Third-party reproduction involves someone other than the couple or the person planning to raise the kid or the intended parents. It is concerned with reproduction that involves donated egg, embryos, sperm, or gestational carrier arrangements. Pregnancy is carried out by a third-party and not the parents. Surrogacy refers to when the egg donor carries the pregnancy. Being an egg donor can be legally, socially, and ethically complex. As egg donation becomes universal, there is much research on how the technology socially and morally impacts the would-be parents, the egg donors and, eventually, the offspring. Arrangements for surrogacy are controversial and subjected to psychological, social, and legal scrutiny for this reason.
Being an Egg Donor: Learn More About Surrogacy
In 1984, the first pregnancy from an egg donor was reported. In the years that have passed, egg donations have helped those struggling with infertility to have a natural child. With the assistance of an egg donor, the intended parents have a genetic link to the child if the sperm used to fertilize the egg is contributed. Egg donation involves IVF or in-vitro fertilization, as eggs are removed from one woman, fertilized in the laboratory, and the resulting embryo is moved to the uterus of the recipient.
The primary step is finding an egg donor. This can be an individual known to the intended parent. It can even be an unknown donor. The donor takes medicines to stimulate the ovary and produce multiple eggs. Once the eggs are created, they are collected and preserved. Sperm from the male intended parent or a sperm donor further fertilizes the egg in a lab.
Following this, an embryo or fertilized egg is selected and transferred to the uterus or womb of the carrier and the pregnancy results. The intended carrier can also be a surrogate or gestational carrier, based on the different circumstances.
Questions and Answers Before Becoming An Egg Donor
#1 Egg Donation: Know the Reasons
Egg donors can help women with surgically removed or malfunctioning ovaries to function effectively. Poor functioning is due to premature menopause, diminished ovary reserve, medical conditions or exposure to therapies like radiation or chemotherapy and the toxins therein. Egg donation is also suitable for women born sans ovaries. Other reasons for egg donation have also emerged in recent times.
Egg donors should be avoiding passing down genetically inherited diseases. Egg donations are also used for women with regular ovulation but lack of quality eggs, in the case of women with multiple failed in-vitro fertilization cycles, women above the ideal reproductive age, and those with the diminished response to ovary stimulating medication.
#2 How Can Egg Donors Be Used in Third-Party Reproduction?
For prospective parents, there are many ways to obtain donor eggs. Anonymous donors unknown to the parents can be found via egg donation agencies or programs. Known or directed donors are close relatives or friends. In some cases, recipients advertise for donors on the internet or via media channels and newspapers.
Recipient and donor may be known to each other in a restricted way and met sans an intermediary program or even an agency. If recruiting donors directly, the legal implications of the same should be considered.
Additionally, women undergoing in-vitro fertilization treatment may donate excess eggs to infertile patients. This donor source is restricted, as it may involve financial incentives, and discounts on IVF treatment, which puts pressure on the donor.
#3 What About the Screening?
Both the anonymous and the known donors are screened as part of FDA and ASRM guidelines. Donors should be legal adults in the state and between 21 and 34 years of age. The reason for the minimum age is to guarantee the donor is old enough to know the choice made and provides informed consent. An upper limit placed on egg donors is because younger females respond better to medicines for ovarian stimulation, producing more eggs and stronger embryos with higher chances of implantation. They also have higher pregnancy rates than aged women. When the donor is above age 35, recipients should be aware of the risk of children with autism or the impact of the donor's maturity on rates of pregnancy.
Anonymous, as well as known donors, are required to complete a detailed medical questionnaire about their family and personal medical history. Included questions range from the history of the family disease to mental health, relationship history, and substance use or abuse habits. In the US, the FDA holds that all egg donors should be screened for risks and clinical indications a disease or infection may be passed down to offspring or even recipients. In case such shortfalls are found, a donor is not considered eligible. Medical professionals review the history with the donor and also physically examine the donor.
