Egg Donation - The Gift of Forever
Egg Donation is a process by which a fertile woman (known as the egg donor) donates 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 has undergone cancer treatment
- Where an intended mother has suffered from multiple failed IVF cycles
- Where an intended mother is advised not to work with her eggs due to an inherited disease.
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, no history of reproductive problems, non- smoker for the last 12 months, no current use – or long-term abuse, of drugs (including marijuana) or excessive alcohol 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 traveled 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 Covid test that was negative or willing to have a Covid 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.
When completing an egg donor questionnaire, do not hold back with any questions you may have. 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, 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.
From starting the process to the aspiration of eggs 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.
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.
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.
Usually day 3 of your donor’s menstrual cycle your IVF doctor will order various hormone tests. The typical tests are FSH, LH, Estrogen. 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.
- 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.
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.
The ultrasound is performed internally. Donors have reported it is uncomfortable and likened it to a pap smear/cervical screening.
The donor will be asked to speak with a psychologist/mental health professional to make sure she fully understands the benefits and risks of egg donation and has proper motivations for becoming a donor. A donor’s 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?
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 children 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.
Usually a cycle starts with the egg donor being put on birth control for a month 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 the IVF clinic for monitoring, blood work and vaginal sonograms to monitor her egg development.
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.