Episode Transcript
[00:00:00] Speaker A: Hey, it's Eloise. Quick heads up before this episode starts, what you're about to hear is from the Fertility Cafe Archive. We're bringing some of our past conversations back because new listeners find this show every week and these stories deserve to keep finding the people who need them. If you've heard this one before, give it another listen. Something always lands differently the second time, and if it's your first time, you're in the right place.
Okay, let's get into it.
Today I'll share the specifics of egg donation, how it's evolved over time, key terms to know, and the different types of donation programs.
[00:00:40] Speaker B: Whoever thought making a baby could be so hard? Luckily, the fertility journey isn't meant to be traveled alone. Eloise Drain has helped hundreds of people build and grow their families over the last 15 years and she's ready to share her insider knowledge and expertise with you. So grab a seat and let's talk fertility and alternative family building in the Fertility Cafe.
[00:01:00] Speaker A: Welcome to Fertility Cafe. I'm Eloise Drain. With the world of social media, people tend to believe almost anything that pops up on their timeline with no thought to the resource that provided the news or information.
There's information constantly storming the Internet, making it hard to know what's true and what's false. And as you can imagine, there are lots of myths and misconceptions surrounding egg donation and the world of alternative family building.
As founder of Family Inceptions, a surrogacy and egg donation agency, and a six time egg donor, I've heard my share of misinformation.
Today, I'll share the specifics of egg donation, how it's evolved over time, key terms to know, and the different types of donation programs. The information I'll share will provide a snapshot on egg donation that will help egg donors and recipient parents understand what they're getting into and and why many people choose this option to create their families. So sit back as we explore the ins and outs of the egg donation journey. Let's start with the obvious. What is egg donation? Egg donation is defined as a safe, tested and relatively non invasive medical procedure that allows eggs to be retrieved from a healthy and fertile donor. The fertile woman known as the egg donor donates her eggs or oocytes to another woman to help her conceive. The recipient of the eggs can either be the intended mother, also known as the recipient mother, or it could be a gestational carrier. Egg donation provides the option in which the recipient mother can carry her own pregnancy, or in which it can be Used in tandem with surrogacy, egg donation was developed in order to help infertile couples, LGBTQ families, and single individuals who wish to start a family.
The first successful egg donation pregnancy was in Australia in 1983. The US had the first successful transfer in 1983 that led to a birth in February of 1984. Luckily, through technology, it's a common practice now throughout the world and has very successful outcomes. I know we're speaking about egg donation in this show, but I wanted to point out that if a woman is completing IVF and using her own genetic material to carry herself or with the assistance of a gestational carrier, she'll complete the same process as what a donor must go through. And if she's working in tandem with a gestational carrier, she'll also need to complete similar medical screening as well.
It's important to note egg donation is highly regulated. It's treated just like any other tissue or organ that gets donated and the FDA has strict rules and regulations that must be followed by by all fertility clinics.
Do you remember biology class?
Honestly, until I got in this field I sure didn't. Truth be told, when I started hearing terms that aren't really used on a regular day to day conversation, I had to look up some definitions.
So bear with me. I'm going to give you a quick rundown.
I've already shared one of the terms oocyte, which is the immature eggs that would be retrieved from the egg donor. Often you'll hear professionals in the industry refer to the donor's eggs as oocytes, ova or ovum.
I spoke about this previously when seeking alternative family building, it's impossible to do anything without the use of IVF or in vitro fertilization, which is a series of procedures and techniques where a woman's eggs and a man's sperm are combined in a lab in order to create an embryo.
A woman's eggs develop inside fluid filled sacs inside the ovaries called follicles.
Controlled ovarian hyperstimulation is the technique used by taking hormone medications that stimulate the ovaries to produce multiple eggs after the IVF cycle. Hopefully a number of viable eggs are produced to freeze the eggs or even the embryos, also referred to as cryopreservation. It goes through vitrification or flash freeze, which is freezing the egg or embryo with extremely rapid cooling so that ice crystals never form around it.
