Egg Donation
Egg Donation - the Gift of Forever
Egg Donation is a process by which a fertile woman (known as the egg donor) provides several eggs to another person(s) (known as the intended parent)for the purpose of assisting the intended parent realize his/her/their dream of parenting.
There are many reasons why an intended parent(s) would need the assistance of an egg donor:
- Where an intended mother has reduced egg quality
- Where a Gay intended parent(s) wishes to work with a loving surrogate to help them create their family
- Where an intended mother whom has undergone cancer treatment
- Where an intended mother whom has suffered from multiple failed IVF cycles
- Where an intended mother is advised not to work with her eggs due to an inherited disease
Anonymous egg donation is the process in which the intended parent(s) and egg donor do not meet each other or exchange any identifying information. Please see our Articles & Videos for more information on the pros and cons of anonymous egg donation.
Known Identity egg donation is the process in which the identity of the egg donor will ultimately be released to the child conceived, if, such a request is made by the child once they reach the age of 18 years. Please see our Articles & Videos for more information on the pros and cons of Known Identity egg donation.
Parents who choose anonymous egg donation report that they made this decision for some of the the following reasons:
- enables them to establish a psychological boundary between the donor and her contribution in creating the child
- minimizes the link between the child and the egg donor
- the intended mother’s role as a mother is not undermined by the presence of the donor
- will protect the child later in life from unwanted contact from the donor
- will protect the child in a situation where the child will inherit a significant Estate
- will protect the child from unwanted comments or slights from family members, especially more elderly members of a family
- if the intended parents have a full biological child and one with the help of an egg donor, that both children will feel equally connected to the parents.
An argument can be made that knowing one’s biological parents can have an impact on the child’s identity. Of course, there are certain instances where knowing a biological parent’s identity is not possible, such as child abandonment or countries that prohibit the sharing of this information. However, there is an argument that in cases such as egg donation or surrogacy, there is the opportunity to record the biological contributor’s identity and records, and that to do so is in the child;s best interest. How and when to disclose such information should remain in the domain of the intended parents of that child.
The decision to disclose the child’s biological background does not have to be made at the time the donation occurs. If a parent becomes the “gate keeper” of the information, then they are empowered if they should decide to undertake that conversation. An intended parent will never have this choice if they elect to work with an anonymous donor.
Part of the story in telling a child about their genetic background, is the telling of how much this child was wanted. Our own experience over the last 40 years of being in touch with children born through egg donation, traditional surrogacy (where the surrogate uses her own eggs and is inseminated with the sperm of the intended father), or gestational surrogacy (the child has no biological connection to the surrogate), is that these children emphasis how much they know they are wanted. Many have told us that they feel proud of their parents for participating in such a new field and for the fact that their parents never gave up on their dream to create them. In all our years, we have never heard a child (often they are teenagers or adults when we speak to them), state that they wished they had not known. These children have no doubt that they were wanted and are loved.
There are no absolute right or wrong answers. We encourage you to view our Articles & Videos to hear from our professionals from around the world on this subject. The best gift you can give yourself is perhaps a consultation with a mental health professional and/or an attorney and you can see these professionals by visiting Our Experts page.
Screening an Egg Donor
There are two different journeys to finding an egg donor. The first, and the one that Fertile Leaf recommends, is to work with an egg donor agency or Concierge. The agency or Concierge will have a database of several hundred donors that are typically pre-screened. Some donors will be fully screened and ready to start a cycle, whereas other donors on the database will be partially screened. The advantage of looking at a database is that the intended parent can view many donors that fit their criteria and affording them the opportunity to make an informed decision in choosing a donor.
The second journey is for those intended parents that have a family member or friend, or perhaps a friend of a friend, or someone they found through an online group, who steps forward and volunteers to assist them.
Both journeys will require screening of the egg donor. Of course, the criteria for the qualifications of being accepted as an egg donor may be less intensive when an intended parent brings their own donor to an IVF clinic or mental health professional for screening. As an example, most recruiting agencies have an upper age limit for donors of 35 years. However, the IVF doctor will waive this upper age bracket if a sister is helping a sister and the donor sister is 39 years of age.
