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It’s not all about the money.
If you’ve ever wondered about donating your eggs, but have a ton of questions about the process, you’re not alone. Here, Dr. Brian Levine, of the Colorado Center for Reproductive Medicine in New York City, Dr. Kate Devine and Michele Purcell, RN, of Shady Grove Fertility in Washington D.C., answer some commonly asked questions about egg donation, what to expect from the process, and things to look out for to ensure your safety throughout the process.
1. Egg donation is a highly regulated part of fertility treatments. Dr. Levine says that the FDA treats eggs just like any other organs when it comes to donations, and there are lots of rules and regulations in place to become an egg donor, just like with any tissue donation.
2. There are three main ways of donating your eggs: through an agency, through a clinic that runs a donor service, or doing a directed egg donation. Agencies are basically headhunters and can pay more depending on the specifics of a donor. Compensation varies but Dr. Devine says, “Appropriate compensation for eggs donors should be based on the local cost of living and should cover her lost wages, mileage, parking, and other expenses.” For example, she explained that in the Washington DC area, compensation for donors ranges from $6,000 – $8,000. Going through an agency, however, you can earn up to $25,000 for donation. You can also seek out an agency or clinic with a donor service on your own, without being headhunted by them. There’s also directed egg donation, which could be a donor donating eggs directly to a family member or friend, but without the process of the agency or clinic doing the matchmaking for them. Levine also adds that some families who have specific criteria, like wanting a donor who goes to Harvard, might put an ad in the Harvard newspaper and pay anywhere from $25,000-$50,000 for that directed donation.
3. Accepting a large payout for a specific directed egg donation (like in the Harvard newspaper example) isn’t always recommended. The suggested compensation guidelines are specifically in place to make the process of egg donation not financially coercive. Michele Purcell, director of the egg donor program at Shady Grove Fertility in Maryland, discourages that practice, and says “You really want to identify women that are doing it for the right reasons. And that’s that they’re helping someone else while also helping themselves, and sometimes, those ads that patients may place, the emphasis is much more on the financial benefit. And you worry about situations like that, that the woman might be donating her eggs just based on the financial compensation. Then in the long run, she might regret that donation [which] could impact her for the rest of her life.”
4. It’s recommended to only donate six times. Levine says this is both for the health of the donor, and also so there aren’t a bunch of half-siblings running around unknowingly. Levine says there’s no national registry or forced disclosure policy in the U.S, so parents don’t have to tell their children if they came from an egg donor or not. Because of this, the six time limit is not very well monitored. Someone could donate six times at one hospital, and then six times at another, though you’d hope they wouldn’t. Sperm banks also have a limit to the amount of times you can donate, though it varies from place the place. The guidelines stated by the American Society for Reproductive Medicine suggest a donor limitation to 25 live births per population area of 850,000.
5. In order to donate eggs, you need to undergo a series of psychological screenings and physical screenings. Psychologically, doctors want to make sure you’re of sound mind and comfortable going through the donation process. There are also several physical screenings to undergo. According to FDA regulations, you can be disqualified if you’ve gotten tattoo or piercing where sterile procedures were not used (or if it is unclear whether sterile procedures were used) in the last 12 months. Doctors may also check your travel history to make sure you haven’t been to a Zika-affected country in the past six months. Levine says young women will often come in wishing to donate their eggs, only to realize they’re ineligible because they recently traveled to Mexico for Spring Break. In the physical exam, they’ll also check your blood work and do an ultrasound to see how many eggs you have, and the likelihood of getting a good outcome. Dr. Devine explains that the screening process for an egg donor is usually mutually beneficial. “This [info] may serve that egg donor very well, whether or not she’s ultimately accepted to donate her eggs, because she gets information on her own fertility and reproduction that she otherwise might not have.”
