Dra. Diane Tober, Author at FertilitySmarts

Should I Donate Eggs Again?

Dra. Diane Tober / September 5, 2019

You made it through at least one egg donation cycle and now you’re thinking about doing another—but you likely still have questions. How much time does my body need to recover? Can I increase my fee or negotiate new contract terms? Will I run out of eggs? Can I freeze some eggs for myself? Does doing multiple cycles increase the risk to my health? These are all important questions, and things you will likely want to investigate before undergoing multiple egg donation cycles. If your last donation cycle was successful—for example, if you produced a lot of high-quality eggs that became embryos and the intended parents (IPs) reported a positive pregnancy—it is likely your egg donor coordinator will contact you again soon to schedule your next cycle. They may even provide you with birth control pills as you leave the clinic, so you are ready to go for another cycle, or they may ask if you’re interested during a follow-up exam (and yes, it is in your best interests to have a follow-up). You may feel elated if and when you find out your IPs are pregnant—or need the money to pay bills—but whatever the case, it is likely best to step back; it might be beneficial to see how your body recovers and take stock of your experience rather than immediately agreeing to do another cycle. Deciding to donate eggs again is entirely up to you—but it is typically in your best interest to not agree to do more than one cycle at a time. Here are some things to think about when considering another egg donation cycle. How did my body respond to fertility drugs? The first thing to consider before deciding to do another cycle is how your body responded the first time. If you experienced extreme discomfort or bloating—an indication of ovarian hyperstimulation syndrome (OHSS)—you are highly likely to have the same or worse experience on the next cycle. This is especially true if the doctor uses the same medication protocol he or she used during your last cycle. Some medications are more likely to cause OHSS, and others have different effects on the body. Some people are more sensitive than others. If you had no negative side effects throughout the process, and it went smoothly for you, hopefully, that will still be the case for your next cycle. But every cycle is different and there are no guarantees. Read: The Egg Donation Medical Process: For Egg Donors How much time does my body need to recover? Many donors report feeling pressured to do another cycle right away. Sometimes there are recipients anxiously waiting for a donor to be available, and this time that donor is you. Yes, it may feel good to know people want you, but this is your body and your first commitment is to your own health and well-being—and taking time for a full recovery is important. The length of time it takes to recover is different for everyone. Some women feel back to normal within a few days, and others may still be sore, bloated, and uncomfortable for months. A good rule of thumb is to wait for at least two or three menstrual cycles before undergoing another donation cycle and surgical procedure. Your ovaries were most likely quite large and need time to settle down to normal size. You will also want to make sure you have normal periods before proceeding with another cycle. Give yourself time to observe your body and make sure you’re not having any lingering pains in your abdomen or ovaries. Will I be able to ask for a higher fee? Or negotiate my contract? Every egg donation cycle will require a new contract. If there was something you didn’t like about your last contract, this is the time to make sure you negotiate better terms for yourself. You can also ask for a higher fee—especially if your eggs produced a pregnancy. Read: What Egg Donors Should Know About Egg Donation Contracts If you are working through an agency it is likely that you will be sent to different clinics and different doctors on subsequent donations. This also means you may be given different medication protocols than you had on your last cycle. If you had a protocol that worked well for you, ask the new doctor if you can use that one again. If your other protocol did not work well for you, ask to have it adjusted. This is a whole new cycle, and since you’ve donated before you have a pretty good idea of how everything works. Use the knowledge you’ve gained to advocate for yourself. Will I run out of eggs? Every female is born with about two million eggs and they do not make any new eggs during their lifetime. Every month some eggs die off. By the time a girl reaches puberty she has about 400,000 left and by the time she reaches thirty, that number is about 100,000. Of course, every woman is different, and some suffer from premature ovarian failure (POF)—meaning they entered menopause before they were supposed to. During an egg donation cycle, the fertility drugs increase the number of eggs that come to maturity in that cycle, but this does not necessarily mean that you are losing eggs faster by being an egg donor. However, that said, some egg donors do go on to face their own infertility. With the lack of research, no one really knows if being an egg donor increases a woman’s chance of becoming infertile. Can I keep some of my eggs for myself? With recent advances in egg freezing a lot of donors are asking: Can I save some eggs for myself? At many fertility clinics, the answer to this is “no.” However, there are some fertility practices that are now offering donors the ability to “freeze and share.” This means that during an egg donation cycle you will give half of your eggs to an intended parent, and keep