For unknown doctors, screening must assess the donor's motivations for donating eggs and provide insights into donor personality. Further, the recreational interests, hobbies, life goals, and educational background of the donor are also examined. This is carried out by a mental health professional. Donors complete written psychometric tests before meeting with the mental health practitioner. Along with a review of the psychometric evaluation, the mental health professional analyzes the donor, discusses the complex, ethical, psychosocial issues and confirms the donor should provide informed consent for egg donations.
A minimum lab testing for donors includes screening or testing for syphilis, gonorrhea, chlamydia, HIV, hepatitis C and B and screening for spongiform encephalopathy and testing when risk factors are associated with it. The outbreak of epidemics like the Zika virus is also to be considered. Egg donor candidates during an explosion should be screened for risk factors. This includes a medical diagnosis of the Zika virus within the past six months, traveling to or residence in countries where the outbreak is rampant to be documented, and intimate relations as associated with risk factors to be factored into the physical assessment. Infectious disease testing must also be carried out. All disease tests should be negative within 30 days before the egg donation. Donor blood type and Rh status must be documented.
Along with this, screening is also carried out for the complete blood count and diseases like rubella titer. Egg donors also undergo genetic carrier screening to identify if they are carriers of heritable diseases. Donors should also be tested for cystic fibrosis and spinal muscular atrophy.
Further testing should be performed on donor ethnicity. Donors of African, Asian, and Mediterranean descent are also required to undergo a hemoglobin electrophoresis screening for sick-cell trait and thalassemias. If the donor comes from the Ashkenazi Jewish community, there is additional screening for CF mutation analysis, Canavan disease, Tay-Sachs disease, Gaucher disease, and other commonly occurring genetic orders in people of this origin.
Donors of French-Canadian descent need to be screened for CF mutation along with Tay-Sachs disease. Fertility clinics may perform additional screening of a wide range of genetic diseases. Some individual programs may even offer Fragile X pre-mutation testing along with karyotyping.
The surrogate is evaluated in terms of complete physical exam and gynecological history. Assessing blood type, ovarian reserve, Rh, cytomegalovirus, and rubella are also factored in. The surrogate should have a uterine cavity evaluation using SHG/sonohysterogram, HSG/hysterosalpingogram, or hysteroscopy. When a female recipient is over 45 years of age, there needs to be a thorough evaluation with an assessment of risk for pregnancy based hypertension, evaluation of cardiac function, and gestational diabetes. A consultation with an obstetrical professional who evaluates high risk is also a must.
This is especially with advanced maternal age or any other medical issue that can impact a pregnancy. Assessment of the male partner (in case there is one) should comprise blood type, Rh factor, semen analysis, and genetic-carrier screening, as required. Egg donors are also screened for conditions such as Zika Virus and West Nile Virus.
#4 How is the Egg Donor Prepared for Egg Retrieval?
For retrieving multiple eggs from the ovaries of donors, a combination of hormonal medicines is pumped in to stimulate the development of multiple eggs in an ovary. Hormones like hMG/ human menopausal gonadotropin, f-FSH/ recombinant follicle-stimulating hormone, or FSH/non-recombinant follicle-stimulating hormone may be given. This is known as the controlled stimulation of the ovaries.
Egg development is monitored via ultrasound. The hormones in the donor’s blood are also measured. Medications that prevent spontaneously ovulating, leading to premature release of eggs include gonadotropin-releasing hormone agonists and antagonists. Once the egg has developed at an appropriate stage, as determined by measurement of the follicular size through ultrasound, the ovulation process is triggered by medicine injected to enable eggs to gain the maturity to facilitate the retrieval process.
Close to 34 to 36 hours once the trigger medicine is administered, and before the egg, the release takes place, egg-retrieval from the ovary results using transvaginal ultrasound-guided oocyte-aspiration. This is essentially a probe that is an ultrasound with a needle guide. It is inserted into the vagina. A needle fits into the guide and is placed within the ovary through the vagina well. Ovary follicles are punctured once at a time, and eggs are collected. In the lab, eggs are evaluated for maturity. Mature eggs undergo sperm insemination processed in the lab.
