Before I became an egg donor, I had a lot of questions about the process: What does egg donation entail? Are there any long-term health effects of donating your eggs? What should I know before I donate? I googled it, but unfortunately there’s a lot of confusion and misinformation out there. This is probably because egg donation is often stigmatized. I read a lot of information online, but I wanted to know more. After all, it was a big decision. I wanted to hear about egg donation from real donors—not just fertility specialists and egg donation agencies. Unfortunately, because of all the moralizing that surrounds egg donation, few egg donors really talk about their experiences. So here I am, a three-time egg donor, telling you about my personal experience with egg donation as well as the scientific research behind the process. If you’re considering egg donation—or want to understand what the process is like for a donor—read on to find out what you need to know.
Who can become an egg donor?
Firstly, you’re probably wondering whether you fit the criteria for donation. Generally speaking, egg donors are between the age of 18 and 35, although this can vary depending on the clinic you want to work with. You have to have a low chance of passing on genetic diseases. In addition to fitting specified health criteria, a potential donor will also have to undergo a scan and blood tests to ensure they’re qualified to donate. If you have certain reproductive conditions, like endometriosis, it might not be advisable to donate eggs, even if a clinic would allow you to do so. “For women with endometriosis, there is evidence that ovarian reserve may be lower and procedural risks slightly higher if they have ovarian cysts,” says Rashmi Kudesia, MD of CCRM. Kudesia is board-certified in reproductive endocrinology and infertility by the American Board of Obstetricians and Gynecologists. If you check all the boxes for becoming an egg donor, remember that certain characteristics—like having an education beyond high school, such as a college degree—can also make you more appealing to prospective recipients. Fitting the criteria is one thing, but you’ll still need to be matched to potential parents. This can take a while after you sign up and depends on how many potential parents the agency works with and your personal characteristics. It took me around eight months to be matched.
What exactly happens during the egg donation process?
Once a potential donor applies—either with a clinic or an egg donation agency—they wait to be matched with potential recipients (also known as intending parents or IPs). Once matched, the donors will undergo some blood tests and scans, says Kelly Rodgers, a five-time egg donor and egg-donation coordinator with Extraordinary Conceptions. The screening process involves a trans-vaginal ultrasound and a follicular count. The follicles are the small sacs in the ovaries where the eggs develop, and it’s important that donors have a healthy number of follicles—a number that needs to be determined by a donor and their healthcare provider. If all is well, Rodgers says, contracts will be drafted and signed. The donor will go on to have hormone injections once a day for the next 10 days, give or take, with the dosage depending on their personal biology and determined by a fertility specialist. “These medications are typically self-administered—which is not as hard as it sounds—via very skinny needles right under the skin, typically in the lower abdomen or outer thigh,” Kudesia explains. The medication contains synthetic versions of naturally occurring hormones called follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are used by the body to promote ovulation during the menstrual cycle. “While on medications, donors will have a handful of monitoring appointments to see how her body is responding to the the medication and, if necessary, travel to the intended parent’s clinic for about seven to 10 days leading up to the egg retrieval,” Rodgers says. This could include more trans-vaginal ultrasounds and blood tests. The scans will help fertility specialists determine when to schedule the retrieval, which is also known as an egg pick-up. The retrieval is a non-invasive surgery, meaning it doesn’t involve cutting into your body. Instead, an implement is inserted through the vagina and a needle enters the ovary. The eggs are retrieved through this needle. You’ll either be under general anesthetic or a deep sedation, so you aren’t able to feel anything during the retrieval. There might be a mild discomfort when you wake up, but generally it isn’t painful. You should be discharged on the same day, after which you should go home and rest. You’ll get your period within the next ten days after the retrieval. After this, you’ll probably be more fertile than usual. Following one full menstrual cycle, your fertility will be back to normal according to Rodgers. After your retrieval, the donated eggs will be fertilized and placed in either a surrogate’s uterus or the uterus of the female IP.
What are the short-term health effects of egg donation?
The most concerning issue when it comes to egg donation is ovarian hyperstimulation syndrome, or OHSS. It occurs when the medication used to facilitate egg retrieval elevates your estrogen levels, says Kudesia. “Because these levels induce water to be drawn out of your bloodstream into the abdomen, severe OHSS can cause bloating and swelling, nausea and vomiting, low urine output, and a risk of blood clots,” she explains. In some severe cases, the donor might have to be hospitalized and given IV fluids. They might also need excess abdominal fluids to be removed. Kudesia points out that egg donors only have a 1 to 2 percent chance of developing a serious case of OHSS. “Though anyone who has a robust response to ovarian stimulation may have a few rough days around the time of their egg retrieval, it is quite rare to see a severe OHSS case these days,” she notes.
How can egg donation impact my future fertility? Can it impact my health?