What Egg Donors Should Know About Egg Donation Contracts

Dra. Diane Tober / August 29, 2018

Deciding to become an egg donor can take you into uncharted personal territories, emotionally, medically, and legally. If you signed up to be a donor through an egg bank, you will not need to wait until being matched before starting the process. But if you’re becoming a donor through a clinic or agency that does not freeze and bank your eggs, once you have been matched with a recipient, it is time to get the ball rolling. And that means signing legal contracts before you start taking any medications. Knowing what to look for when reading and signing legal contracts is important in order to make sure you understand the conditions and terms of your contracts and that you are comfortable with those conditions. Make sure you read the contract thoroughly and understand each item, and ask questions if there is something you do not understand. Before you sign on the dotted line, here are some things you should know about egg donation contracts. Will I have my own attorney? Most egg donation programs work with attorneys to draw up legal contracts. Some use the same attorney for both the donor and the recipient(s). However, using the same attorney as the intended parents could be seen as a “conflict of interest.” How do you know the attorney that is supposed to be representing your interests will not prioritize the paying clients over you? You Can Request Your Own Attorney You can request to hire your own attorney and, in some cases, the clinic or agency will cover the costs of your legal representation. A more likely scenario is that you will be provided with legal representation from a different attorney than the one assigned to the intended parents, but still one of the clinic’s choosing. If you still have concerns about having an attorney who only represents you and your interests, talk to your donor coordinator and try to negotiate your own choice of attorney without having to cover the costs yourself. You should feel comfortable that you have an attorney who is representing your interests. Read: Navigating the Decision to Become an Egg Donor Read: Becoming an Egg Donor: The Recruitment and Screening Process Read: Becoming an Egg Donor: Agencies, Clinics, Egg Banks & Private Arrangements Can I negotiate my egg donation contract? Most women going through the egg donation process—especially for the first time—think that they are required to accept whatever terms are laid out in their contracts. Many are afraid that if they do not accept the contract terms, or if they try to negotiate, they will be rejected from the program. This is not the case—nor should it be. While some egg donation programs have non-negotiable contracts, most realize that you may want to make some changes, and are entitled to do so. If you are told that your contract is non-negotiable, and you are not comfortable with the terms of the contract, it’s in your best interest to find a clinic or agency where you can negotiate the terms that are right for you. First and foremost, this is your body and for now, these are your eggs. What you negotiate now can affect you immediately and also years down the road. So yes, you can—and should—negotiate your contract to make sure your interests are covered and that you are prepared for all possible circumstances, as much as possible. If a recruiter tells you your contract is non-negotiable, see this as a red flag and go elsewhere. There are plenty of clinics, agencies, and egg banks to choose from. Make sure you discuss the terms with the attorney representing you and that your interests are protected. Below are some things to consider when negotiating your contract. How many cycles am I signing up for? Some clinics, agencies, or egg banks will build multiple egg donation cycles into a contract. They may require you to agree to undergo three cycles, rather than just one at a time. Why? Screening donors cost clinics money. Donors have to undergo a range of medical tests, be screened by psychologists and genetic counselors, and other logistics. Donors also have to be instructed on how to self-administer injections and other logistics. The screening process costs staff time and money. If a donor decides to only undergo a single donation cycle, the clinic invests more time and money screening and preparing the donor for her cycle than donors who undergo up to six cycles. However, you cannot possibly know ahead of time if you really want to do multiple cycles. Your decision to do so likely depends a lot on your experiences the first time, how you reacted to the fertility medications, how easily you recovered, and whether or not you had a good relationship with agency personnel or medical staff and doctors who were in charge of your cycle. Rather than agreeing to sign up for multiple cycles at once, it is in your best interest to negotiate to do one cycle at a time so that you have the freedom to consider whether or not this is something you want to do again. You should also know that even if you agree to do multiple cycles in your contract, and you change your mind after your first (or subsequent) cycle, no one can force you to undergo a medical process or procedure. But you may face some extra expense and hassle if you try to get out of your contract. What is the timeline for my egg donation cycle? Your contract should indicate when you will start your egg donation cycle. Sometimes you will start medications as soon as you sign the contract and are matched with a recipient. Other times, the clinic or recipients may want to wait, based on their schedule, or perhaps to sync your cycle with the intended mother or gestational surrogate. You can also negotiate your start date and let them know when you are and are not available. If you have a vacation

