions of PGT decision-making, offering perspective from the unique context of Eastern European patients seeking treatment in Russia.

The Cultural Context: Eastern European Perspectives on Assisted Reproduction

Eastern Europe encompasses diverse nations, languages, and traditions, yet certain shared cultural patterns influence how couples approach fertility treatment:

Family-centered values:

In many Eastern European cultures, having children holds profound significance—not just as personal desire but as fulfillment of familial and sometimes social expectations. Extended family involvement in major life decisions is common, and the journey through infertility can carry particular emotional weight [1].

Attitudes toward donor gametes:

Using donor eggs or sperm involves accepting that your child won't share complete genetic heritage with both parents. Cultural attitudes vary:

More common perspectives:

Strong preference for genetic connection when possible
Concern about extended family acceptance of donor conception
Questions about disclosure to the child
Emphasis on finding donors with similar physical characteristics
Value placed on biological motherhood even without genetic link [2]

The decision to use donor gametes itself often requires significant emotional processing before couples even reach questions about genetic testing.

Religious influences:

Orthodox Christianity, Catholicism, and other faith traditions maintain a meaningful presence in Eastern European societies. Religious perspectives on assisted reproduction vary:

Orthodox Christian views:

General acceptance of medical assistance for married couples
Some theological concern about "excess" embryo creation
Varying positions on embryo selection and disposal
Emphasis on sanctity of all human life from conception [3]

Catholic perspectives:

Official doctrine restricts certain ART procedures
Individual believers may hold diverse personal views
Focus on moral status of embryos
Concern about commodification of reproduction [4]

Personal spirituality: Many Eastern Europeans maintain spiritual worldview even without strict religious practice, influencing their comfort with genetic intervention.

Approach to medical technology:

Eastern European patients often demonstrate:

High respect for medical expertise and scientific advancement
Willingness to travel for quality treatment
Pragmatic approach to healthcare decisions
Simultaneous appreciation for both modern medicine and traditional values [5]

The NGC patient profile:

Our international patients from Eastern Europe typically share certain characteristics:

Well-educated and professionally accomplished
Resourceful in researching treatment options
Seeking high-quality care at reasonable cost
Navigating treatment independently or with partner support
Balancing modern medical options with traditional values

Understanding this context helps frame the specific ethical and emotional considerations these couples face regarding PGT.

Common Ethical Concerns About PGT in Donor Cycles

"Playing God": Selection vs. Screening

The concern:

"By choosing which embryos to transfer based on genetic testing, aren't we inappropriately intervening in natural processes? Where is the line between healing and playing God?"

This question arises frequently and deserves serious consideration.

Perspectives to consider:

The screening viewpoint: PGT-A identifies embryos with chromosomal abnormalities that would naturally result in failed implantation or miscarriage. From this perspective, testing doesn't create selection that wouldn't occur biologically—it simply provides advance information about which embryos have developmental potential [6].

Most aneuploid embryos (75-85%) would never result in pregnancy. The remaining would cause early miscarriage. Extremely rarely, they result in chromosomal conditions like Down syndrome [7].

The intervention viewpoint: Natural conception allows a chance to determine outcomes. Genetic testing represents human intervention in a process many view as beyond human decision-making authority. Some feel discomfort with any embryo selection, viewing all embryos as having equal moral status regardless of chromosomal content [8].

Religious perspectives vary:

Orthodox Christian theology: Generally permits medical intervention to assist procreation for married couples. PGT-A is often viewed as acceptable when used to identify embryos capable of healthy development, not as eugenic selection [9].

Catholic teaching: More restrictive, with concerns about embryo disposal and the moral status of all embryos from conception. However, individual Catholic couples may reason that PGT helps ensure viable pregnancy rather than exercising inappropriate selection [10].

Personal spirituality: Many couples develop their own ethical framework, often concluding that using available medical knowledge to increase chances of healthy pregnancy aligns with responsible parenthood.

A middle ground:

Many couples resolve this tension by distinguishing:

Screening for viability (identifying embryos capable of development) vs. Selection for traits (choosing characteristics like intelligence)
Medical necessity (avoiding severe genetic disease) vs. Enhancement (optimizing desired features)
Current capabilities (chromosome number) vs. future possibilities (polygenic traits)

Most couples feel comfortable with PGT-A screening for aneuploidy while drawing clear boundaries against trait selection.

