Egg Donation and Surrogacy

Click here for Conceiving Through Egg Donation (6 of 10): Egg Donor Profiles.

Using an “Out-of-Town” Egg Donor

Some egg donors are able to travel to make their donations. Be aware that if you choose a donor beyond the vicinity of your clinic, you will be responsible for all travel expenses, including car fuel, airfare, hotel, food, and other incidentals, including the same for a travel companion in some cases. The egg donation agency will coordinate the donor’s schedule and handle all the arrangements, but will require money ahead of time based on estimates.

The typical cycle for out of town egg donors will require up to three separate trips. The screening requires about two days. A few weeks later, the FDA lab tests will require one day (these may be done in the donor’s home town, depending on the clinic’s policy). The third trip covers the monitoring and egg retrieval, and here protocols vary from clinic to clinic. Some allow nearly all the monitoring off-site at a clinic near the egg donor’s home town. Others require a full five or six days of on-site monitoring leading up to the retrieval. Both you and your agency should contact your clinic’s egg donor coordinator to find out their protocols.

Travel makes the process more complicated and expensive, but they can be worth it to work with the donor you want.

How are egg donors matched with recipients at your agency?

At this current stage in technology, donor eggs are not frozen for later use. So a specific recipient has to choose you before you can donate.

When working with our egg donation agency, a recipient will select you from the donor database, and only then will you begin your medical screening. You may work with a local clinic or one in a different city, if that is convenient for you.

Before you start your medications, you will be presented with an egg donor contract and provided an attorney to review its terms with you (the clinic will present you with a consent form as well).

The choice of an apparent paragon of fecundity for the Republican VP (and the attention given to her pregnant teenage daughter), touch gingerly on the abortion issue, just a small point on the reproductive freedom spectrum that spans from adoption to stem cell research. It highlights the Republican position against abortion: overturning Roe. v. Wade is at the very top of McCain’s “Human Dignity and the Sanctity of Life” agenda, which he characterizes as “only one step in the long path toward ending abortion.” So Republicans will force all women, even rape victims, to bear unwanted children, but what about people who want to have babies?

As it stands, insurance coverage for infertility treatment is non-existent or very limited. On June 27, 2007, Representative Anthony Weiner (D-New York) introduced the Family Building Act of 2007 (H.R. 2892), which would require insurance coverage for the treatment of infertility. It has made no progress since, and will have to be reintroduced once the new Congress is in session. Of its approximately twenty cosponsors, all are Democrats. Wonder how Republicans can be against “family building”? As a staff member from Weiner’s office explained to me, Republican lack of support is based on reluctance to challenge the health insurance industry. [RESOLVE, the infertility support organization, has advocated this bill.  A handful of states already offer some limited insurance coverage for fertility.]

Infertility is a public health issue (one of its many causes is sexually transmitted disease). Obama supports biomedical research and NIH funding, sex education, and increased access to contraception. McCain does not address these issues.  [The candidate’s positions appear in detail on their Web sites: John McCain on Health Care, and on Human Dignity and the Sanctity of Life.  Barack Obama on Health Care and Women.]

Infertility is a disease that affects millions of men and women, no matter their income, class, education, or politics. Adoption, which McCain offers as the abortion alternative, is not a cure. Although neither candidate addresses the issue directly, it appears likely that infertile couples seeking treatment will fare better with a Democrat in the White House.

I have been fielding inquiries from reporters recently about the whether the current economic downturn is driving women to be egg donors. Although it makes sensationalistic news copy and sounds plausible, there is no way to draw any convincing conclusions from the actual statistics. According to the CDC, the most reliable source for assisted reproductive technology statistics in the US, the number of fresh donor egg cycles has been steadily increasing every year, irrespective of the state of the economy. [In 2005, the latest year for which complete statistics were posted, there were nearly 10,000 fresh (as opposed to frozen) donor egg cycles in the US.]

But what about the economy’s influence on the recipient’s side? An IVF cycle using donor eggs can cost up to $30,000 (this factors in medical costs, plus donor compensation and agency fees). If the economy is so bad, wouldn’t people have less money to spend on these costly procedures, thus decreasing the demand for donors? The prevailing assumption is that fertility patients are so desperate that they would go to any expense to undergo treatment, despite their incomes or chances of success. We’ll have to wait and see if the numbers continue to increase in 2006, 2007, and 2008 before we begin to draw any conclusions. It is true that those taking advantage of the assisted reproductive technologies are generally wealthier than the general population, since it is prohibitively expensive for most people (and insurance does not cover it in most states). And the possibility of a larger and better quality donor pool, motivated by the need for extra income, may keep the number of donor cycles from slipping steeply.