If embryos are being transferred without freezing, the recipient and donor cycles must be matched. The recipient's uterine lining or endometrium should be ready for the transferred embryo. For periods when the embryo is frozen, the menstrual cycle of the donor and recipient need not be synchronized. The recipient's endometrium must be prepared to get medicines injected, so it is ready to receive the embryo.
The hormonal preparation principle is akin to individual protocols. Women whose ovaries are functioning are given a hormone to suppress menstruation. When the egg donor begins medicines to stimulate the ovaries, the recipient is also prepared (if the surrogate is different from the donor). For the recipient, estradiol is essential for encouraging the development of the endometrium. Estradiol is provided in the form of oral pills. It may also be given through an injection or a transdermal patch. Ultrasound and blood tests can access endometrium readiness at this time. Recipients start on progesterone the day following the receipt of medicine triggering ovulation by the egg donor. Progesterone is given to cause specific changes within the endometrium for the implantation of the embryo. It produces particular changes and is administered through a tablet, vaginal gel, or intramuscular injection.
The transfer of an embryo into the recipient's uterus takes place 3-5 days post the fertilization of eggs in the lab. The embryo transfer is carried out by passing the catheter with the embryos into the uterus via the cervix. If the recipient has extra embryos, these can be frozen for another attempt at pregnancy. With a positive pregnancy test, medicines continue through the first trimester to support early pregnancy.
#5 How Much Are Egg Donors Paid?
Egg donors are receiving money for donating their eggs and for the effort involved in the donation process. Average first-time egg donors are compensated around USD 10K. Repeat egg donors are compensated USD 12K, on an average. Donors with exceptional qualities that are hard to find may be paid more. Egg donors will receive a percentage of total compensation; generally, once injectable medicines start. A balance of the payment is received once egg retrieval procedures are carried out, irrespective of the number of eggs retrieved.
#6 Can Egg Donors Donate Multiple Times?
A majority of egg donors donate more than once. Some agencies also have a limit on the total number of donations an egg donor can make. Medical records and recommendations from the IVF doctor post each cycle must be carried out to ensure there are no medical concerns.
Once intended parents select the egg donor, egg retrieval takes place within 2-4 months. This is generally the time it takes for screenings, contracts, and medicines. If you need to donate your eggs more than once, there needs to be two regular periods between cycles.
#7 Do You Need to Abstain From Intimate Relations During the Entire Egg Donor Process?
While each IVF process is different, the average abstinence period is 3-4 weeks in all. Not many egg donors are interested in intimate relations, as there are many symptoms during egg donation such as bloating and abdominal tenderness.
#8 How does the Egg Donation Process Progress?
Being an egg donor entails more than just filling out an application. Applicants should learn about the process before applying. Most egg donation agencies and programs provide as much information as possible to potential egg donors.
The egg donation process involves the creation of a profile, matching, contracts for legal and ethical purposes, medications, screenings, and much more. A quick overview of the process right from applying to egg retrieval is discussed below:
Profile Creation: This is the first step towards attracting intended parents to connect with you. Provide as much information as possible.
Matching Profiles to Requirements: The next step occurs when intended parents evince interest in the presented profile. You can then review the prospective parent’s profile to see if forward movement is possible.
Meeting Contractual Obligations: Contracts refer to the legal part of egg donation. This is when contracts are finalized, drafted and, eventually, signed for both the egg donor and the prospective parents. The donation agency generally covers lawyer fees.
Screening: This stage includes a psychological screening, a physical examination, drug testing, and genetic testing.
Use of Medications: Egg donors will be required to take oral contraception and start injection medication for two weeks before retrieval.
Recovery & Retrieval: Quick surgery under light sedation signals the end of egg donation journeys. Remember to relax for a minimum of 2 weeks or until the next menstrual cycle.