The egg or embryo is literally frozen in time. Whatever stage it was in, it will stay in until thawed. Then we have a gamete, which is a mature sexual reproductive cell such as an egg or sperm that unites with another cell to form a new organism. And when the male gamete and female gamete meet, it's called a zygote. The single celled zygote begins to divide and eventually becomes a blastocyst. In the medical clinics, you'll hear reference to blastocyst embryos. Almost all clinics do the extended five or six day blastocyst transfer as they believe it produces a more successful outcome. Embryos that survive this to this stage of development has a high implantation potential once transferred into the uterus.
OHSS is Ovarian hyperstimulation syndrome and I'll go into detail later in the show about what this is.
Fet, or frozen embryo transfers, is what the majority of clinics are all doing and in all honesty, would prefer to do. If possible, I'll share why shortly. Have I lost you yet? Are you bored? Sorry. Why does all this matter? Well, because knowing the foundation of this process can better help you visualize the process. And when the time comes when you're speaking to a medical or legal professional and they begin using some of this terminology, you can easily follow what they're talking about.
If you're embarking on this journey, regardless of your role as an egg donor or a recipient parent, there's several decisions you'll need to consider on how you want to complete your journey. What type of arrangement you're comfortable with? What program would work best for you? Are you going to work with a fertility clinic, frozen egg bank, egg donation agency, or go the independent route when it's time to find your egg donor or when you're ready to donate your eggs. What about fresh versus frozen embryo transfers? Is one better than the other?
One of the first decisions made in the egg donation process is the relationship that will exist between the donor and the recipient parents.
Currently, the most common egg donation arrangement is an anonymous or closed egg donation.
Information from both parties is kept confidential. Typically, you'll see these arrangements through the fertility clinic or frozen egg bank.
Recipient parents will see a donor's profile, which would include her genetic and medical history, her family's medical history, education level, her personality and physical description.
There won't be any adult photos and it's often limited to her baby pictures. Her full name will never be disclosed.
So to determine which donor would be a good fit, recipient parents choose donors with similar features like hair color, eye color and blood type, to name a few. A frozen embryo transfer is always anonymous and the egg Donor has no say to whom would get her eggs, nor will she know who received it or if a pregnancy or child resulted from the donation.
Given new technology with programs such as 23andMe and Ancestry.com, anonymity is quickly becoming a thing of the past. And because of this, donors and recipient parents alike are opting to do semi anonymous donations.
This arrangement is when only specific information is provided to each party and each party would agree on what information would be shared, which is normally first names and what state they live in. It's also possible for the parties to speak over the phone. However, no one is obligated to stay in touch with the other party once the donation is complete. It's more common to find semi anonymous arrangements when working with egg donation agencies or fertility clinics that have donors willing to complete fresh cycles for quite some time. It was assumed by many the only way someone could have an open or known egg donation arrangement was if the egg donor was a family member or friend. That's no longer the case. Open donations are becoming more common. Recipient parents and egg donors are agreeing to disclose their identifying information such as names, addresses, etc. And many times they meet in person and agree to have a long term relationship.
What that relationship looks like will be something all parties agree to up front. But now recipient parents can work with a donor they didn't have a relationship with prior.
Often you'll find the open donation arrangements through egg donation agencies or if you go the independent route. It's very unusual at this current time anyway to have an open donation with an egg donor located through a frozen egg bank or even a fertility clinic.
Lastly, there is the identifiable donor arrangement in which all parties agree that egg donor's information will be identifiable to any child born using her eggs. Once the child turns 18 years of age, there is a push for open donations or at least the identifiable donor arrangements, not just because of the development of DNA and genetic technology, but ultimately for the sake of the child that will result from these donations.
For most people, knowing their genetic history is important and it helps with medical questions they might have over time. People conceived via donors have expressed the importance of understanding their genetics and knowing where they come from.
Regardless of the donor arrangement, egg donors have absolutely no parental rights of children that may result from their donations.
