Now that you have decided that egg donation is the next step in your journey toward parenting, the next stage is the method of implementation. Will you opt for an egg donor agency, your infertility doctor’s egg donor program, or an online forum, or consider a friend or relative as your donor? This article will specifically address asking a friend or relative to be your egg donor. While the focus is on egg donation, much of the discussion will also be applicable to scenarios involving a friend or family member as a sperm donor.
The decision to try and work with a family member or friend is the easy part. However, the process of doing so can be challenging. Many intended parents express anguish over how to initiate a conversation about egg donation with a close friend or relative. The fear of refusal or imposing an uncomfortable situation upon a potential donor is often nerve-wracking. The donor, especially if a close relation, might not feel she has the option of declining. Furthermore, there are risks involved in egg donation. The thought of asking a family member or friend to bear these risks can be overwhelming for some.
With this article, we hope to alleviate those concerns and offer a pathway towards ethically approaching a family member (familial collaboration) or friend about helping you to create your family of choice. The good news is that you do not have to figure this out for yourself. Your fertility doctor, mental health professional, and attorney are well-versed in these situations, offering a wealth of knowledge, experience, and training they are eager to share with you. We encourage you to book a consultation with these professionals to fully understand the subtleties of this option. In addition to these professionals, this article provides valuable insights to guide you in your decision-making process. It is divided into two subject matters.
- Asking for Help: How to approach a family member or friend.
- Considerations in Familial Collaboration: An analysis of the pros and cons of working with a family member or friend.
- Asking for Help
The best approach is to write to your prospective donor and outline the fertility journey that led you to need the help of an egg donor. Writing a letter or email will help focus your thoughts on what you are asking of her and will assist you in seeing the question being asked from your donor’s perspective.
Instead of confronting your donor face-to-face, receiving a letter or email gives your donor the space she needs to carefully consider what is being asked of her without having you standing right there awaiting an answer. Giving your donor time to consider her response is being respectful to her privately.
Be direct in what you are asking of her. Clearly state that you are looking for an egg donor and that your preference is that the donor be a family relative. However, follow this up by reassuring her that you also have other options – working with an egg donor agency, your doctor’s egg donor program, or the possibility of seeking out a donor on an online forum. If she indicates that she is reluctant to be a donor, you could invite her to assist you in looking for a donor through one of these forums.
She may need help understanding this unfamiliar concept, so be sure to include details and resources related to being an egg donor and the process involved. Make it clear that you want her to completely understand what she could potentially agree to and acknowledge the lifelong implications of this decision. Express that if she would like to assist you, you would like to offer her the option of consulting with a mental health professional, either together or independently.
You do not need to overwhelm her with tons of information at this early stage. An agreement, in principle, is fine. There will be time later to speak to her about issues and concerns and for you both to look at the medical process involved. Adopt a kind and respectful tone in your letter or email and clearly explain that you will respect her decision, whatever that may be. Let her know that you are aware that this may be the biggest gift you have ever asked from anyone and probably the biggest gift she will ever have to consider offering to someone.
- Considerations in Familial Collaboration
According to the American Society of Reproductive Medicine (Fertility and Sterility Vol. 107, No 5, May 2017), collaborating with an adult intrafamilial egg donor is generally ethically acceptable when all participants are fully informed and counseled. However, care should be taken to avoid coercion, and all parties must take steps to ensure that the egg donor has informed consent regarding her participation. When a sister donates her eggs to her sister or brother (first-degree relative) or to a cousin (second-degree relative), who are of similar age to herself, this is referred to as intragenerational donation. Whether you are considering asking a family member or friend to donate eggs to you, this is referred to as a ‘known’ or ‘open donation.’ Anonymous or closed donations occur when the donor is unknown to the recipients and often occur when a donor is found via an egg donor agency or a doctor’s in-house donor agency. (However, some agencies and in-house donors are open to the recipient meeting the donor and forming a relationship.)
Familial egg donation ensures that some portion of the infertile person’s genes will be passed to the offspring, thus maintaining a kinship tie that would be lost if an unrelated donor were used.
(Fertility and Sterility Vol. 107, No 5, May 2017).
Collaborating with a family member means that your child will share some of the same characteristics that are prominent in your family (e.g., a dimpled chin, eye color, etc.), and your child will share some genes with you and, therefore, more likely to resemble other members of your family.
For a male gay couple, using one dad’s sperm and the eggs from the other dad’s sister or cousin means the child will be genetically related to both.
Collaborating with a friend permits the recipient to enjoy an open or known donation process in which almost full access is given to family histories, and questions that arise can quickly be answered.
While a family member donating or a friend donating may offer many advantages over working with an unknown or anonymous donor, some serious issues should be considered.
a. How to choose between donors?