Of all the pieces I have seen and read on this, Dr. Sanjay Gupta’s video clip was the most sound and reasonable (part of the CNN article “Dim economy drives women to donate eggs for profit”).  I agree that marketing, outreach, and egg donor education has help boost the number of donors in our pool more than any other factor. True, once they hear about it, compensation is the primary incentive for potential donors, in good or bad economic times.  However, the unfortunate impression that impoverished women are driven to sell their body parts for money is way off base, and indicates a complete misunderstanding of the realities of egg donation.

Here are some facts about egg donors and egg donor compensation that most people don’t know:

• The ethical limit for compensation is $10,000, according to guidelines submitted by the ASRM (the American Society for Reproductive Medicine) in 2000 and again in 2007. Any legitimate clinic or agency abides by ASRM guidelines.
• Donors are compensated for their time and effort, not for their eggs. The compensation remains the same no matter how many eggs are retrieved.
• As Dr. Gupta points out, the vast majority of women ages 21-30 are ineligible. Donors must be in excellent health, non-smoking, and fit. They must be free of infectious and genetic diseases (some women are not even aware they are carriers for some diseases such as cystic fibrosis or Fragile X). They go through a whole battery of psychological and medical tests, plus a course of injections for about 8-12 days, and only get paid when it’s all over. It’s hardly a way to make a quick buck.

But here is what most outside the fertility industry don’t know: each donor is chosen specifically by a recipient, who is typically an upper middle class highly educated Caucasian or Asian-American, looking for the same. (Matches for other ethnic groups are made, of course, but with less frequency.) Recipients often demand high academic achievement and test scores, great physical attractiveness, athletic, musical, and/or artistic ability, and other highly desirable traits.

I get many applications from women who are fit, healthy, and fertile. They would likely pass their medical screenings, but for most of them, it would not be easy to find recipients for their eggs. Because of the nature of the demand, the reality is that most egg donors are educated, middle class women looking to supplement their incomes, not poor fertile women exploited by rich, infertile ones.

The best sources for statistics and information are the Web sites for the American Society for Reproductive Medicine (ASRM.org), the Society for Assisted Reproductive Technology (SART.org), and the Center for Disease Control (CDC.org).

Click here for more specific information on egg donation.

Thinking about being an egg donor and want to learn more about it?

I recently posted an article on INCIID (the InterNational Council on Infertility Information Dissemination) which provides answers to your questions, including:

• full description of the medical procedures, risks, and side effects
• how much time egg donation takes
• how much egg donors get paid
• donor eligibility requirements
• all other logistics

Egg donation helps thousands of people each year realize their families, and it relies on the generosity and dedication of healthy, vibrant, and intelligent young women. It is important for each egg donor candidate to be fully informed: click here to learn if egg donation is right for you: “Top 10 Questions Egg Donors Ask,” by Kathy Benardo.

Click here for Conceiving Through Egg Donation (5 of 10): Using a Private Agency.

Evaluating Egg Donor Profiles

Choosing an egg donor, just as with every other part of the IVF (in vitro fertilization) process, can be stressful. Unlike other components of assisted reproduction, there is no science to it. Some people have very clear ideas, and others have no set criteria at all. You may consider this choice overwhelmingly monumental, and feel pressure to make the “right” decision. But there is no right or wrong here. You just need to make a decision you feel really good about.  Most prefer egg donors who bear some resemblance to them, but they also want to feel an emotional connection. I suggest approaching the selection process with a list of prioritized criteria, but have your gut cast the deciding vote.

Different agencies present their profiles in various formats. We offer photos and summary profiles on our site. (Most recipients want to see photos, but those who don’t can choose an option not to view them.) Clients then request more information on the profiles that interest them, which we send by e-mail. Our more comprehensive profiles provide information gathered from the application as well as the interview, plus whatever additional photos of the egg donor candidates we may have on file.

In order to protect the privacy of the egg donor, we assign each one a code. We do not name the schools that they attended (but describe them as “selective 4-year private liberal arts college,”  “large 4-year state university,” “Ivy League university,” etc.). We are particularly keen on protecting our donors’ privacy, but other agencies are less so. Some may reveal the candidates’ first names, and provide copies of their actual applications which may include names of schools, friends and family members. As long as the egg donor agrees to this, it is ok. We gather photographs of each candidate, from infancy (if available) to adulthood, and to take our own whenever possible. If you have additional questions about the donor regarding anything that may be important to you (such as height and eye color of her aunts and uncles, education levels or professions of her grandparents, or whatever), we ask the egg donor on your behalf. Any egg donation agency should do this for you.

Egg donation agencies have various screening protocols; you should ask each agency what their screening involves. After the application review, we interview egg donors in person whenever possible. If not, we interview them by phone. Transcripts of grades and test scores are often obtained, but are important for validation purposes if the donor candidate claims high academic achievement. We use the candidates’ social security numbers and birth dates to conduct routine background checks. The best applicants are not only attractive and intelligent, but are responsible. Showing up to interviews on time and responding quickly to phone calls and e-mails are signs that a candidate is serious and committed.