Current knowledge is that women are born with about 400,000 eggs and during each menstrual cycle the body recruits 30 or more eggs to mature one for possible fertilization. During a donation cycle, a donor is given increased doses of this maturing hormone so that more of the eggs recruited that month would mature (typically 8-15). Therefore, the eggs that your donor donated to you would have been lost that month when she has her menstrual cycle.
“I was never going to use those eggs in any case. I could flush my eggs each month or offer them to an intended parent. A child would never have been created from my eggs if not for the intended parents really wanting and creating that child.”
The first child born from egg donation, according to the Wikipedia, was reported in Australia in 1983. Since that time, IVF doctors have honed their skills on how to evaluate egg donors to offer an intended parent the highest rate of success. Please remember that every IVF doctor and each egg donor agency or Concierge will have their own criteria in accepting an egg donor. The list below is meant as a guideline and is based on our over thirty years of experience of working in this field.
Initial Qualifications to be an Egg Donor
- Humanitarian motivation should be evidenced in addition to any compensation she will receive.
- Age 20-30
- Normal height, weight ratio (BMI), usually in the range of 19-28
- Be in good health, both physically and emotionally
- Regular Menstrual cycles
- Not currently on Depo-Provera, Norplant, Nexplanon, or any brand of a hormonal IUD
- Having both ovaries, and no history of reproductive problems
- Non- smoker for the last 12 months
- No current use, or long-term abuse, of drugs or excessive alcohol – this includes marijuana use
- No family history of inherited genetic disorders
- No tattoos or body piercings within the last 6 months and none during this cycle
- Reasonably healthy family medical history
- Willingness to take hormone injections
- Willingness to participate in an appointment with a mental health professional
- Dependable, mature, and reliable (able to keep appointments and be prompt)
- Not travelled to a country affected by Zika virus in the last 6 months.
- Free of STD in the last year
- Be available for at least 6-12 appointments
- Had a Corvid test that was negative or willing to have a Corvid test.
The process of becoming an egg donor is a lengthy one and not for the faint of heart. Below is a high-level overview of what it takes to become an egg donor.
Advice for Egg Donors
But first, here is some advice to share with your egg donor:
- Do not hold back with any questions you may have on the Questionnaire or any documentation presented to you. If you do not know an answer to a question, mark that question as “I do not know” instead of “no”. Please remember that there are no silly questions. Someone has asked the question before and who knows, maybe your question will result in a rephrasing of the question to be clearer!
- Never feel embarrassed to broach certain subjects. You are dealing with professionals and they have all heard it before.
- Everything matters. You matter, your understanding of the process matters, your questions matter and your answers matter. An egg donor contributes to another life and every question should be carefully considered and answered.
- Be honest about your own and your family’s health histories. It is understandable that when our family medical histories are put to paper, that suddenly the vision that you are healthy is shattered. This is normal. No one has a perfect family medical history.
- The professionals guiding you through this journey will discuss the answers with the donor in detail. It is therefore especially important that the donor accurately portrays her family medical history to avoid discrepancies.
- Be prepared for the egg donor journey to last longer than originally anticipated. Sometimes there is a lab error and tests are lost and an entire month is lost. A blood test could come back abnormal and treatment then retesting is needed. Since the functioning of the ovaries varies from month to month, it may be necessary to cancel a cycle and restart the following month. None of this is caused by the fault of the donor, many delays are just human error or our biology working the way it does.
- Finally, do not give up. The gift of egg donation is priceless and a life changer to another couple. In the end, it will all be worth it.
Step-by-Step
From starting the process to the aspiration of egg will take 3-4 months. Of course, with complications this time frame can be extended. It is highly doubtful that a cycle with a woman new to egg donation will take less than the 3 month time period, even if she is a sister and the intended parent waives many of the steps discussed below.