Fertility Treatment, Third Party Donation

Egg Donation Risk and Recovery: What We Know and What We Don’t

Dra. Diane Tober / July 26, 2018

When considering egg donation, one of the first questions most women ask is: Are there risks? Unfortunately, this is one of the most difficult questions to accurately answer. Most clinic and agency websites, and advertisements to recruit egg donors, state that egg donation is safe and that the “risks are less than 1%.” “Less than 1%” sounds reassuring; however, this number is not accurate, due to little short-term—and no long-term—research on egg donor health and well-being. Read: Navigating The Decision to Become an Egg Donor In reality, no one knows how frequently egg donors experience side effects from the fertility drugs, surgical complications, or immediate or long-term complications because there has been no research conducted on egg donors’ experiences over time. Most of the information available in scholarly journals pertains specifically to women who have undergone egg retrieval for their own fertility treatment—not egg donors, who are younger and more fertile. This is one reason why I started my research on egg donors—so that women considering egg donation can have more information about the range of egg donors’ experiences, make informed decisions, and know-how to advocate for themselves throughout the process, should they decide it is something they want to do. What We Know Every medication has possible side effects. Every time a person undergoes a medical procedure there are possible surgical complications, as well as possible reactions to anesthesia and post-surgical infection. We do not know how frequently egg donors experience either side effects from the drugs or surgical complications because no one is systematically keeping track of this information. Different clinics may also have different egg donor outcomes, depending upon the protocols they use, how many eggs they aim to take, and the skill of the person performing the surgery. For egg donation, there are different categories of complications, that can occur at different stages of the process, some of which are more serious than others. These can include: Fertility drug side effects Surgical complications and reactions to anesthesia Post-retrieval complications Ovarian Hyperstimulation Syndrome (OHSS) Ovarian Torsion Read: The Egg Donation Medical Process: For Egg Donors Fertility Drug Side Effects There are different types of fertility drugs used during an egg donation cycle. Some are commonly used by women to prevent pregnancy, such as birth control pills. Other drugs are used to stimulate the ovaries to produce more eggs. And others are used to release the eggs from the follicle so they can be surgically retrieved. Different medication protocols have different effects on your body, and no two women are alike. Some medication protocols require more injections than others over a longer period of time, and some physicians may prescribe higher dosages than others, both of which expose your body to more hormones. It is important to understand what fertility medications you’ll be taking and the effect they can have on your body. Some of the commonly used medications and their immediate side effects can include: Lupron—Dizziness, body pain, headaches, hot flashes, appetite loss, nausea or vomiting, trouble sleeping, constipation, redness at the injection site, bone pain Pergonal—Abdominal or stomach pain, bloating, chest pain or trouble breathing, decreased amount of urine, feeling of indigestion, general feeling of discomfort or illness, headache, nausea, vomiting, or diarrhea Gonal-F—headache, nausea, vomiting, stomach/abdominal pain, pelvic pain, bloating, injection site reactions (redness or pain), breast swelling, numbness, runny nose, sore throat, acne, skin rash, swelling, weight gain Follistim—severe abdominal pain, shortness of breath, nausea, diarrhea, bloating, vomiting, swelling in hands or legs, weight gain, numbness, pain or redness at injection site Ganirelix—nausea or vomiting, diarrhea, shortness of breath, severe pelvic pain, swelling in hands or legs, stomach bloating, headache, vaginal bleeding, pain or redness at injection site Fertimax/Clomid—headache, upset stomach, bloating, dizziness, vaginal bleeding, mood changes, breast tenderness Cetrotide—nausea/vomiting, headache, pain/bruising at injection site, rapid weight gain, rapid fluid build up in stomach/chest/heart area (OHSS), decreased urination hCG—headache, irritability, restlessness, fatigue, depression, swelling in feet/legs, pain at injection site, blood clots, rupturing or swelling of ovaries, increased risk for OHSS Different women react differently to these pharmaceuticals. Some may have no or minimal adverse reactions, and others may have severe allergic reactions and need to be seen by a doctor immediately. Throughout an egg donation cycle, if any of the medications cause you to feel dizzy enough to faint or cause serious discomfort you should call the clinic right away. Surgical Complications The ovaries are near other major organs and arteries in the body. With almost any surgery there are risks of injuring surrounding organs. In some cases, there may be heavy bleeding from the ovaries following egg retrieval. Pelvic infection within days following retrieval can also occur. If you wake up from your retrieval in severe pain or feel light-headed or dizzy before you are sent home to recover, don’t leave the retrieval without being seen by a doctor. If you have any doubts about your health post-retrieval or any concerns at all, it is important to contact the clinic or, if necessary, go to the emergency room. If your clinic or agency tells you what you are experiencing is “normal” and will go away in a few days, trust your gut and ask to be seen, to be on the safe side. Your health and future fertility are important, and you are your own best advocate. Post-Retrieval Complications Within one-to-two hours after the retrieval, you will likely be sent home with antibiotics in order to prevent infection. It is a good idea to rest for at least the rest of the day, if not a few days. Some donors recover within a few hours after retrieval surgery and can get back to a normal routine pretty quickly. Others may experience pain, swelling and bloating. The doctor should have you come back for an exam and ultrasound about a week after retrieval, to make sure your recovery is on track. If you feel back to normal pretty quickly after your retrieval surgery, it is still important not to engage in any