#9 Do You Need to share 100% Health History To be an Egg Donor?
Egg donation agencies and programs generally do not accept you unless all medical records, as well as those of the biological family, are available. Share personal health data regarding family members. It is essential to be comfortable and share history because it is an integral component of the process.
An incomplete health history delays application approvals. The approval process is fastest when a complete health history is provided during the initial application.
#10 What do I need to Consider to Commit to the Egg Donation Process?
Egg donation involves a lot of things. Firstly, you will have to screen for medical conditions and provide your complete health history. Then, you will have to opt for hormone stimulation, monitoring egg retrieval, and some amount of travel. As an egg donor is a vital piece of the process, it is a serious responsibility. Not only the parents but the doctor as well, require you to follow a specific schedule. Egg donors in the cycle need to be abstinent to prevent unwanted pregnancy. Egg donors should avert strenuous physical activities or heavy lifting during the recovery period and the cycle.
#11 How Important is Psychological Screening?
Most egg donation agencies require you to be tested using personality tests. A social worker or psychologist then assesses you for mental preparedness for the egg donor journey. Detailed, personal-psychological plus social history about the self and the family must be shared. This includes answering queries about physical abuse, substance abuse, and mental pathologies. Egg donors should be comfortable sharing their personal family history during the mental health screening process.
#12 How Does Your Partner Feel About Egg Donation?
Another challenge is to know that your family, friends, and partner are comfortable with the egg donation process. Having a committed person who can emotionally support you and provide assistance during the journey is also important. The consent and support of primary support persons of the egg donor are critical.
Once the donor has signed a legal contract, the donor cycle begins at the start of the next menstruation period. Within 10-14 days, a physician may start a series of subcutaneous medicinal injections to stimulate egg maturation within the ovaries. Around 6-7 monitoring appointments are scheduled for the donor at the fertility center. These are generally in the morning. They last about 30-45 minutes. Appointments monitor the body’s response to medicines and cannot be factored out.
Towards the close of the medical cycle, a trigger shot is taken. Within 36 hours, the egg will be ready for retrieval. The fertility center provides the required instructions for administering injectable medicine.
#13 How Does Egg Retrieval Take Place?
For the retrieval procedure, donors face twilight anesthesia administered through an IV system. A vaginal ultrasound probe guides the tiny needle through the vaginal wall to retrieve the ovaries from the eggs. This minor outpatient surgery lasts thirty minutes. Soon afterward, donors must rest to refrain from intimate relations and severe physical activities, until cleared by the physician.
#14 What Are the Requirements to Become an Egg Donor?
The requirements to be an egg donor include excellent health, good medical history, and a strong motivation to remain dedicated to the process. Ideally, the donors should be between 21 to 28 years in age, have regular periods every month, no reproductive disorders or abnormalities. They should have good physical and mental health. The Body Mass Index should be between 21 and 28. The egg donor should ideally be a non-smoker. She should not have used nicotine or drugs or even undergone depo shots or Nexplanon/Implanon arm implants as a form of birth control. The egg donor should also be willing to face a mental and medical evaluation. They should be agreeable to taking injectable medicines and ready to commit their time for a minimum of six months.
#15 What are the Medicines an Egg Donor Must Take
The first medicine a donor must take to complete retrieval successfully is Lupron. It is also known as Leuprolide Acetate. An injection per day for twelve days, then a single dose per day are given. This is accompanied by gonadotropin therapy for over 22 days. Lupron controls a woman’s hormonal levels and prevents egg release. According to studies, Lupron is harmless for humans and leaves the body just after discontinued use.
Another fundamental medicine is Cetrotide, or Ganirelix acetate also called GnRH Antagonist. One injection is administered per day or every three days. With gonadotropin therapy, it is generally given after treatment for four to five days. This medicine may be a substitute for Lupron to prevent egg maturation and release at the time of the process.