6. Since the screening process of egg donation is so intensive, only a very small percentage of people who’ve expressed an interest in donating, actually are eligible to donate. Rates vary from clinic to clinic, but this is due in part to the strict screening process. Levine says at his clinic only about 10% of people who do an initial screening make it to the second step. After that group is whittled down, usually only 10% of that second group makes it to the actual donation process. Levine says out of a hundred people who fill out a survey online, only one ends up becoming a viable egg donor. Purcell says at Shady Grove, they have around a 3-4% acceptance rate. Purcell notes that the majority of potential donors are washed out between the application process and the second stage. Sometimes women don’t meet the age requirements for donation, sometimes they don’t live locally enough (a person from California applying for an East Coast based fertility clinic), and BMI requirements are also responsible for a lot of drop outs.
7. Your STI history can also impact eligibility. Levine says that although they screen for STIs, the tests they run are mostly looking for HIV, hepatitis, syphilis, active gonorrhea, and chlamydia. Levine says, “HPV is so incredibly common amongst the young sexually active population, that we can’t discriminate against that. If you’re having an active [herpes outbreak], we probably wouldn’t want you to cycle, because you’re probably very uncomfortable, but in general, just having herpes antibodies or having HPV on your pap in the past is not going to preclude you from becoming a viable egg donor.” Purcell agrees, “There’s not a big concern that that would be transmitted through an egg.” However, FDA regulations will not let you donate if you have been treated for gonorrhea, or chlamydia within the last 12 months. And if you test positive for Hepatitis B, Hepatitis C, or syphilis, you can’t donate, as those can be transmitted and passed on.
8. According to Dr. Levine, the best candidates are women who have graduated college, who are between 26-32 years old and have regular periods. Purcell says that while they recruit women from ages 21-32 at her clinic, it is such a big decision to donate eggs, that she personally prefers donors to be over 25 since at that age you’re potentially more mature. BMI requirements also vary from clinic to clinic; At CCRM, Dr. Levine says their BMI recommendation is 24, though it’s not their only cut-off. At Shady Grove, their BMI cut off is 28. Obviously BMI isn’t the only indicator of good health, but Purcell notes that “[BMI] can impact the ease of the egg retrieval…and it can impact how you metabolize drugs, and also impacts your overall selectability by a recipient — if a recipient is looking at a donor’s profile and wants to identify a donor that they view as healthy.”
9. You’ll most likely need to be matched with a recipient before starting the donation process. It’s not like sperm donation in the movies, where someone pops into a clinic, does their stuff, and leaves the clinic to deal with any matching. Since egg freezing is still a relatively new technology, a donor mostly waits to match up with a recipient couple before undergoing the process. At Shady Grove, Purcell says only about 12% of their cycles are previously frozen eggs, while the rest are donors and recipients undergoing the treatment together. Dr. Levine at CCRM also says that the majority of their egg donations are also “fresh” and fertilized at the time of the collection.
10. To find the most reputable clinic, Dr. Levine says women should do some research to find out who does the best IVF treatments. Levine recommends going to the CDC’s published fertility rate reports, calling up the best clinics, and telling them you’d like to become a donor. Regardless of if you want to donate your eggs through a clinic or an agency, you can still call up clinics and see which agencies they work with. Purcell also recommends asking the clinic about possible risks and what are those risks at that particular clinic. “We could give overarching risks but then what are the risks at your fertility clinic: How many cases of infection, or bleeding, or OHSS do you see in a year?” Dr. Devine says that one of the first questions any potential egg donor should ask going into a clinic is if that clinic adheres to ASRM guidelines, since they’re there for a reason.
11. Egg donation can be fatal. OHSS, or Ovarian Hyperstimulation Syndrome, is where too many hormones during the egg retrieval process can make a patient sick with abdominal pain, nausea, vomiting, diarrhea, bloating, or even death. “It’s not a benign process,” Dr. Levine says, “You have to go through 10-14 days of injections of hormones to make your ovaries grow, and then as your ovaries are growing and producing eggs, it’s possible that your ovaries grow too many eggs.” Dr. Levine says he’s seen many women who have gotten sick because clinics were being reckless with their donors’ health. If the procedure is done correctly, you shouldn’t get sick. Remember that the clinics have as much of a responsibility to the donor as they do to the intended parent to protect everyone’s health.