Before you get too attached to any one profile, make sure that the donor is actually available. Some data bases have hundreds of candidates, some of whom may be reserved by other clients while others may have been on the site for years without any follow up. Even if none interest you right away, it’s a good idea to talk to one of the program managers for recommendations of profiles that meet your criteria, in case you missed some. Also, if they are in the process of screening new candidates, they can contact you if another possible match becomes available.

All egg donor candidates will be physically fit and healthy with good family medical histories. So apart from excellent health, think about the other qualities you would like in a donor. Most people take physical resemblance as the leading factor: these include height, body type, hair and eye color, skin tone, and ethnic background. This is a reasonable starting point.

Secondary considerations may be education, special talents in athletics, music or the arts, interests, personality type, and motivations for donating. Typically the high achieving recipients focus on test scores and grades or prestigious college degrees.  Most people understand that there is a lot more to test scores and fancy schooling than innate intelligence, which is itself a result of both genetic and environmental factors. But I think what drives this focus is the need for the egg donor to be like them both physically and mentally. There is a sense that even if high grades and test scores are not transmitted by DNA, the donors are of a “stock” or class similar to theirs.  It’s just another way to establish an emotional connection. And most people do want some sense of connectedness to the donor, which is impossible to formulate intellectually or measure physically.

Photographs, more than any other component of the profile, facilitate that inchoate emotional connection.  You can evaluate resemblance, the primary criterion, much more accurately through photographs than by written description.  Probably one of the reasons that IVF clinics do not show photographs of egg donors to their patients is that it throws the whole criteria curve off, making photographs inordinately more important than other factors. IVF clinics do not want to forfeit that much control in the matching process to their patients. But when working with a private egg donation agency, you do get that advantage.

Furthermore, although most people do not care to admit it, aside from resemblance, it is important for their donor to be pretty. In fact, we have found that egg donor selection is a bit of a beauty contest, and people will pass on some very high achievers if they don’t find them attractive. This is especially true when the male partners become actively involved in making the choice. Alas, for women especially, life is always part beauty contest, and one could argue that good looks endow real measurable advantages.  But luckily, not only is beauty subjective, but true unattractiveness is rare. Appealing physical features are infinitely various. Most of the energetic, ambitious, and intelligent women who apply are indeed attractive, even if they are not fashion models.

Can I be on the birth control pill or other form of contraception?

Yes. While applying to be an egg donor, you should continue to use your preferred form of contraception. (If you get pregnant, you are not able to donate.) During the screening and cycling process, you will be instructed to go off hormone-type contraception (the pill, Nuvaring) at certain times. Sexual activity will need to be avoided for the short cycle period, as instructed by the clinic.

Click here for Conceiving Through Egg Donation (4 of 10): Finding an Egg Donor.

Finding Your Egg Donor through a Private Agency

There are a number of companies, unaffiliated with any particular medical facility, which serve as egg donor brokers. Finding a donor through an egg donation agency offers a number of advantages which give you more control over the selection process. You will be able to review hundreds of egg donor profiles from candidates all over the country, each with much more detailed information than your clinic would offer, including photographs. Any eggs retrieved would be all yours; no shared cycles. You can choose to work strictly anonymously or not.

Most egg donation agencies have password-protected data bases on their Web sites, available to clients to view after they register. Some require a fee to view the data base. Excellent donors may be found this way, but there are a number of things you should keep in mind when looking at agencies (and chances are you will be looking at many).

Firstly, unlike your clinic, egg donation agencies perform no medical tests. They “pre-screen” candidates. This includes assembling information gathered through written applications and supporting materials such as driver’s licenses, photographs, and school transcripts. Your clinic will be responsible for medically screening the donor only after you have made your selection.

Many who manage these agencies have no medical or even legal training at all. Anyone can do it. Take a look at the backgrounds of the founders and staffs of every agency you consider, just to get a sense of who you are working with. This information should be accessible on the agency’s Web site.

There are no standards or licenses required to establish an egg donor agency. Since these agencies perform no medical tests, they require no FDA registration, although this may change in a few years as these agencies grow in number. (Some agencies claim FDA registrations, but these will be inactive.) The New York State Department of Health offers a license, but it is not mandatory.  There are industry affiliations that may endorse, to some extent, a program’s legitimacy. An agency may claim to be a member of infertility support organizations such as RESOLVE (The National Infertility Association) or the AFA (American Fertility Association).  However, agencies pay membership dues to join these groups without any thorough scrutiny of their practices.