The Value of "Imperfect" Life

The concern:

"If we screen embryos, are we saying that people with disabilities have less value? What about children born with chromosomal conditions—doesn't their existence have worth?"

This profound ethical question deserves thoughtful consideration.

Important distinctions:

Individual human worth vs. embryo selection: The value and dignity of living people with chromosomal conditions is absolute and not diminished by decisions about embryo transfer. Most aneuploidies are incompatible with life—they never result in birth. PGT-A primarily identifies non-viable embryos [11].

Conditions detectable by PGT-A:

Trisomy 13 (Patau syndrome): Typically fatal within first year
Trisomy 18 (Edwards syndrome): Most die before birth or within first year
Monosomy X (Turner syndrome): Survivable with medical care
Trisomy 21 (Down syndrome): Compatible with meaningful life

The Down syndrome question:

This deserves special attention because it's one of few PGT-A-detectable conditions compatible with life. Perspectives vary:

Some couples reason: "Given the choice, we prefer to transfer embryos without this condition. This doesn't diminish the value of people with Down syndrome—it reflects our family planning decisions."

Others feel: "We're not comfortable making this selection. If an embryo with Trisomy 21 implants naturally, we'd welcome that child. We choose not to test."

Both positions are ethically defensible. The key is making an informed choice aligned with your values.

For donor egg cycles specifically:

The question becomes more complex: "If we're already using donor gametes (accepting non-genetic parenthood), does genetic normality matter differently?" Couples answer this individually based on their circumstances and values.

Sex Selection: Where Different Cultures Draw Lines

The reality:

PGT-A inherently reveals embryo sex as part of chromosomal analysis. This information can be used for family balancing where legally permitted.

Legal landscape:

Russia: Sex selection for non-medical reasons is officially restricted
Many Eastern European countries: Varies by jurisdiction
Western Europe: Often restricted [12]

Cultural attitudes:

Eastern European couples demonstrate diverse views:

Some couples:

Value the information for family planning
Appreciate ability to balance family composition
View it as responsible use of available technology

Others:

Feel uncomfortable with sex-based selection
Prefer surprise/natural outcome
Request labs not disclose sex information

Ethical considerations:

Arguments for sex selection availability:

Reproductive autonomy—couples should control family planning
Information exists anyway as a consequence of PGT-A

Arguments against:

Reinforces gender preferences and potential discrimination
Commodification of children based on characteristics
Societal impacts if widely practiced at scale

NGC's approach:

We respect patient autonomy:

Sex information available to those who want it
Option to receive results without sex disclosure for those who prefer
Genetic counseling to discuss implications
Support for whatever decision aligns with your values [13]

Emotional Dimensions of the PGT Decision

PGT decisions involve strong emotions that go beyond medical data. While testing offers hope, control, and better embryo selection, it also increases anxiety, especially during the waiting period and around the fear of unfavorable results. Studies show that although anxiety rises while awaiting PGT results, most patients feel relief when euploid embryos are identified, and overall satisfaction with having genetic information remains high, even when outcomes are stressful [14].

For donor egg patients, emotions are often intensified by past failures and high expectations for success. The possibility of finding no euploid embryos is a common fear, although this occurs in only about 12.7% of donor egg PGT-A cycles, meaning most cycles identify at least one viable embryo [15]. Younger donors have particularly high euploidy rates, reaching 75–80% [16].

Patients differ in how much information they find helpful. Some value definitive results, while others experience information overload. Genetic counseling and PGT-inclusive guarantee programs can reduce emotional and financial stress by preparing patients for all outcomes and providing a clear path forward if no euploid embryos are found [17][18].

The Genetic Connection Question

Using donor gametes already involves accepting non-genetic parenthood. Does this change how couples view genetic testing?

