Inside the Egg Donation Process

There's been a lot in the media about the rising number of egg donors spurred on by the bottoming-out economy. If you are considering egg donation to build your family, the reports give you pause. Are agencies and clinics accepting less qualified donors as a result? Are financially desperate donors being taken advantage of? Are donors outnumbering intended parents?

"It's true that the number of applications is up," confirms Barbara Skidmore, RN, a Donor Egg Program Coordinator at the Center for Human Reproduction at North Shore University Hospital in Manhasset, New York. "We are definitely getting more calls and sending out more information packets." But by and large, she explains, this translates to "a higher volume of less qualified applicants."

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Skidmore is quick to point out that of 100 applications, only two to five are actually accepted as qualified donors. That's Stuart Miller's estimation as well. The CEO of the national agency Growing Generations, headquartered in Los Angeles, Calif., says, "Out of 100 applicants, maybe two make it through."

Inside the Egg Donation Process

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In addition to completing a detailed, written application (see Egg Donor Screening Questionnaire) and a medical evaluation that involves a gynecological exam and several blood tests, potential donors are subjected to psychiatric evaluations to make sure they're "on board" and are donating "for the right reasons."

Lisa Wilkins, Ph.D., principal and founder of the Tiny Treasures New England agency, in Burlington, Mass., confirms that more applications haven't resulted in chock-a-block donor databases, "We've had 500-750 donor inquiries a month, through phone calls and website downloads, but our donor base is only slightly higher than in the past."

In other words, donor quality is a high priority.

Basic Donor Qualifications
Donors need to be at least 21 and no more than 32, though there are certain circumstances (siblings, for example) where a donor will be older. They are generally compensated between ,000 and ,000 per cycle. ASRM guidelines suggest donors be restricted to six lifetimes cycles. While Skidmore says most of her donors have donated multiple times, they are restricted to five lifetime donations at her clinic. Wilkins estimates 50 percent to 70 percent of her donors donate more than once.

Donor Intake Boot Camp
The muti-tiered screening process is intense. "The process is not easy on donors because we want them to know what they're getting into medically and emotionally," explains Skidmore. Most donor applicants drop out or are screened out in the intake process which usually requires "four to five appointments." Wilkins confirms that most are screened out for medical reasons.

Donor pre-screening is important. "Find out about the agency's process," Miller recommends. "Does the agency meet the donor in person? Does it verify genetic histories? How about school attendance and test scores?" An agency may boast of a large donor database, but how up-to-date is it? How vetted? Are the donors listed actually available? How long have they been listed on the site? How many have been matched with clients?

The majority of donors come from agencies, but, at least in North Shore's case, the agencies must be New York State accredited. The Coordinator and Psychologist must meet with donors in person. "Even if a donor lives in North Carolina or Colorado and comes to us from an agency, we meet with the woman and put her through the screening process."

When donors go through the psychological intake process, "We make sure they know the process will not be easy," explains Lesli Figlerski, PhD, a Donor Egg Consultant Psychologist for the Center for Human Reproduction at North Shore University Hospital, in Manhasset, New York. She tells them "they will be on medication for several weeks and will need to give themselves injections, they will be poked and probed, and they will have surgery." Donors are informed that there is also a small risk to their own fertility. "The chances are slim, but egg removal could leave some scar tissue or their ovaries could be hyperstimulated or twisted," Figlerski elaborates.

The goal in the intake process, she explains, is to "make sure our donors make good decisions, ones that will leave them intact, the way they went in." So what's under the microscope? "We really take a good look at a donor's coping skills," Figlerski states. Wilkins, who's screened donors since 2002, says she "often knows within a few minutes if a donor will be a good fit or not." Miller agrees that there are "red flags" to look for, for example, "if a donor says she's not telling anyone about the fact that she is donating, she's probably not psychologically prepared."

As a result of the rigorous screening process, "the donors that do stick it out are amazing people." And while it's true that money is a motivating factor, there's more to it. "They may come into the process for the money, but that's not what makes them stay," Figlerski notes. "What makes them follow through is the benefit of helping others." Personally, she says, she "really loves the donors," because they "really are interesting people."

Ready to Talk Disclosure?
The initial intake meeting for recipients takes about two and one-half hours during which the recipients must come in with their partners to meet with the Coordinator, their doctor and the financial department.

In addition to making sure a couple is on the same page about receiving a donor egg, a "big part" of the intake process is the "disclosure" discussion at the Center for Human Reproduction. Figlerski makes sure her couples talk about what they will tell their child about how they were born. "I expose them to the pros and cons of telling and not telling and let them make their own decisions." The majority of donor egg patients are open to disclosure but "what's really most important is that husband and wife agree on how they will handle it," She adds.

Figlerski points out that the donor egg guidelines favor early disclosure, which, barring rare religious or cultural beliefs, she tends to agree with. "Every person has a right to know their genetic history," she states.

Matchmaking
As far as choosing a donor is concerned, "usually something about the donor will speak to" the intended parents, explains Skidmore. "Perhaps they like the same books or enjoyed the same subjects in school." Sometimes "couples leave my office and go home and choose a donor that night; sometimes the process takes six months until they find someone who they are comfortable with." Though recipients never find "their clone," Skidmore proudly boasts that she's "never had anyone who tried to find a donor and didn't find a donor."

"Couples should come up with a list of three to five elements that are really important to them," recommends Miller. For some couples this list may include physical appearance, for others intelligence or special talents. In any event, the list will help "narrow the field." Miller is adamant that couples take the time to review a donor base at the same time as opposed to separately, "You should sit down together when you're not stressed and take the time to look at the candidates together." Like finding a partner, explains Wilkins, "You'll feel the click."

Legal Issues
An important aspect of the screening process is legal. "It's important for donors and intended parents to understand all the legal issues that donation triggers," says lawyer Melissa Brissman. "You don't want to get all the way through the medical process only to realize you are on a different page about a legal issue." The biggest issues that must be contractually agreed upon by donors and intended parents are:

Termination of custodial and parental rights
Extent of future contact
Notification of live birth
Restricting the use of eggs by third parties for conception
Waiver of liability for medical complications
The finances of the donation
All of these issues are resolved in a written contract signed by both the donor and intended parents. You can take a look at a sample egg donation contract here.

Demand Exceeds Supply
So, the bottom line? Despite the fact that applications are on the rise, the screening process is tough! Even with all the inquiries and media attention, the demand for donor eggs still exceeds supply. That's right, there are more intended parents than egg donors. But the donors who do get through the intake process? They're amazing people, who aren't just in it for the money.

So while all the hype in the media has raised concerns, ultimately, it helps gets the word out about egg donation as a family-building option. "Egg donation is fairly new," Wilkins explains, "I'd like to see people become as comfortable with it as they are with adoption."

Inside the Egg Donation Process