Egg Donation and Surrogacy

Click here for Conceiving Through Egg Donation (8 of 10): Repeat Egg Donors.

Anonymity and Openness in the Egg Donor/Recipient Relationship

When working with a private egg donation agency, as long as there is mutual consent between egg donor and recipient, the relationship can be as closed or as open as both parties desire.  The idea that the donor and potential offspring would knowingly meet one day instills anxiety in some donors and recipients, and comfort in others. It is a completely personal attitude.

Egg donation has not had the chance to evolve the way adoption has regarding openness and public acceptance. In the past adoption was shrouded in secrecy and anonymity, but now it is commonplace for domestic adopting parents to meet birth parents (typically before the birth), and adoption is celebrated for what it is. There still may be, for some, a stigma attached to egg donation, which creates the desire to keep it private or even secret. After all, you chose an egg donor who resembles you so your child could “pass” as your own. You don’t want your child and other family members to feel he or she is only “related” to the paternal side. On the other hand, secretiveness is unfair to the child and creates an unhealthful atmosphere. Egg donation will never lose its stigma until it is pushed out in the open by brave parents. Not everyone is willing to be a hero, however.

Still, it remains a basic right to know how you are brought into the world. Some prospective parents even go so far as to request donors with A-positive blood types, for instance, under the assumption that the child would be unable to figure out his or her mother was not genetically related.  We don’t encourage this kind of deception, but we do believe that anonymity between egg donor and recipient is fair.

We have had success, however, with non-anonymous relationships, too. But ground rules must be established. Once the seal of anonymity is broken, donor and recipient must determine to what extent they should be involved in each other’s lives, and in the lives of any potential offspring. Everyone must agree where to draw that line. Do you want to meet the egg donor? In person?  Through a phone conversation? Will it be a one-time meeting or a series of meetings? Will you exchange full names and contact information? Will the child have any contact with the donor? If so, when and how?

Typically, recipients request a one-time meeting. If you really want the egg donor to be part of the child’s life, the fact that she is genetically related to the child may raise some unchartered legal issues. However, these same issues have been overcome for adoption, and a similar evolution may occur in egg donation. We are just not there yet.

When both egg donor and recipient are open to a non-anonymous relationship, qualified counselors, obtained through your agency or other source, should negotiate the points of contact, whether it is a phone conversation, exchange of letters, or an in-person meeting. You can state your intentions for future contact in the egg donor contract, but they are not necessarily legally enforceable.  Some parents just want to know if the donor, in theory, would be open to meeting any potential offspring at some point in the future. Some egg donors have a relaxed attitude, and others reject it outright. Their feelings have the same wide range as the recipients.

Keep in mind that you will always have photos and a full description of your donor for your reference, and to show your child when you choose. As more babies are born through egg donation, there will be more support and guidance for parents and children on how and when to confront the issue. As it now stands, your IVF clinic will keep records on file in case any medical emergency arises which would justify revealing the identity of the egg donor. If you work with a private agency, expect them to do the same.

Click here for Conceiving Through Egg Donation (7 of 10): Out-of-Town Egg Donors.

Does Using a Repeat Egg Donor Offer Any Advantage?

The ASRM guidelines allow any one donor to go through up to six egg donation cycles. Any candidates who have donated eggs before should be clearly marked as such on their profiles, for the obvious advantages she offers.

First of all, she knows exactly what she is getting into, and is less likely to have second thoughts about the process of donating eggs. Although she will have to be screened again for her next cycle, you can be assured she has already passed at least one screening, and has no major genetic or psychological issues. Secondly, you will know the results of her previous donations, which need to be good enough to qualify her for another cycle. These results will include the number of donor eggs retrieved, the number fertilized, and if enough time has passed, whether a pregnancy and live birth resulted.

If you choose a repeat donor, her egg donation records will be forwarded to your doctor for review as part of the donor’s screening. If you have any questions about the results, ask the clinic to send redacted records directly to your doctor to get an informed opinion. Don’t jump to any conclusions about the number of donor eggs retrieved or pregnancy results.  Keep in mind that factors beyond egg quality determine pregnancy and live birth. The stimulation course, number of eggs fertilized, transfer day, and a host of other variables determine results.