The psychological complexity:

For donor egg recipients:

Many women describe complicated feelings:

Grief over loss of genetic connection
Simultaneous desire for healthy pregnancy
Questions about "motherhood" definition
Acceptance that genetic normalcy matters for child's wellbeing regardless of maternal genetics

Common reasoning: "I won't be genetically related to my child, but I still want the best possible start in life. Genetic health matters even though genetics aren't mine."

For donor sperm users:

Similar dynamics apply, though societal attitudes may differ toward male vs. female genetic contribution.

The "why bother with genetics" question:

Some couples wonder: "If we're already compromising genetic connection by using donors, why invest in genetic testing?"

The answer typically involves distinguishing:

Genetic relationship (whose DNA): Already accepted as not both parents'
Genetic health (chromosome normalcy): Still impacts child's wellbeing
These are separate considerations

Most couples conclude: "We may not contribute all genetics, but we can still optimize the genetics our child receives from the donors."

Financial Pressures and Ethical Decision-Making

Financial considerations play a major role in PGT decision-making and can create ethical tension, especially for patients from Eastern Europe. Many couples choose Russia for IVF because of lower costs compared to Western Europe or the USA, high-quality care, shorter waiting times for donor cycles, and more flexible regulations [22]. Even so, the overall investment remains substantial: a donor egg IVF cycle combined with PGT-A, travel, and accommodation can total €11,500–22,000, which for many families represents years of savings.

This financial pressure directly affects how couples approach PGT. Some choose to skip testing to reduce costs, reasoning that donor eggs already offer high success rates and preferring to reserve funds for a potential second cycle. Others view PGT as a form of insurance, believing that avoiding unsuccessful transfers of aneuploid embryos ultimately saves time, money, and emotional energy.

The ethical dimension emerges when financial strain amplifies emotional responses. Poor PGT results can lead to resentment or regret, while declining testing may later trigger guilt about not having done “everything possible.” Differences in risk tolerance between partners can make decisions more difficult, and patients may feel vulnerable to marketing pressure around expensive add-ons.

NGC addresses these challenges through an explicit ethical commitment to non-directive counseling. Patients receive honest guidance on when PGT is likely to add meaningful value, transparent pricing without hidden costs, and support for decisions based on individual circumstances rather than profit maximization [23]. For many couples, guarantee programs help resolve the financial–ethical tension by including PGT in a fixed cost and offering financial protection if treatment is unsuccessful, allowing patients to focus on medical decisions rather than ongoing cost calculations [17].

How NGC Supports Values-Based Decision Making

We recognize that PGT decisions involve far more than medical factors.

Our approach:

1. Comprehensive genetic counseling
Pre-cycle consultation exploring:
- Medical indications for PGT
- Ethical concerns specific to your values
- Emotional readiness for potential results
- Cultural and religious considerations
- Financial impact on family planning
1. No-pressure environment
We present information and respect your authority over decisions. Many couples appreciate:
- Time to discuss privately between partners
- Option to consult religious advisors
- Flexibility to change decision before cycle start
- Validation that declining PGT is a legitimate choice [24]

Customized result delivery

Results can be delivered:

With or without sex information
With detailed or simplified interpretation
Via genetic counselor who explains implications
With time for questions and emotional processing

Cultural sensitivity

Our international team understands:

Eastern European family structures and decision-making patterns
Religious perspectives common in the region
Financial realities for cross-border patients
Cultural attitudes toward assisted reproduction [25]

Ethical boundaries

We will not:

Pressure patients toward PGT for profit
Offer trait selection or non-medical sex selection without careful counseling
Judge couples' values-based decisions
Compromise medical standards to accommodate problematic requests

Real Patient Perspectives

Anonymized patient experiences illustrate the diversity of approaches:

Anna and Dmitry (Ukraine)

Background: Orthodox Christian couple, three failed IVF attempts with own eggs, chose donor eggs.

Their decision: Initially declined PGT due to discomfort with embryo selection. After genetic counseling discussing how PGT-A identifies non-viable embryos (not selecting against life), they reconsidered. Chose testing, found 4 euploid embryos from 7 blastocysts. Successful first transfer.

Reflection: "Understanding that most aneuploid embryos would never result in pregnancy helped us ethically. We weren't choosing against disabled life—we were identifying embryos capable of development."