12. It’s a red flag if the clinic won’t protect your anonymity or only works with one agency. Yes, you have to give up your personal and medical history as part of the process, but if the clinic won’t protect your privacy and anonymity from any potential parents, Dr. Levine says that’s a red flag. If you don’t want to disclose your identity, you shouldn’t feel pressured into letting the intended parent know about them. You should feel empowered to speak up, even though you’re being compensated.
13. The actual process of egg donation takes two weeks, however the screening process can take six weeks. At Shady Grove, the process starts off with an online application that involves demographic info, health history including BMI, family history, all the FDA questions about travel. Then, if the potential donor is accepted, the clinic will bring her in and check her ovarian function using hormones and a transvaginal ultrasound. After that, there’s a five-hour, comprehensive medical visit where a nurse practitioner will go through the patient’s history, explain the consent process and risks, infectious disease blood work, genetic testing, do a urine drug test, teach the patient how to do injections at home, and do a psychological test. After that, there’s a face-to-face session with a mental health provider (sometimes a second session is done here as well), and after that, you’re left with the 3-4% of candidates who enter into the egg donation program. Donors then inject themselves with a series of hormones to trigger ovarian stimulation and ovulation.
Then, the actual egg retrieval process takes only 20 minutes (though you should plan to be at the office for around three hours that day), and takes place in their ambulatory surgery center. They use IV sedation (not general anesthesia). You may feel crampy the day after, and most women choose to take 1–2 narcotic painkillers the day of the egg retrieval, possibly one more the next day, and then ibuprofen if anything, the day after.
After a week, the clinic will call you back, see you for an ultrasound, and touch base about the process, and they’ll either invite you back or not. Purcell says 80% of donors at Shady Grove are invited back to donate again.
At CCRM, Dr. Levine says that since their patients come to them through an agency, the agency also handles the online application, the physical and psychological screenings, and then are sent to the clinic to be evaluated to be a potential donor.
Dr. Levine says that most people can work throughout the cycle, and go back to work the next day. And then, you should wait at least a month before doing another cycle, if you choose. Levine says this is for both the health of the donor and the resulting eggs.
14. You shouldn’t have sex until your next period after completing an egg donation cycle because you’re very fertile at this time. “We warn patients not to have sex until they get their period in the event that an egg was not picked up during the retrieval, we wouldn’t want them to get pregnant,” Levine says. “We educate women that they are very fertile after the retrieval, and while our intent is to retrieve every egg from every follicle, there’s no guarantee that one wasn’t left behind, so we advise women to ideally abstain until their next period or use condoms. A lot of women will resume oral contraception or the vaginal ring, and we still advise them, for two weeks into the next month to still use condoms.”
15. Know that all types of women donate eggs. Levine says he sees many 22-year-olds, fresh from college, who are looking to pay off some of their student debt, as well as actors and artists looking to augment their income, and sometimes people who are very spiritual who don’t want children personally, but want to know that there are children they helped make.
16. It’s not all about the money. Purcell says one of the biggest misconceptions about egg donation is that women donate just for the compensation. She says the majority of her egg donors don’t do it for the money, but to help somebody else. “It’s kinda like when you go and donate blood and you leave, and you’re like, ‘That feels really good. I hope someone was able to use it, and benefit from it’, and I think our donors have that same type of feeling of being grateful for the experience.” She also notes that her donors go through a lot to be an egg donor: “If you were to break that down into an hourly compensation, that isn’t why they do it. Some of our best donors have personal experience with infertility, a family member, a friend, a media story that really called their attention.” Levine agrees, saying that, “the money helps, but the altruism is the driving factor.”
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