Fertility Treatment, Third Party Donation

The Egg Donation Medical Process: For Egg Donors

Dra. Diane Tober / July 13, 2018

Becoming an egg donor can feel overwhelming and scary—especially the first time! Once you’ve been selected, the process can move pretty fast. Here is what you can expect from the medical process of providing eggs. Every month, in a natural menstrual cycle, women produce multiple egg follicles (sacs in the ovaries that hold the developing eggs), but only one follicle will become a mature egg and be released from the ovary during ovulation. The remainder of the other developing follicles do not receive enough hormones from the body to develop into mature eggs, so they pass from the body during menstruation. Some women naturally have more developing follicles than others—what’s known as your resting antral follicle count—and the number of eggs your body produces may change from month to month, and reduces over time. In an egg donation cycle, a physician prescribes medications, or fertility drugs, to stimulate the ovaries to get more follicles to develop into mature eggs than the usual one per month. There are many different medication protocols that can be used to create a higher number of mature eggs than usual, a process known as superovulation. Your egg donor medication protocol may vary depending upon which doctor you go to, your resting antral follicle count and other fertility tests, and how many follicles are developing mature eggs in a single cycle. If you’re a repeat donor and have your protocol information that worked well for you (or didn’t) from a prior cycle you can share that information with the doctor, and they may use the protocol that already worked for you. Others will prefer to stick to a protocol they’re comfortable with. It is important that you understand which drugs you will be taking upfront, what trigger shot the doctor plans on using, and how many eggs they aim to retrieve. The first stop in the medical process is any pre-screening that is initially done. Read: Becoming an Egg Donor: The Recruitment and Screening Process Medical Pre-Screening When you sign up to become an egg donor, after being selected by recipients, you will be required to undergo a series of medical tests. Some clinics or egg banks may conduct these tests before you are chosen by intended parents (IPs), but most conduct the medical screening after you have been matched with recipients. Not all clinics do genetic testing or counseling, and there is some variation from clinic to clinic in the tests you may undergo. Usually, the initial medical screening includes: Blood draw on the third day of your menstrual cycle to check your hormone levels, anti-mullerian hormone (AMH) to make sure you have a good ovarian reserve and how your ovaries might respond to hormone injections Blood tests to check for sexually transmitted infections, HIV, Hepatitis, Zika, and other afflictions Urine drug screening tests Transvaginal ultrasound to check your ovaries After you have completed the above medical screenings, and are selected by IPs to be their egg donor, you will be ready to start your “egg donation cycle.” If you’re providing eggs to an egg bank, you will not need to wait to be matched with recipients. There are four different phases to the medical process of an egg donation cycle: Regulating your cycle with the recipient The stimulation phase