Whom to choose is not an issue when you only have one sister. But what if you have more than one sister or more than one friend who wants to help you become a parent? Here are a few criteria that may help you:
- Donors should ideally be aged between 21 to 38 years. However, a 21-year-old may need to be more mature to understand her lifetime commitment fully and may also be young enough to be coerced. An ideal age would be 27-38, with her own children.
- Do you like her? We understand that you love your siblings, but do you like her? Do not create a child with someone you do not like.
- If it is a choice between friends, consider her likeness to traits in your family.
- Choose a donor with a similar personality, education, interests, and hobbies.
- If you are athletic, choose a donor that has athletic tendencies.
- Religious affiliation may be less important but should be considered.
- If finances are a consideration, the location of your donor and closeness to your fertility clinic is something to consider.
Ready yourself with a concise explanation for why you preferred one sibling or friend over another. Doing so will prevent you from being caught off guard and perhaps saying the wrong thing.
b. Coercion
The physical and emotional closeness of the relationship between the donor and the recipient(s) must be seriously considered. In a close-knit family, the donor may feel she cannot say “no” when asked to donate her eggs. Even if no demands are made, other family members may exert psychological pressure on the donor to help the family member. The donor may feel guilty that she could help but has chosen not to.
Extra care should be taken if the donor relies on the recipient for financial aid or well-being. The coercion may not be deliberate but may unconsciously occur, and therefore, special attention needs to be paid to possible pressure playing a role in the donor agreeing to help. A mental health professional may be of great help in these kinds of situations. The element of coercion is well recognized in familial organ donations and can be dealt with through separate counseling sessions for the participants.
A mental health professional can allow the donor the chance to withdraw from the egg donation process without the recipient becoming aware of the donor’s initial reluctance. Equipped with various explanations, the counselor can then communicate to the intended recipients that the donor is not in a position to continue with the procedure.
c. Failed Donation Cycle
Consideration needs to be given to how the parties will feel if the egg donation procedure does not result in viable embryos or pregnancy is not achieved. There are several scenarios, but it is quite possible that the donor will not pass the medical or psychological screening process, will not take her medication correctly, will not respond to the medication, or the number of eggs aspirated may be low, or the quality of the eggs not suitable for fertilization. It is possible that only a few embryos are created, and those may be of low quality. After multiple embryo transfers, a pregnancy may not be achieved, or a miscarriage may occur. Things can go wrong at every step of the process. The baby may have a genetic or congenital disability. The long-term stress of raising a disabled child may cause significant psychological stress to the parents and the donor.
The donor may blame herself for all these failures, feel reproached by others, embarrassed, or guilt over these failures or outcomes. Any one of these situations could lead to a deterioration in the relationship with the donor and within the family.
Consulting with a mental health professional will open these issues up for conversation, and the counselor could assist by providing coping mechanisms should these situations occur. It is always better to discuss something openly in advance than deal with the discomfort of a potentially difficult situation further down the line, as everyone had already agreed on the path if things did not go as planned.
d. Second Thoughts
Most donors will have second thoughts about donating during the donation process. This is perfectly healthy but also unavoidable.
The egg donor process is a lengthy one. The process starts with a medical evaluation involving a detailed questionnaire and an in-depth physical evaluation. The psychological interview can be stressful for someone who has never participated in a psychological session. The counselor will be direct and ask probing questions about her motivation to donate because the counselor wants to determine if there is coercion or an ulterior motive to donate that has yet to be verbally expressed. The counselor will inquire into past and present relationships, including intimate relationships. In addition, they will openly discuss the right to change her mind with the donor and offer her options concerning informing the other parties in this agreement. The counselor is not there to encourage the donor to change her mind about donating, but it is their job to explore all the options available to the donor. The psychological testing is laborious; it takes 60 to 90 minutes to complete. It can be stressful to wonder what the test will reveal about yourself, some of which you may not even be aware of! There are at least five medical appointments needed. (Typically, a donor attends somewhere between 5-10 appointments) and this means considerable time away from work and family. All these appointments, none of which can be missed, can add to stress levels.
During the donor cycle, it is highly recommended that the intended parent keeps in regular contact with their donor. Showing your appreciation and investing your time in her well-being will be appreciated. Stay calm if your donor expresses second thoughts about her participation. Perhaps it is just that she cannot face another injection because her injection site is not already bruised. It may be that her boss is commenting about her excessive time off work, or her partner is not as supportive as you initially thought. This is where access to a mental health professional will be invaluable to you and your donor. The counselor can get to the root cause of the donor’s concern or anxiety, promote an open conversation, and perhaps offer a solution.
e. Clear Relationship Boundaries
Before committing to a donor cycle, everyone should openly discuss the changes that will occur in their relationship. While these discussions can be intimidating, do not let them deter you. Open discussions can give you a clearer idea of whether this donor suits you.