Maria (Poland)

Background: Single woman at 43, used donor sperm, strongly values genetic information.

Her decision: Enthusiastically chose PGT-A. "As a single parent, I wanted maximum information to make informed decisions. Knowing which embryos were chromosomally normal gave me confidence."

Outcome: 5 embryos tested, 3 euploid. Pregnant after first transfer.

Irina and Stefan (Belarus)

Background: Catholic couple, moral concerns about embryo disposal.

Their decision: Declined PGT-A. "We believe all embryos have potential. We'll transfer embryos based on morphology and trust the outcome to God."

Outcome: Transferred 2 blastocysts, one implanted successfully. They plan to transfer remaining embryos in future.

Reflection: "We respected the science but made a decision consistent with our beliefs. The clinic supported us without judgment."

Ekaterina and Viktor (Russia)

Background: Second marriage, Victor has children, wanted daughter.

Their decision: Chose PGT-A partially for sex selection (legal in Russia). "We were already testing for chromosomes, and knowing sex allowed us to complete our family as we hoped."

Outcome: Identified female euploid embryo, successful pregnancy with daughter.

Natasha (Moldova)

Background: Limited budget, maximizing every euro spent.

Her decision: Agonized over PGT cost but ultimately chose testing. "The guarantee program included PGT, which helped financially. I wanted to avoid wasting money on transfers that couldn't work."

Outcome: Testing revealed 2 euploid from 6 blastocysts. Successful on second transfer.

These diverse experiences demonstrate: There is no single "right" approach. NGC supports patients in finding decisions aligned with their unique circumstances and values.

Finding Your Own Balance

Ethical dimension:
- What are our core values regarding embryo selection?
- How do our religious/spiritual beliefs inform this decision?
- Where do we draw personal boundaries?
- Can we reconcile potential outcomes with our values?
Emotional dimension:
- Can we handle the "no euploid embryos" result?
- Do we want maximum information or prefer less knowledge?
- What will help us feel we did everything possible?
- How will we manage anxiety during result waiting?

1. Practical dimension:
  - Does our financial situation allow PGT?
  - Are we in a guarantee program that includes testing?
  - What is our timeline/urgency for pregnancy?
  - Do we plan multiple transfer attempts?
  Medical dimension:
  - What is donor age/egg quality?
  - Any paternal genetic risk factors?
  - Previous pregnancy loss history?
  - Participation in clinical protocols requiring PGT?
  There is no universally correct answer. The right decision is the one that:
  - Aligns with your values and beliefs
  - Addresses your medical situation
  - Fits your financial reality
  - Gives you peace of mind regardless of outcome

Faqs

Will NGC judge us if we decline PGT for religious reasons?

Absolutely not. We respect patients' values-based decisions. Many couples decline PGT for ethical, religious, or personal reasons, and we fully support their autonomy. Our role is providing information and medical care, not judging your choices. Your relationship with us remains the same regardless of whether you choose testing.

If we're Orthodox Christian, is PGT acceptable according to Church teaching?

Orthodox theology generally permits medical assistance for procreation in married couples, including genetic screening to identify viable embryos. Individual priests may have varying perspectives, so we encourage discussing with your spiritual advisor. Many Orthodox couples feel comfortable with PGT-A when understanding it primarily identifies non-viable embryos. We're happy to provide information for consultation with clergy.

Can we do PGT but ask not to know the sex of embryos?

Yes. Sex chromosome information is inherent in PGT-A results, but we can withhold this from your report if you prefer. Many couples choose comprehensive chromosomal screening while maintaining surprise about sex. Simply inform your genetic counselor of this preference before testing.

What if PGT results create ethical dilemmas we didn't anticipate (like mosaic embryos)?

Genetic counseling prepares couples for potential scenarios including mosaicism, segmental aneuploidies, and unexpected findings. If complex results arise, our counselors provide detailed explanations and help you navigate decisions consistent with your values. You're never alone in processing difficult information—we support you through decision-making regardless of complexity.

We come from a culture where discussing infertility is taboo. Will our privacy be protected?

Absolutely. Patient confidentiality is paramount. We understand cultural sensitivities around fertility treatment in many Eastern European communities. Your treatment information remains strictly private. You control what information is shared and with whom. Many of our international patients appreciate our understanding of the private nature of this journey.