- Complete application
It is understandable that if the donor is a family member or close friend that all parties will agree to forgo the answering of a lengthy questionnaire. This may be the right choice for a donor who is a blood relative. However, in completing an application, the donor shows commitment to the process and gives her time to carefully examine her agreement to donate. In addition, reading the family genetic report and medical report may remind everyone of the increased risk of inheriting a medical problem. If nothing else, the application will contribute towards everyone carefully considering if this donor – lovely as she is – is the right donor to work with. If the donor is not a blood relative, it is highly recommended that the donor completes a questionnaire as in the future this medical information may become valuable to the parents or the child. Lives move on and close acquaintances sometimes become distant, but fond memories. There appears to be many advantages to having the medical information in a safe location and no recognizable downside.
- Review application
Clearly, no good can come from having an application and not carefully reviewing it! The intended parents should carefully read and reread the application multiple times and ensure that all questions are satisfactory answered. It is recommended that all additional answers given to questions be carefully documented and shared with all parties. It is an easy mistake to assume an answer is fully understood, but in sharing the documentation of any follow up questions, everyone can be sure there was no incorrect assumptions made. It is also highly recommended that the application be reviewed by a professional in the field. The IVF doctor will most likely review the application but feel free to share the application with your mental health professional, case manager and attorney. These people are all experts in the field and their trained eyes may fall on an irregularity that requires further investigation.
- Initial bloodwork – Hormones
Usually day 3 of your donor’s menstrual cycle your IVF doctor will order various hormone tests. The typical tests are FSH, LH, Estragon. A newer test, anti-Mullerian hormone (AMH) may be ordered as those levels are useful in predicting ovarian reserve (basically how many eggs can be expected to be retrieved). For a more in-depth look at the definitions and functions of the hormones involved in reproduction, please visit our Articles & Videos.
- Ultrasound for antra follicle count
This ultrasound will give your IVF doctor a good indicates of the donor’s ovarian reserve or how many eggs may be aspirated at the end of the cycle.
- Second round of bloodwork
The IVF doctor will order a 2nd round of bloodwork and these tests will take 2-4 weeks before results are received.
a. Donor’s blood type. For more information visit our Articles & Videos and review the Article entitled: on Understanding Blood Types.
b. Social Disease Testing – Every doctor’s office has their own requirements for social disease testing and in most cases these tests are dictated by law or a medical governing body. In the USA, the Food and Drug Administration (FDA) requires the following testing be completed on all egg donors:
- HIV, types 1 and 2
- Hepatitis B Virus (HBV)
- Hepatitis C Virus (HCV)
- Treponema pallidum (syphilis)
- Chlamydia trachomatis
- Neisseria gonorrhea
- West Nile virus
Most IVF clinics will require these tests as a minimum and will have a list of additional testing needed. Be aware that if the donor is sexually active, frequently her partner may also need to undergo social disease testing.
c. Genetic Testing & Karyotype Testing: Most egg donors are screened for a minimum of 23 genetic disorders such as cystic fibrosis and inherited disorders related to hemoglobin, such as sickle cell anemia or thalassemia, depending on ethnicity addition. Some egg donor agencies and IVF clinics will screen donors for close to 300 genetic disorders. The field of genetics is thriving, and additional tests are continually being discovered. It is, however, important to note that being a carrier is not the same as having the genetic condition in question. A donor may be a carrier of a genetic condition but does not have that genetic condition herself. We are all carriers for several genetic conditions, only some of which can be detected with today’s technology. Being a carrier is part of being human – it is normal. In addition, a negative test result greatly reduces, but does not eliminate, the possibility that the child will not be a carrier of or have an inheritable condition.
If an intended parent elects to have their donor undergo genetic testing and karyotype testing, then it is also recommended that the intended father undergoes the same testing so their results can be compared. If a sperm donor is involved, it is recommended that the egg donor duplicate the testing already undertaken by the sperm donor. We also encourage you to schedule a session with a certified genetic counselor to review these results.