Once the eggs are donated, there is nothing further an egg donor needs to do.
In my own personal egg donor journeys, I experienced several different arrangements.
I first learned about egg donation on my first trip to California. I had donated kidney to my cousin and after surgery he wanted me to visit him as. As you guessed it, he lived in California. While there, I saw an ad for egg donation. Definitely something I thought I could do.
By that point, I already had three children and I didn't have any issues getting pregnant. I kept it in the back of my mind and a little over a year later decided to reach out to the agency to see if I could apply.
I submitted my application and I was told it would be near impossible to match me because I was African American and black women didn't have infertility issues. Clearly we know that's not correct, but information wasn't readily available 20 years ago like it is now. Eventually, I was matched. My first journey was an anonymous arrangement. I had no clue who the recipient families were. I assumed they were another black family and that they also didn't receive any of my identifying information.
Truth be told, it was not the greatest experience and honestly, I felt used. I didn't get any guidance from the agency. Once I was matched, I pretty much had to figure it out on my own. Meds were shipped to me. I was monitored by a local clinic, and when I was ready, I. I flew to the location where the fertility clinic was the day before retrieval, had the retrieval the next day and was handed a check after being dropped off at the hotel door by a clinic staff member and was told to take a taxi back to the airport and go home. I just assumed to not do that again. But several years later I came across a site that advertised egg donation and surrogacy. I don't know what possessed me to add my information, but I did with really the mindset I was never going to be matched. Well, wrong on that assumption. Within hours of submitting my profile, I was inundated with emails from families seeking a black donor. I was then able to choose whom I was going to donate for.
My second journey was semi anonymous. I shared with the recipient couple my identifying information.
However, I only knew them by first name and the state in which they lived.
The remaining four donations I did were all open donations.
Two of these donations were for the same family who wanted to complete sibling journey.
I was comfortable enough with the recipients that I actually stayed in their homes while I was completing my journeys.
I've had the opportunity to meet the children from my open donations and I'm friends with their parents to this day. My own children are aware that I was a donor and they've had the opportunity to meet one of the children that resulted from my donations as well.
Becoming an egg donor is a big ask.
But what I've learned in my life is that the secret to living is giving. I know that sounds corny as hell, but it's true. Whether it's your time, your money, or in this case, your eggs, it makes a significant impact for so many, and you can't even imagine how many lives you will touch by your willingness to do this for someone else.
But it really does give you a gratifying feeling knowing you are the one who helped make this impact.
Egg donation is a choice that will benefit you significantly in exchange for a minimal amount of your time, while also changing the world for a family in need, but it's not for everyone Perhaps the biggest part of becoming an egg donor is meeting the requirements. Not all women can donate.
Programs vary in the criteria they set to determine who would be a good candidate. The basic requirements to become an egg donor are to be between 21 and 32 years old, free from any sexual transmitted diseases, non smokers, non drug users, and have no family history of genetic diseases or family history of mental illness.
You'll be required to complete medical and psychological screening. The fertility clinic will screen you for general medical health, completing a physical and gynecological exam, infectious disease screening through blood and urine tests, and inherited disease screening through a blood test as well. Further, you're required to meet with a licensed mental health professional to complete a psychological evaluation.
Once the results are back from the screenings, you'll be notified if you're qualified to move forward with the actual donation process.
What's fascinating is women are born with all the eggs we're ever going to have, and we don't make any new eggs during our lifetime. We're born with approximately 2 million eggs, but each month thousands die, even before we reach puberty. By the time we become teenagers, we have about 350,000 remaining eggs, and every month they gradually die off until we reach menopause.
When someone is considering becoming an egg donor, sometimes there's a fear that you won't have enough eggs for when you're ready for your own family.
I don't want to say it could never happen. However, that would be an unusual case. In egg donation, the goal is to obtain several mature eggs. It's difficult for anyone to know how many eggs you would produce because it's different for everyone.