Scientific References

[1] Culley, L., Hudson, N., & Lohan, M. (2013). Where are all the men? The marginalization of men in social scientific research on infertility. Reproductive BioMedicine Online, 27(3), 225-235.

[2] Readings, J., Blake, L., Casey, P., et al. (2011). Secrecy, disclosure and everything in-between: decisions of parents of children conceived by donor insemination, egg donation and surrogacy. Reproductive BioMedicine Online, 22(5), 485-495.

[3] Russian Orthodox Church. (2008). The Basis of the Social Concept: On Healthcare. Official Church position on bioethical issues.

[4] Catholic Church. (2008). Dignitas Personae: On Certain Bioethical Questions. Congregation for the Doctrine of the Faith.

[5] Inhorn, M.C., & Patrizio, P. (2015). Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Human Reproduction Update, 21(4), 411-426.

[6] American Society for Reproductive Medicine. (2024). The use of preimplantation genetic testing for aneuploidy: a committee opinion. Fertility and Sterility, 122(3), 421-434.

[7] Franasiak, J.M., Forman, E.J., Hong, K.H., et al. (2014). The nature of aneuploidy with increasing age of the female partner. Fertility and Sterility, 101(3), 656-663.

[8] Bayefsky, M.J. (2016). Comparative preimplantation genetic diagnosis policy in Europe and the USA and its implications for reproductive tourism. Reproductive BioMedicine & Society Online, 3, 41-47.

[9] Breck, J. (2000). The Sacred Gift of Life: Orthodox Christianity and Bioethics. St Vladimir's Seminary Press.

[10] Tauer, C.A. (2001). Embryo research and public policy: a philosopher's appraisal. Journal of Medicine and Philosophy, 26(4), 423-439.

[11] Greco, E., Litwicka, K., Minasi, M.G., et al. (2020). Preimplantation Genetic Testing: Where We Are Today. International Journal of Molecular Sciences, 21(12), 4381.

[12] Dondorp, W., de Wert, G., Pennings, G., et al. (2013). ESHRE Task Force on Ethics and Law 20: sex selection for non-medical reasons. Human Reproduction, 28(6), 1448-1454.

[13] NGC Clinic. (2024). Genetic counseling and patient autonomy protocols. Internal clinical guidelines.

[14] Dommergues, M., Benachi, A., Benifla, J.L., et al. (2010). The decision to terminate or continue a pregnancy complicated by fetal abnormalities. Prenatal Diagnosis, 30(8), 763-766.

[15] Doyle, N., Gainty, M., Eubanks, A., et al. (2020). Donor oocyte recipients do not benefit from preimplantation genetic testing for aneuploidy to improve pregnancy outcomes. Human Reproduction, 35(11), 2548-2555.

[16] Albero, S., Moral, P., Castillo, J.C., et al. (2024). The impact of (very) young donor age on euploid rates. European Journal of Obstetrics & Gynecology and Reproductive Biology, 297, 59-64.

[17] NGC Clinic. (2024). Guarantee packages with PGT-A testing. Retrieved from https://ngc.clinic/en/our-services-en/guarantee-packages

[18] NGC Clinic. (2024). Patient-centered counseling approaches. Internal training materials.

[19] Breck, J. (2000). The Sacred Gift of Life: Orthodox Christianity and Bioethics. St Vladimir's Seminary Press.

[20] Shannon, T.A., & Wolter, A.B. (1990). Reflections on the moral status of the pre-embryo. Theological Studies, 51(4), 603-626.

[21] NGC Clinic. (2024). Comprehensive genetic counseling services. Retrieved from https://ngc.clinic/en/about

[22] Fertility Tourism. (2024). International IVF treatment costs and destinations. Medical tourism research compiled data.

[23] NGC Clinic. (2024). Ethical guidelines for patient counseling and informed consent. Internal clinical protocols.

[24] NGC Clinic. (2024). Values-based decision-making support. Genetic counseling protocols.

[25] NGC Clinic. (2024). International patient services and cultural competency. Retrieved from https://ngc.clinic/en