Look to see if the company is a member of The American Society of Reproductive Medicine (ASRM) and/or its adjunct, the Society of Assisted Reproductive Technology (SART).  By joining these affiliations, a company pledges to abide by these organizations’ ethical standards. The most important for our purposes is the ASRM guideline for donor compensation (first published in 2000 and restated in 2007). The ASRM maintains that remuneration for the time, inconvenience, and discomfort of egg donation (as opposed to the oocytes themselves) is ethical and justified, and should be determined irrespective of the quality, number, or intended use of the oocytes. Any amount above $5,000 requires justification, and any amount beyond $10,000 is inappropriate. The purpose of this limit is to prevent coercively high fees that could obscure the risks, among other ethical concerns.

If a company claims to be an ASRM or SART member, but offers its donors compensation over $10,000 (and/or elaborate gifts or financial incentives beyond a fee of $10,000), it is operating unethically, but not unlawfully. The ASRM guidelines are just that: recommendations, not laws. Most IVF clinics are ASRM /SART members, and pledge not only to abide industry guidelines but only to work with companies that do the same. Clinics examine the ethics of these egg donation agencies with various levels of scrutiny. For this reason, it is important to check with your clinic about its policy regarding outside agencies, and to see if they would be willing to work with any one you choose. Some clinics are real sticklers; others are more relaxed in their policies.

If you find an egg donor you absolutely love who asks a fee of $15,000, no law prohibits you from paying that amount, but be aware that it will require some ethical breaches by all parties involved (however arbitrary these guidelines seem to be). In the end it is the donor, not the agency, that is most important to you.  Egg donors generally do not sign contracts with agencies, and may register with more than one in an effort to be matched as soon as possible. Depending on how the agency works, either the agency or the donor sets the fee. It may be negotiable.

You should also examine the agency’s own fee structure, which should be described on its site. Apart from donor compensation, most charge about $3-6,000 for their services, which may include some more advanced level of screening by a psychologist, but not typically. Remember this is on top of not only the donor fee, but legal fees (about $1,300) and medical fees, set by your own clinic. Some require the full fee up front, and some require the fee in stages. Make sure you are clear on the agency’s refund policy, and that you know exactly what happens to your money if your egg donor does not pass her medical screening or backs out at any point. It is my program’s policy to return our fee if the donor does not start her screening at all after being matched (which does happen on rare unfortunate occasions). If she goes through with the screening but does not pass, our fee is non-refundable, but we permit the client six months to select a new egg donor from NAFG’s program at no extra charge. The donor fee is held in escrow once medications begin, but it is returned in full if the retrieval does not take place.

Since there are separate stages and many possible outcomes along the way in this arrangement, you will find many variables in agency policies. Make sure you understand and are comfortable with an agency’s policies before you start searching their data base. If you become very interested in a particular egg donor, you may want to request a sample service agreement ahead of time so you can be aware of the terms in full. Some terms may be negotiable; you’ll never know until you ask.

If registering with more than one agency, keep track of their names and access codes, especially if initial fees are required. When you pay a fee to view a data base, your access may expire after a certain number of days. Be wary of “teaser” profiles, incomplete descriptions of donors available free of charge which require credit card payment in order to view in full. You could spend $50 just to find out the donor is “unavailable.” There are many agencies which require no registration fee at all. They just want to know that you are working with a legitimate IVF clinic, and they are happy to help you.  This is the Northeast Assisted Fertility Group’s policy.

How much do egg donors get paid?

The Northeast Assisted Fertility Group offers each egg donor $10,000, payable immediately after the retrieval.  The compensation is agreed on beforehand and does not correspond to the number or quality of eggs retrieved.

How much do egg donors get paid?

There are no laws regarding how much you can get paid to be an egg donor. However, the American Society for Reproductive Medicine (ASRM) establishes ethical guidelines for egg donor compensation; the current cap is $10,000 per cycle (egg donors get paid for the time and effort of the cycle, not for the eggs retrieved). Other programs may offer more than $10,000, but keep in mind that the egg donor, recipient, and clinic would all be working unethically under these circumstances.

Click here for Conceiving Through Egg Donation (3 of 10): Egg Donor Candidates.

Finding Your Egg Donor through Your Own IVF Program

If your IVF (in-vitro fertilization) clinic has its own egg donor program, you may find your donor through their own pool. Although these programs are typically anonymous and do not show photographs of the egg donor candidates, they present non-identifying information as well as screening results. Some of the bigger clinics have waiting lists up to a year long for egg donors. It’s probably a good idea to put your name on the list even if you choose to look at other sources in your search.

Since egg donors are in great demand and costs are high, clinics usually match two recipients to each donor for a “shared cycle.” This means that the retrieved donor eggs will be divided equally between two recipients, who also share the costs of the procedures and egg donor compensation. One recipient is considered “primary” in case there are too few eggs to share (fewer than about twelve). The secondary recipient in that case would not be responsible for the cost, which then becomes the full responsibility of the primary recipient.  It may be possible to do a non-shared cycle at your clinic; keep in mind the cost will be higher.