Through the controlled ovarian hyperstimulation process, you'll take various daily injection medications which will stimulate your produce the eggs. Once the eggs are removed or harvested, as it is also referred to, it can either be fertilized immediately or frozen to be used later. The goal is for you to produce several eggs, which increases the probability of healthy fertilized embryos. Now, let's talk about the risks. It would be extremely partial of me to only share one side of the egg donation process and pretend as if there aren't any risks involved.
I'm not here to be misleading in any way. I believe the more information people are equipped with, the better they can decide what best fits their own lives.
As with everything in life, especially in the medical arena, there are some risks involved with egg donation. It's common to feel some discomfort during the egg donation process. Some women develop soreness or mild bruising around the injection site. You may even experience breast tenderness, mood swings, and even mild fluid retention, just like you would when you have your menstrual cycle every month. These are considered normal symptoms. Occasionally, the medications can cause more hyperstimulation than intended. Known as ovarian hyperstimulation syndrome, or ohss.
This occurs when the ovaries have an exaggerated response to the hormones given to increase egg production. There are varying levels to ohss, mild, moderate and severe. Mild OHSS will cause abdominal pain and swelling. It normally goes away after your next period.
Moderate OHSS are similar symptoms as mild, however more intense where pain meds may have to be taken but again should go away after your next period.
Severe OHSS is the rarest but can cause serious medical complications such as blood clots, cancer, kidney failure and fluid buildup in the lungs.
Severe cases have occurred in about 2% of the population completing an egg retrieval process. Fortunately, in order to govern this risk, the fertility clinics take every precaution and monitors the cycle very closely. You'll be required to attend doctor's appointments every other day while you're on medications. And if there is a concern that there would be ohss, the fertility clinics will cancel the cycle and not move forward. It's actually happened to me.
I'll share the step by step egg donor process and go much more in depth about what the egg donor journey looks like in a future episode. Just like in surrogacy cases, there are compassionate or altruistic donors as well as compensated donors. In a compassionate egg donation situation, you would not receive or receive very little compensation for your time and discomfort. In a compensated journey, you would receive compensation, and that compensation will vary. Different programs offer different comps. All costs for the entire journey are paid for by the recipients, not the donor. Egg donors can receive anywhere from $5,000 to $10,000 and even more if there is a Greater demand for their specific genetics. The compensation a donor would receive is not based on how many eggs are retrieved or based on the number of embryos created. The compensation is based on the time involved, her pain and suffering and the risk compensation from the various programs are similar. However, donors that are in higher demand often receive higher premiums. Egg donation has evolved since I first started 20 years ago.
Recipient parents were given the option on whether they wanted to do fresh or frozen cycles as there were concerns that the success rate would be different depending on which method they used.
Fresh versus frozen eggs or even embryos aren't really much of a thing anymore. Thanks to the freezing technology, vitrification or flash freeze, frozen embryo success rates are now as high as that of fresh embryo transfers. More clinics are opting to complete frozen over fresh transfers and some no longer even offer fresh embryo transfers. It used to be if you wanted a fresh cycle and you were completing egg donation, you had to have patience and flexibility from both the egg donor and the recipients. Fresh cycles were completed real time. The donor didn't begin her cycle until after she was selected, so there was more lead up time to get her eggs and ultimately to having an embryo transfer. There was a synchronization of menstrual cycles that occurred between the donor and the recipient mother or gestational carrier cycle.
The hopes was that the eggs could be retrieved and fertilized just in time to be transferred directly to the uterus without having the need to be frozen. But then technology was vastly improved with vitrification and screening such as PGS or pre implantation genetic screening or pgd. Pre implantation genetic diagnosis was vastly improved. These tests are performed after an embryo is created to check for genetic abnormalities and chromosomal disorders. If tested is desired on the embryo prior to transfer, you wouldn't be able to do a fresh embryo transfer. The embryos need to be frozen to complete these tests.