Here’s where things become a bit more controversial: While many experts deem egg donation to be safe judging from the current research, many donors would like more long-term studies on egg donation. Many donors go on to have their own children, but at present there aren’t any long-term studies that have monitored the impacts of egg donation on donor health. Raquel Cool, co-founder of We Are Egg Donors, a global forum for egg donors, is one of the people advocating for more studies. Cool is currently working on a book compiling personal accounts from donors as well as data on their retrievals. “We are big advocates for more research on donor health,” she says. “We’d like more transparency on how eggs are retrieved, how many overstimulate and to what extent of severity, and finally, how egg donation impacts our health down the line. There have been no long-term studies on donor health outcomes.” On the other hand, Kudesia feels the research that’s currently available is a firm enough indicator that there aren’t any long-term effects of donation. “Though we do not have registries or long-term cohort studies to specifically report on egg donors, we nonetheless have a lot of scientific data from which to extrapolate long-term effects,” she says. Kudesia points out that the egg donation process mirrors the first half of an IVF cycle. It involves the same medication and retrieval process as IVF patients undergo, and IVF has been around since the ’70s, which is one of the reasons she considers egg donation to be safe. “Multiple scientific papers, following tens of thousands of women for up to 30 years after IVF, have established the long-term safety of the procedure for moms and babies,” she says. Those studies haven’t found any long-term risks of ovarian or breast cancer, for example, Kudesia says The studies that look specifically at egg donors also haven’t found any risks of egg donation, Kudesia says. “I would echo the statement of the American Society for Reproductive Medicine, which is that though there is no evidence of long-term risk.” She goes on to say, “Prudence suggests that women be informed of the possible risks, and limit the number of times they donate to six cycles.” She adds that fertility clinics must take precautions to avoid OHSS. “Though I would be thrilled to see more specific literature on this topic, what exists is very reassuring to me for women and clinics following the guidelines.” Before donating, it’s important not only to understand the research or lack of research on the long-term medical effects of donation, but also the emotional impact it may have on you as a donor.
What are the emotional impacts of being an egg donor?
Many potential donors are curious about how egg donation will affect them on an emotional level. Of course, this is a difficult question to answer because the process affects everyone differently. Kudesia states that donors need to be mentally prepared to donate their eggs. “All donors meet with a mental health professional to make sure they’ve thought through the possible ramifications of possibly having genetic offspring out in the world,” she explains. “If, after that discussion, you have any reservations at all, I would not recommend donating.” My personal experience with egg donation has been emotionally rewarding. I’ve never regretted my choice, and I feel great about my decision to donate. However, not everyone has the same experience. Some people experience remorse about not having a relationship with their offspring, for example. You might not get pregnant with or birth the child, but in terms of DNA, the child is biologically yours. In that sense, it can be difficult to know they exist without being able to contact them. Most donors I know, myself included, aren’t bothered by this, but it’s something you have to consider before donating. Another aspect to consider is whether you’d want an open, semi-open, or totally anonymous donation. Certain clinics and egg donation agencies only facilitate anonymous donations, while others facilitate open donations, semi-open donations, or a mixture of the two. This is usually stated quite clearly on their websites. Personally, I’ve done one anonymous donation and two open donations, where I’m still in contact with the recipient families.
Could I be paid for egg donation?
According to international law, you’re not allowed to sell your eggs because they’re bodily tissues, but you can be compensated for your time since you might lose out on other forms of income while donating. More often than not, you’ll have to take time off work or studying and your personal life to become an egg donor. Rodgers notes that the time commitment is something every donor needs to understand. “While the donation itself, in which you are on medication and undergoing the egg retrieval, is roughly two weeks, the medical screening process and legal contract finalization can add approximately six weeks time.” If you travel overseas to donate, as I did, it can be even more time-consuming. In addition to compensation, you shouldn’t be expected to pay any medical expenses associated with the donation as those should be covered by the egg recipients. This usually includes covering any emergency expenses in case you have any health complications, like OHSS. Your contract should include the exact details of what is covered by the agency or recipients. If an agency asks for any money up front, be wary. Also note that in some places, including the U.S., you might be taxed on any funds you receive in compensation for donating. In other places, like Australia, donors aren’t usually compensated at all according to Cool. If you’re curious about compensation, speak directly to the agency or clinic you’d like to sign with.
How do I know which egg donation agency or clinic to sign with?
While many agencies and clinics genuinely care about their egg donors, others might not treat their donors well. This is why it’s important to do a background check before signing up. Cool notes that according to accounts by donors shared on We Are Egg Donors, there is a notable difference between the way donors in the U.S. are treated compared to donors in other countries. “Unfortunately, in the U.S. we see more instances in which higher numbers of eggs are retrieved, more cases of OHSS, greater challenges with withdrawing consent, and women feeling like they are being treated more like a number than a patient,” Cool says. Your chances of getting OHSS are higher if more eggs are retrieved, since a higher egg count is usually associated with a higher amount of follicle-stimulating medication. As such, a clinic might overstimulate donors to get more eggs—at the price of the donor’s health. “High numbers are becoming so normalized within the industry that we see experienced donors rejected for subsequent cycles, or questioned about their medical records because they are considered ‘low producers’—yet their past cycle figures are between five and 20 [eggs], which is considered a safe and optimal range,” Cool says. “Some clinics offer their clients (that is, the egg recipients) a cost savings option: a ‘shared cycle,’ in which a donor is stimulated to produce eggs—in one cycle—for two or three recipients rather than one,” Cool explains. This incentivizes clinics to over-stimulate donors so that they can collect more eggs for each of their clients. This is why carefully vetting agencies and clinics is important. “I would do my best to vet agencies or clinics through word of mouth or reviews,” says Kudesia. “A clinic is perhaps the easier setup to vet, as all success rates are publicly reported and available online. Picking a clinic with high volume and success rates might help ensure that their methods prioritize patient safety and experience rather than trying to maximize egg number at any cost,” she adds. Kudesia also suggests you discuss the process with the agency or clinic before signing up, including the strategies they use to minimize your chances of getting OHSS. “Getting detailed, compassionate answers to these questions would be reassuring. Being rushed or pushed into donating should be immediate red flags,” she says. When I donated my eggs, I was very well prepared: I researched a lot beforehand, I asked plenty of questions, and I thought about the emotional impact of donating before I did it. For those reasons, I felt confident in my decision and the people caring for me during the retrieval procedures. Your generosity as an egg donor can mean the world to someone who wants to start a family, but it’s important that you’re well informed about the entire process before you start this journey.