- Genetic screening – screens for a family history of birth defects or hereditary diseases by taking a comprehensive family history
- Karyotype testing, test for blood type and screened for cystic fibrosis and inherited disorders related to hemoglobin, such as sickle cell anemia or thalassemia, depending on ethnicity.
d. Urine drug screen – This test is done at the beginning of the screening process and sometimes repeated just before the aspiration.
- Physical examination including ultrasound and pap smear/cervical screening
The ultrasound is performed internally, and donors have reported it is uncomfortable and likened it to a pap smear/cervical screening.
- Psychological Screening
The donor will be asked to speak with a psychologist to make sure she fully understands the benefits and risks of egg donation and has proper motivations for becoming a donor. A donors mental and emotional health is an important consideration to exclude the presence of psychiatric disease which could be inherited by a child. The donor will also complete a standardized psychological test, the most common being the Minnesota Multiphasic Personality Inventory-2 (MMPI). This test will be scored by a professional psychologist. Here are a few examples of some psychological questions and discussions:
a. How do you feel about sharing your genetic material with a child you will not know or have a relationship with?
b. Have you discussed this egg donation with your partner, family or friends?
c. Let’s talk about your current relationship status. If single, do you intended to share that you donated with a future partner?
d. How much information do you want the intended parent(s) to know about you?
e. What kind of contact would you be interested in pursuing with the intended parent, before, during and after this donation?
f. How do you feel about a child contacting you in the future?
g. Do you want to know if the intended parents achieve a pregnancy?
h. If you were to experience infertility problems in the future, how would you feel about your decision to donate eggs?
i. Do you think you will donate your eggs to other intended parent(s)?
j. Do you have someone close that you can talk to about this donation and may be willing to accompany you to medical appointments, maybe help you with the injections and/or be present at the aspiration (removal) of your eggs?
- Legal issues
To avoid potential legal issues, the intended parent(s) should have an attorney draft an egg donor contract or if the word “contact” is to official, then at least an agreement between everyone. The contract should state that the egg donor is waiving her parental rights and that all children born from her donated eggs will be the child of the intended parent(s). Also, if you know the egg donor, the egg donor contract should spell out the terms of any future relationship between the donor and your child and include some provision as to who will inform the child of the egg donation and when this will happen.
- Cycle Begins
Usually a cycle starts with the egg donor being put on birth control for about followed by 2-3 weeks of hormone treatment (injections, pills, patches, creams). During the treatment phase of the cycle, the egg donor should be prepared to make 4-6 visits to IVF clinic for monitoring, blood work and vaginal sonograms to monitor her egg development.
- Egg Retrieval
The egg retrieval, also called Trans Vaginal Aspiration, almost always takes place in the morning and last about 15-30 minutes. The donor will be sedated for this procedure with “Twilight Sedation” not general anesthesia. This means that the donor cannot drive herself home and alternative arrangements need to be made in advance as well as a last-minute backup plan in case of emergency.
The aspiration is done vaginally, without incision or the need for stitches. The IVF doctor will use an ultrasound with a probe to locate the ovarian follicles. A very thin hollow catheter with suction capabilities is pushed through the vagina wall and is pushed against the surface of the ovary. Fluid from each follicle is then drained and somewhere in the fluid is a precious egg. This process continues until as many follicles as can be seen are drained then repeated on the second ovary. The tubes containing the follicular fluid are prelabelled with donor’s name and ID as well as that of the intended parent. These tubes are immediately taken to the IVF lab where an embryologist will isolate the eggs and placed the eggs in a medium where they will continue to grow for a few hours and then fertilized or frozen.
The donor will rest in the IVF clinic recovery room for about an hour after the procedure. The donor is then ready to return home. It is highly recommended that the donor takes the rest of the day to relax at home and indulge in binge watching her favorite TV shows or movies. The donor is cleared to return to work or normal activities the following day. The donor should have her menstrual cycle about 2 weeks after the retrieval. Warning: the donor is still fertile and frequently not all eggs were retrieved, and she will be able to conceive that month so be sure to use remind her to use protection during intercourse.