Repeat egg donors are very desirable and get matched very quickly. If you absolutely insist on a repeat donor, it may take you longer to find one. Keep in mind that being a repeat is just one of many factors that make a good candidate. Most first time egg donors pass their screenings and do well in their retrievals, and even some repeat donors can back out due to changes in their lives. A cycle with a repeat egg donor is no more likely to result in a pregnancy than one with a fine first-timer. It may even give you pause to think your donor has been responsible for numerous pregnancies before yours and you are adding more half siblings into the mix. Of course, even with a first time egg donor, any subsequent donations remain beyond your knowledge and control.

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.

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.

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.

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.

Click here for Conceiving Through Egg Donation (Part 2 of 10): Adoption.

Who Would Want to Be an Egg Donor?

IVF clinics and independent egg donor programs reach potential donors through advertising, mostly through Web and classified ads in local and college newspapers. Put “egg donor” into any search engine and you will see how various programs vie for applicants through both altruistic (Help a Family in Need!”) and monetary (“Generous Compensation!”) incentives.

People often ask why women want to donate. Some are inspired by a friend or relative who has experienced infertility. Others feel that they have “good genes” and their eggs would make healthy babies. We’ve encountered a few candidates who consider themselves very fertile, or may have just terminated an unwanted pregnancy, and feel a donation would make up for the loss in some way. But even when these reasons are involved, the compensation is the most powerful incentive.

However, it takes more than just desire for money to be an egg donor. Egg donation is not an easy way to make a quick buck. Donors generally do not get paid until after the retrieval, which can take weeks or even months after they first apply. Before they see any money, they need to go to many doctors’ appointments, answer many questions, endure medical tests and procedures, and follow a slew of directions.  All this takes intelligence, maturity, and a great sense of responsibility.

Furthermore, women who donate their eggs are not impoverished or desperate for money. Many donors are ambitious, educated, intelligent, and independent women in their 20s from middle class backgrounds, who could use some extra cash to supplement their incomes.  Indeed, the majority of recipients are white, educated professionals seeking donors with ethnic, class, and educational backgrounds similar to their own. In our experience, white, educated women are the most sought after donors. The second largest demand is for educated Asian American women, especially those of Indian and Chinese heritage.

Most programs make their applications available on their Web sites to submit electronically or by regular mail. The most basic requirements:

• age between 21 and 30
• good health and habits (no illnesses or conditions, no smoking or drug use)
• good family medical history
• body mass index under 27.

About half the applications submitted to my egg donor program are not qualified for one reason or another. Many applicants can technically qualify, but ethnic background, attractiveness, and education level determine their ability to be matched.

Click here for Conceiving Through Egg Donation (Part 1 of 10): Introduction.

If it’s Not My Baby, Why Not Just Adopt?

Yes, using donor eggs means that your child or children will have a maternal genetic relationship to another woman, typically a complete stranger. This random aspect makes it somewhat analogous to adoption. But the similarity ends there. First and foremost, egg donation allows the intended father to be the biological father, establishing a true genetic relation. Most couples consider this a tremendous advantage.

Knowing the precise source of both egg and sperm provides health assurances that adoption cannot. The sources of donor eggs and sperm (from intended father or anonymous donor) have been screened for infectious and hereditary diseases. In adoption, the health and medical care of the mother and baby may be unknown and are not guaranteed.

In adoption, the birth mother typically cannot make a legally binding commitment to prospective adoptive parents until after a postpartum waiting period. But a child created through egg donation, when carried by the intended mother, is her child, starting from conception. The intended mother becomes pregnant, nurtures the child in the womb, receives prenatal medical care, and gives birth. Although it was not her egg that formed the embryo, the uterine environment has a connection to fetal health and development in ways that scientists are still investigating and discovering. So you are giving a part of yourself to your child in a real physical way.

Adoption remains a wonderful option for many other reasons. However, egg donation takes advantage of the latest technologies to create a child partially related to the intended parents under the strictest medical supervision from conception to birth. For some, this greater amount of control makes egg donation worth the investment.

This is Part 1 of a 10-part series entitled “Conceiving Through Egg Donation.” Throughout the series, I will be providing practical advice for those seeking to conceive through an egg donation program.

Beginning to think about using donor eggs? Here is an introduction.

Conceiving with donor eggs occurs in three stages: the donor search (which can take anywhere from a few days to a few months), the donor screening (about six to eight weeks), and the IVF cycle (about four to six weeks). About 10,000 donor cycles are performed in the US every year, and the number continues to grow. As a commercial enterprise, egg donation only started in the early 1990s. Since then technology, regulations, and attitudes toward this practice have been constantly evolving.  The medical aspects of IVF may be familiar to you, but you may not have a full understanding of the logistics when a third party becomes involved. This blog should provide a sensible guide to the process.