- Is it clear to the donor that the eggs she will donate would have been lost during her next menstrual cycle anyway? Without your intervention, those eggs could never have created this child. Your donor must recognize that this child exists because you created this life by bringing together the egg and the sperm. Your donor is graciously giving you back some of your genetic pool of genes (for familial donations). The situation is slightly different if you work with a friend in that the friend is sharing her family’s DNA with you. It must be clear to your donor that she is not giving you a baby but allowing you to have one.
- Who else in the family will know about this donation? Whose choice will this be? Some recipients decide it should be left to the donor to determine who gets informed about the familial donation. Some donors prefer not to tell anyone else in the family to avoid questions when the recipient does not achieve a pregnancy or if something goes wrong during the donation process. Discuss who is to know and when and who will do the telling.
- What will the child be told, when, and by whom? In most cases involving familial or friend donation, the child will be told of their unique beginnings. It is typically the parents who decide when the right time and place is to tell their child. However, if several family members already know of the donation, the sooner the child is informed, the better, as someone in the family will surely slip up sooner or later.
- Finances generally make everyone uncomfortable but need to be openly discussed. Will your donor receive compensation? If yes, how much and when? If not, what expenses will be reimbursed, etc.? There are always expenses that a donor incurs, whether it be paying for travel, babysitting services, lost wages, or even her car being scratched in the parking lot of the doctor’s office. Usually, when the expenses are minor, the donor may express that she does not want compensation. However, if there are complications with the cycle and your donor is hospitalized, who will pay her expenses and lost wages? At the very least, there should be some discussion about when unexpected expenses should be reimbursed.
- The relationship between the parties and between the donor and child will differ. Nothing will change the fact that the donor and child are biologically related to each other and that this child could never exist without the donor’s assistance. It is recommended that this relationship should not be downplayed but embrace the fact that your child has another loving adult in their life. However, respect should be granted to the child about sharing this information with others. The special relationship can be acknowledged, but it does not mean it must be continually discussed. A mental health professional will be invaluable in guiding you through this process.
- Openly discuss what kind of relationship your egg donor and child will have. It is essential to set some parameters for the relationship. If your donor does not have children of her own and later cannot, how will this impact or change her relationship with your child?
- If your donor has children of her own, what will they be told about their relationship with each other and when?
- For many familial donations, the parties refer to the donor as “Aunty” but sometimes use the phrase “special Aunty.”
f. Donor’s Partner and Recipient’s Partner
It is important to consider the feelings and opinions of the donor’s and recipient’s partners. In familial donations, sometimes the family members do not necessarily like their sibling’s choice of partners! It may be difficult for a sibling to donate eggs to someone with whom they have an antagonistic relationship.
Respect needs to be given when a partner does not support the donation. But at the same time, respect needs to be given to a woman to decide what to do with her own body.
It is recommended that the partners participate in at least one counseling session to understand the process thoroughly and express their feelings and thoughts.
g. Costs
No doubt, working with a sibling or friend as your donor will save you money. Finding an egg donor through an egg donor agency, your fertility clinic’s in-house donor program, or even finding a donor through online forums will be more expensive. For some recipients, the cost of these options is simply out of their reach, and the only way they can have a family is through the help of a family member. This is all understandable, but make sure you do not leave your donor feeling that without her help, you will never be a parent. That is a burden that is unfair to leave on anyone’s shoulders.
h. Legal Issues
Depending on where you live, there can be many legal complexities around egg donation. In most countries, the person who gives birth is the child’s mother. If you are participating in surrogacy, consult with an attorney to establish your parental rights when donor eggs or sperm are involved.
Legal issues can arise around the “ownership” of frozen embryos and eggs. It is, therefore, important to have documentation in place that addresses the “ownership” of any frozen embryos and frozen eggs before any egg donor cycle begins.
i. Who will the baby bond with?
No matter how comfortable everyone is with a familial or friend donation, uncomfortable moments can occur when the child becomes a reality. The moment when your baby lunches out of your arms towards the donor or wants to sit next to their “special Aunt” can be awkward. Of course, there will be moments of uncertainty, even jealousy. But remember that these are single moments in time, and if you think about it, your baby probably lunged toward other people before or wanted to sit next to granny as well. Yes, your child behaves fondly towards your donor; that is normal and healthy, but never misunderstand that you are this child’s parent!
A lot goes into egg donation; remember, it is a process. Have a Plan B in place in case your donor – for whatever reasons – cannot proceed with this donation. Familial donation or having a friend donate is usually beautiful for everyone involved. Yes, more steps are involved than anticipated, but all this hard work will have been worth it in the end.
Author: Karen Synesiou, Infertility Portal, Inc.