Frozen embryo cycles are more routine because it does offer more benefits. One of course it's ready to go as soon as recipient, mother or the gestational carrier are ready to go. There's no lag time spent trying to align menstrual cycles. It provides a lot of flexibility in coordinating schedules, travel and could speed up the time for transfer. Not to mention, frozen embryo transfers are also less expensive than fresh embryo transfers.
For many, the concern with completing a frozen transfer is if the embryo would survive the thaw process.
I wouldn't be concerned with that too much now. Frozen embryos are still high quality and have a very good success rate. In some clinics, even better than fresh.
I know all this information is all fine and good, but how do you know where to find an egg donor or where you want to donate?
This is the start of your decision making process. Do you work with a fertility clinic in house donor database, frozen egg bank, egg donation agency or go the independent route? It's best to inquire with a fertility clinic while you're doing your research as to what options they have.
Banks can be standalone facilities and or part of a fertility clinic. If it's a standalone facility, the bank can ship the eggs to the fertility clinic of choice.
Generally, if a frozen bank is part of a fertility clinic, you may only access available eggs if you're working with that facility or their clinic's network.
Now, that's not always the case, but it's currently the most common.
Frozen egg banks are also the most cost effective option for a recipient.
There are still many fertility clinics that only offer in house egg donor database options where they have pre screened candidates. But she doesn't begin the full medical screening or or actual medication and retrieval process until after she has been selected. Then there are egg donation agencies which are often separate from a clinic. If you find an egg donor through an agency, the agency will work directly with the fertility clinic of choice and manage the process with the individual chosen.
Independent journeys are when the egg donor and recipient have found themselves directly and agree to work with each other.
You still must go through the fertility clinic to complete the medical process, but there are no middlemen connecting you. There are various platforms in which individuals advertise that they are either looking to become or looking for an egg donor.
Each program offers different options for your family building needs. As a recipient parent, it's important to consider what your family goals are regarding how many children you would like to have. You must take into consideration these factors, especially if you would like to have more than one child and want your children to genetically related.
You'll want to take into consideration how likely will the eggs produce embryos and how many embryos will be produced. Unfortunately, a transfer doesn't always take on the first attempt. If you only have one embryo, would you start the process all over again? Frozen egg banks are the quickest and the least expensive way to find donor eggs which are already produced and ready to be fertilized.
Banks sell eggs in lots of six per batch.
Provided there are enough eggs, you may purchase more than one lot from the same donor.
You can rest assured that the facility has fully screened the donor and you'll be able to select the eggs produced by your donor who meets your desired criteria. You'll receive medical and genetic history on her and her family, education level, and information on her physical characteristics and personality. You'll likely only see childhood photos, but sometimes you may see adult photos. This will vary on the bank. If you're working with a fertility clinic that offers a frozen egg bank, usually their donors are local and for anonymity purposes will only share the childhood photos. However, if you work with facilities that are nationwide, you may see adult photos. If you're an egg donor, a bank, once you're selected, can move you through the process fairly quickly. You undergo medical screening, sign consent forms, start your meds, have your retrieval, receive your compensation, and you're done.
But remember, you'll have no say who gets your eggs or how many people they're offered to. It's understandably a personal choice. If you're a woman who wants information or more detail on who you're donating to, a frozen egg bank may not be the best option. If you're okay with not knowing, then you may find donating through a bank is quick, efficient and fulfilling. Frozen egg banks also have a stricter guideline on the donors they allow into their program.
As mentioned earlier, if you decide to work with the fertility clinic's in house egg donor program, the donor is usually pre screened but may not have completed all of her screening and no eggs have been retrieved yet. Once recipient parents select a donor, the clinic will complete her medical cycle and retrieve the eggs. Unlike frozen banks, usually you will receive all the eggs produced by the donor as an egg donor. The downside to working with the fertility clinic's in house program is would be the waiting to be matched period before you can start the process.
More than likely once you're chosen, you're completing a donation for one family.