Follistim, also known as Bravelle/Gonal F/Repronex/Memopur, or follicle-stimulating hormone/FSH or gonadotrophins is also given. One injection per day is administered for ten days. FSH is the same hormone the female body uses to mature eggs at the time of the menstrual cycle. Sacs or follicles are generated using FSH. More eggs are produced as a result of this.
Side effects of FSH include fatigue, headache, moodiness, bloating, or other problems. But there are no long-term effects. In a rare situation, impacting 1 to 2 percent of IVF cases, ovarian hyper-stimulation syndrome or OHSS may occur. This takes place when FSH harms the body by causing enlarged ovaries. While IVF clinics safeguard against this, treatment can be required for this condition. Such cases require fluid draining from ovaries or even hospitalization. Women should not overexert while taking FSH as this can twist or tear the ovaries.
Human Chorionic Gonadotropin/ Trigger Shot, also known as Pregnyl, Profasi, and Ovidrel, is another medicine used for egg donation. It is injected 36 hours before egg retrieval. This is a pregnancy hormone secreted by the placenta of the woman. It is used for egg maturation prior to extraction. Sans the hCG, donor eggs would not be used for in-vitro fertilization. Akin to FSH, side effects include moodiness, bloating, headaches, and fatigue, but not in the long run.
#16 What Are the Risks and Egg Donor Faces?
Egg donation is a safe process. It has no known side-effects in the long run. It is a good practice to understand potential side effects and risks accompanying the process, though. Medicines can have specific side effects. Some of the medications associated with egg donors can cause bloating, moodiness, fatigue, and headache. Some may also trigger ovarian hyperstimulation syndrome. This is very treatable and rare.
Additionally, antibiotics are used to avert bacterial infections and allergic reactions. Consult your doctor if you are allergic to medicines. As with most needles, there can be some unease and a chance of getting injured, while drawing blood.
If a donor has intimate relations without protection, there is a chance of pregnancy, as fertility-enhancing drugs are in the human body system. Once the retrieval is over, donors may also experience some amount of discomfort. Severe conditions like infection, bleeding, and bowel discomfort may result. In certain cases, surgery can be needed to repair internal damage.
#17 Can Egg Donation Be Painful?
Egg donation can be painful. You may experience procedural discomforts, such as the retrieval process, blood-drawing, or ultrasound imagery. Mood shifts can happen, once you donate eggs. Consult a doctor about whether you are equipped to be an egg donor.
#18 Is the Screening Process Complicated?
The day one chooses to become an egg donor is an exciting milestone in life. The change is not outwards, but internal. Becoming an egg donor changes your life. Helping others to grow a family can be rewarding, but there are some pitfalls. The process of being an egg donor requires a lot of screening, some of which can be quite complicated. These include medical exams, interviews, background checks, questionnaires, and many questions to be considered. The process can be complicated, but worth it for donors.
#19 How Long Does the Process Take?
Doctors extract eggs from the body, but the process can be quite complicated, too. There is downtime. There is also a sizeable recovery period. The egg retrieval process is quick. Recovery takes place within a day or more. You need to be mindful of how your body feels post the retrieval.
#20 Is it a Scary Experience?
Once eggs are retrieved, the journey is over. You don’t know if the eggs were used or fertilized, unless you are a surrogate, as well. It can be a daunting experience, and counseling may be vital throughout the egg donation process so that you can adjust.
#21 Is Egg Donor Fee Taxable?
In the United States, it is illegal to sell organs. Income received as an egg donor is taxable, and you should plan as per this requirement.
Egg donors can have a rewarding experience because they help less fortunate couples to gain the chance at parenthood. This in itself, can be a tremendously enriching experience. Besides the monetary incentive, there is a psychological sense of helping someone in need, too, and a sense of satisfaction in helping infertile couples. But taking precautions and safeguarding your interests are equally important. Remember to consider all the factors before taking the plunge!