Most patients consider using donor eggs after going through a number of unsuccessful IVF cycles. You may have a diagnosis for your infertility, or you may not. Sometimes doctors just can’t tell why a patient isn’t getting pregnant. In these cases, egg donation is offered as the next, more advanced level in the long ART road. Since it often follows an extended period of struggle and disappointment, most patients don’t begin their search for an egg donor in an encouraged state of mind.

Try not to feel that you have wasted precious time in your previous efforts to conceive. Egg donation’s distinct advantage allows you to turn back the biological clock, since it is generally the age of the egg, not the uterus, which predicts results. Take comfort in the fact that egg donation is one of the most successful fertility treatments available right now.  About one half of all embryo transfers from fresh donor eggs result in live births. That’s an amazing statistic. (For non donor egg, it ranges from about 37% to 10%, diminishing incrementally as maternal age increases.)

Take a look at your own clinic’s statistics to learn how many IVF cycles they do per year (donor and non donor, fresh and frozen) and what their success rates are. Compare their numbers to some other clinics in your area, as well as the overall statistics provided by the CDC. Remember that some of the better clinics take on more difficult cases, therefore success rates can be misleading. (SART data reports can be found on www.sart.org and the CDC Web site.) Of course, trust in your doctor is paramount, and you should feel comfortable asking him or her any questions about these statistical reports.

Just twenty years ago egg donation was inaccessible to the general public. It has since created thousands of dearly wanted children. But this success is achieved at a price, and not only a financial one. Everyone needs to reconcile these advantages in technology with their own sense of “family values” (for lack of a better term).  No one can do this for you. You should be fully informed of the issues to consider along the way.

This is a comprehensive guide to conceiving through egg donation, which looks at the entire egg donation process from a variety of angles. Please click any of the headings below to read the full article.

1. Introduction – Conceiving with donor eggs occurs in three stages: the donor search, the donor screening, and the IVF cycle. (Beginning to think about using donor eggs?)
2. Adoption – Using donor eggs means that your child will have a maternal genetic relationship to another woman, typically a complete stranger. (If it’s Not My Baby, Why Not Just Adopt?)
3. Egg Donor Candidates – IVF clinics & independent egg donor programs reach potential egg donors through advertising, mostly through Web and classified ads in newspapers. Put “egg donor” into any search engine… (Who Would Want to Be an Egg Donor?)
   
4. Finding an Egg Donor – If your in-vitro fertilization (IVF) clinic has its own egg donation program, you may find your donor through their own pool. (Finding Your Egg Donor through Your Own IVF Program)
   
5. Using a Private Agency – A number of companies, unaffiliated with any medical facility, serve as egg donor brokers. Finding a donor through an egg donation agency offers a number of advantages… (Finding Your Egg Donor through a Private Agency)
   
6. Egg Donor Profiles – Choosing an egg donor, just as with every other part of the in vitro fertilization (IVF) process, can be stressful. Unlike other components of assisted reproduction, there is no science to it. (Evaluating Egg Donor Profiles)
   
7. Out-of-Town Egg Donors – Some egg donors are able to travel to donate their eggs; be aware that if you choose a donor beyond the vicinity of your clinic, you will be responsible for… (Using an “Out-of-Town” Egg Donor)
   
8. Repeat Egg Donors – ASRM guidelines allow any one egg donor to go through up to six egg donation cycles. Any candidates who have donated eggs before should be clearly marked… (Does Using a Repeat Egg Donor Offer Any Advantage?)
   
9. Confidentiality and Anonymity – When working with a private egg donation agency, provided there is mutual consent between egg donor and recipient, the relationship can be as closed or as open as both parties desire. (Anonymity and Openness in the Egg Donor/Recipient Relationship)
   
10. Signing the Contract – Once you’ve made your choice, signed a contract with the egg donation agency, and paid the fees, your clinic can start the screening process. (Donor Reserving, Screening, and the Egg Donation Contract)

Katherine Benardo is Director of the Egg Donation Program at the Northeast Assisted Fertility Group (NAFG).  Located in New York and Boston, NAFG is committed to creating happy, loving families through gestational surrogacy and egg donation.