Sometimes the clinic may ask you to complete a shared cycle, which means the eggs produced would be split between two families to help with cost. But that doesn't happen all the time and through an in house program through a clinic, it's still an anonymous arrangement. And if having more control of the process is important to you, then perhaps you should consider going through an egg donation agency.
Through an agency, you get to decide who you will donate for. Once you're selected, you can ask the agency to provide you with the information on the recipient.
Of course, how much information is shared will be dependent upon the type of arrangement everyone agrees to.
Also different than a frozen egg bank or clinic in house program, you're required to have an egg Donation agreement between the egg donor and the recipient parents when you work with an agency program, this agreement stipulates the rights, responsibilities and desires of all parties. It will also detail the outcome of the type of relationship going forward.
And sometimes it also discusses the outcome on the remaining eggs being shared with another family if the recipient family decided that they no longer needed them. If you do decide to go through an egg donation agency, be aware that there is a waiting period. There's no time frame on how quickly you'll be matched. For the recipient parents, an agency egg donor offers more options to personalize the journey in addition to the same information you would get from a bank or clinic in house program agencies normally offer a lot more photos, more about the donor's personality and the ability to decide what type of arrangement you want with the donor choosing from the anonymous, semi, anonymous, open or informational arrangement I discussed earlier.
Often agencies can offer recipient parents a wider variety of donors, including donors with a specific ethnicity, race or education level.
Agencies specialize in recruiting these donors and build a network of donors to choose from. It's ordinarily why recipient parents choose to work with an agency because you do receive all the eggs produced by the donor. Donor eggs through an agency can be utilized in various ways. You'll have to ensure your fertility clinic allows for these options, but you can choose to cryopreserve the eggs or fertilize them and cryopreserve the embryos. And if you're a same sex male couple, you can split the eggs and each partner fertilizes eggs so that your children share genetics to the donor.
Having excess eggs can minimize any anxiety over finding the same donor in the future to complete sibling journeys or to complete additional temps if need be.
Thanks to technology, excess eggs or embryos are still able to be frozen. The clinic usually selects the embryos to transfer, then freezes the remaining embryos for future transfers or if all goes well, a future sibling.
Working with agency donors also has a downside.
The most obvious is that nothing is guaranteed. You're using a live donor in a fresh donation cycle and there is always a chance that the donor won't produce enough viable eggs.
And financially, an agency donor will cost more than a frozen bank or even fertility clinic's in house donor program.
Unless it's a shared donor cycle, you're paying the full cost of the donor's medical and psychological screening, travel if needed, legal costs, compensation, agency fees, and the clinic's cost to complete the ivf.
Regardless of the program, the medical process for the donor, once she is selected, will be the same as mentioned previously, all donors must go through a medical and psychological screening, genetic screening, infectious disease screening, genetic testing and drug screening. The difference will be the time frames. Frozen banks will be about two to three months. Fertility clinics and egg donation agencies will vary. Once selected, it could take about three to five months.
So there you have it. I know it's a lot of information and we only touch the surface. In future episodes, I'll go into greater detail on the medical process, how to find and become a donor, the debate on nurture versus nature when it comes to determining the must have qualities in your donor, and the enigma of ethnic egg donors. You won't want to miss these episodes, so be sure to subscribe to fertilitycafe on whatever platform you're listening on.
I hope you've enjoyed today's episode and that I've given you better insight into egg donation and the considerations for both donors and recipients.
If you enjoyed this episode of Fertility Cafe, we'd love you to leave us a review on itunes, Stitcher or your listening platform of choice.
We'd also love you to share Fertility Cafe with friends and family members who would benefit from the information shared. Thank you for joining me today. I'm Eloise Drain. Remember, love has no limits. Neither should parenthood.
[00:31:39] Speaker B: Thank you for joining us in the Fertility Cafe. Whether you're an intended parent, a woman considering egg donation, thinking of becoming a surrogate yourself, or a friend or family member of someone dealing with infertility, we're here to help. Visit our website, thefertilitycafe.com for resources on fertility, alternative family building and making this journey your own.
