Egg Donation Overview

While any woman can choose to use an egg donor, most women who do so are unable to produce their own healthy eggs due to early menopause, poor egg quality, chromosomal or genetic disorders and age -- most women who use donor eggs are over the age of 39 [source: CDC]. Women who have had radiation, chemotherapy or ovarian surgery, as well as those who have had poor luck with fertility drugs, are also candidates.

Women typically make their decision to work with an egg donor along with their physician and go through the process with a fertility doctor or clinic. Many fertility centers work with individuals who also require sperm donation or with couples.

The egg donation process begins with a basic medical screening, usually including blood tests, cultures, a Pap smear and uterine evaluation. Recipients of egg donations must have a normal uterus or choose to work with a surrogate mother. Women who are over the age of 40 are given a mammogram, and those over the age of 45 are also given a chest X-ray, an EKG and a fasting metabolic panel, a basic blood test [source: Washington Fertility Center]. Recipients participate in psychological evaluations and legal and financial counseling.

Assisted reproductive technology, including egg donation, is costly. The costs vary among clinics but range between $15,000 U.S. to well over $50,000. The fee structure, which can include pre-screening and diagnostic testing, donor compensation and fees, medications, in vitro fertilization, embryo transfer and embryo freezing (cryopreservation), greatly affects the cost. Medical fees are usually listed separately.

Egg donation also requires a legal contract. The egg donation contract should establish the recipient's financial responsibility for all expenses incurred, address confidentiality and privacy, specify each party's responsibilities and establish parental rights. In the 1998 case Buzzanca v. Buzzanca, the court decided that genetics was not necessarily the primary factor in determining parental rights (and the names that appear on a child's birth certificate). Parental rights are instead established when intended parents initiate and consent to reproductive treatment such as surrogacy, sperm donation or egg donation.

After deciding to use an egg donor, recipients work with their clinic or an egg broker to select potential donor candidates. Candidate selection is usually done through anonymous donor databases, many of which are at least partially online, and are searchable by race, ethnic origin, religion, hair and eye color, height and education. The recipients also complete a personal profile letter to be shared with the donor. Personal profiles are non-identifying and contain details about the recipient, the recipient couple and the couple's struggle with infertility. Once the recipient (or recipients) has selected several desirable donors, the clinic or broker contacts those donors to confirm availability and to share the recipient profile. If the donor and recipient agree, it's a match.

Next, we'll learn about the women who choose to become egg donors. What criteria are considered? Does it matter where donors live? Let's find out in the next section.

While some women donate their eggs for financial reasons, most donors are driven by altruistic motivations and the satisfaction they get from helping create a family. Some women become donors to help a friend or family member who can't conceive naturally. In an American Society for Reproductive Medicine (ASRM) survey of 100 egg donors, 68 percent said that helping someone was the most important reason for why they chose to donate. Twenty nine percent cited financial compensation as their primary motivation, and 3 percent donated to help a family member or friend. One hundred percent of those surveyed reported they would donate again and 50 percent would even forgo compensation [source: ASRM].

Egg donors must conform to specific criteria and undergo psychological testing to be considered. Most programs require that donors are at least 21 years old and usually no older than their early thirties. By age 35, a woman's egg quality is diminished.

Donor candidates must also meet criteria for the program or clinic they intend to work with. Such criteria include but are not limited to:

Donors shouldn't be in an unstable relationship or marriage, use psychoactive medications, have a serious psychological disorder, have undergone treatment for physical or sexual abuse or be mentally unable to consent to the process [source: Department of Health, State of New York].

Once a candidate meets the initial criteria, selected donors undergo a physical exam, infectious disease testing, genetic screening and psychological evaluation [source: Genetics & IVF Institute]. Donors then complete personal and family medical histories, provide personal interests as well as photos of themselves as a baby and adult.

Donors are compensated for their time and effort, not for the eggs themselves -- which is illegal. Donor fees range from $5,000 upward, with some reports of women being paid many thousands of dollars for eggs. ASRM guidelines suggest $5,000 as the current, reasonable compensation rate [source: ASRM].

An egg donor contract should address donor compensation and each party's financial and legal responsibilities. Parental rights are established through this contract, as are confidentiality and privacy rights. Donors waive all parental rights to any resulting offspring and to any embryos remaining from the donation process.

While a small percentage of women donate to help a friend or relative, the majority of women donate anonymously. The identity of such donors remains anonymous to the recipient and to any children resulting from the donation. Anonymity should be guaranteed, but there are some instances in which an anonymous donor might lose her anonymity. Any of the parties involved, including the clinic, could breach confidentiality, though this is rare. Sometimes anonymity is broken willingly. The Donor Sibling Registry, a Web site created in 2000, helps individuals conceived from a sperm, egg or embryo donation find genetic half-siblings, mothers and fathers. Donors themselves are also welcome to seek their own genetic offspring through the registry. The registry currently has almost 12,000 matches and close to 20,000 registrants [source: The Donor Sibling Registry].

What's the egg donation process like? How are eggs actually removed from the ovaries? Go to the next section to find out.

Once a donor and recipient have been matched and the associated legal and preliminary medical criteria are complete, the women begin a multi-step medical process before egg harvesting.

The donor and recipient's menstrual cycles must first be synchronized. Synchronization involves many steps, and donors are taught to administer their own medications -- both through injections and pills. On the first day of menses, a physician assesses the donor's ovarian function through blood tests and a vaginal ultrasound, and the donor begins taking birth control pills.

The next step is to suppress the donor's natural ovulation. This is managed through daily injections of gonadotropin (GnRH) agonists that shut down hormones secreted naturally by the pituitary gland. A cycle takes about four weeks, and in addition to birth control pills and GnRH agonist injections, a donor undergoes routine blood tests and vaginal ultrasound examinations to monitor progress. To bring this cycle to an end, the donor stops taking birth control pills and has a menstrual period that is synched with the recipient's cycle.

During the process's next stage, the ovarian stimulation process, the donor injects herself with hormones to help stimulate the release of multiple mature eggs. Normally, women release only one egg each month. The recipient also uses medication to suppress her own ovulation and to thicken the lining of her uterus for upcoming embryo implantation.

During the ovarian stimulation phase, the donor undergoes frequent blood tests and ultrasounds to monitor egg follicle development. When the follicles are fully developed, the donor injects herself with human Chorionic Gonadotropin (hCG), helping her eggs separate from the follicle walls for retrieval. At this time, the recipient adds progesterone injections to her list of medications that prepare her body for the embryo transfer.

The timing of the hCG injection is crucial to successful egg retrieval, and eggs are collected about 34 to 36 hours after the hCG injection by ultrasound-guided needle while the donor is under anesthesia [source: WebMD].

The harvested eggs are combined with sperm -- either from a sperm donor or from the recipient's husband or partner -- and after a few days of incubation, two to four embryos are placed in the recipient's uterus via a thin tube inserted through her cervix [source: CDC]. This is in vitro fertilization (IVF).

Typically, all the eggs harvested in a cycle are inseminated. If there are any remaining embryos, they legally belong to the recipient and can be saved through cryopreservation for future pregnancy attempts.

Egg donation is not risk-free. Medications used to synchronize menstrual cycles sometimes cause hot flashes, mood swings and breast tenderness. Also, the medications used during the ovarian stimulation process may cause ovarian hyperstimulation syndrome (OHSS), fluid retention and swelling of the ovaries. There are varying degrees of OHSS, from mild abdominal pain to life-threatening blood clots. However, with careful monitoring, a donor has less than a one percent chance of developing severe or life-threatening OHSS [source: WebMD]. Long-term risks of egg donation and ART are unknown but a link between fertility drugs and an increased risk for ovarian cancer is being studied [source: Department of Health, State of New York].

In recent years, regulations and guidelines have gone into effect concerning donor cells and tissues, procedures and compensation. As part of the FDA's "Good Tissue Practices," clinics are required to test donors for infectious diseases and maintain accurate records. Additionally, the American Society for Reproductive Medicine's (ASRM) Ethics Committee reports that compensating donors more than $10,000 is unreasonable and risked coercion. As we've learned, ASRM recommends women be compensated no more than $5,000 [source: ASRM].

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