to make the ovaries produce more eggs The trigger shot to release the eggs from the follicles so they can be retrieved Retrieval surgery to remove the mature eggs and the fluid from the follicles 1.Regulating Your Cycle If you are doing a fresh egg donation cycle when you first get “matched” with a recipient your doctor or nurse coordinator will want to coordinate your cycle with the cycle of the person receiving your eggs. The clinic will provide you with a calendar, so you can track your monthly cycle and keep track of the different prescriptions and dosages throughout. In most cases, you will start taking the birth control pill on the first day of your menstrual cycle and continue taking the pill for the next three weeks, or so. The recipient of your eggs could be either an intended mother who plans to carry the pregnancy herself or a gestational surrogate, someone who plans to carry a pregnancy for someone else. In either case—unless all of your eggs are being frozen—your monthly cycle will need to be timed, so that your eggs are ready to be retrieved around the same time the recipient’s uterus is ready for the fertilized eggs (or embryos) to be transferred. To coordinate donor and recipient cycles, different drug protocols can be used. Some use what’s called a “long Lupron” cycle–also known as a “long GnRH agonist” protocol. Lupron is a drug that was initially used to treat men with prostate cancer and is used “off-label” for fertility treatment—meaning it was not approved specifically for this purpose. Lupron is used to shut down the ovaries, which some refer to as a medically induced menopause. A long Lupron protocol means you will be taking Lupron injections for many weeks throughout the cycle. Long Lupron cycles require that hCG be used as a trigger shot to release the eggs before retrieval surgery. HCG triggers are associated with a higher risk for ovarian hyperstimulation syndrome (OHSS), to be discussed below. On a long Lupron protocol, donors start on both Lupron and birth control pills simultaneously to suppress and control when ovulation occurs. Most physicians no longer use this method—especially for egg donors—because it is more costly, it requires more injections over a longer period of time, and because it may increase donors’ risks for complications. If the doctor in charge of your egg donation cycle wants to use this protocol, you might consider talking to your own doctor to find out if this is the best option for you. Young women, and women who produce large numbers of eggs (high responders), are usually not good candidates for this protocol. 2. The Stimulation Phase After several weeks, once your cycle is regulated

Fertility Treatment, Third Party Donation

Becoming an Egg Donor: The Recruitment and Screening Process

Dra. Diane Tober / April 30, 2018

Becoming an egg donor requires a series of steps, from navigating the initial decision from selecting and signing up with an agency or clinic, going through the screening process and meeting their criteria, being selected by intended parents, signing legal and medical consent forms and going through hormone injections and surgery to retrieve the eggs. From first signing up to be matched with recipients, to the egg retrieval surgery date, it could be a matter of weeks, months or longer. Knowing what to expect in the egg donation journey can help you navigate terms you are comfortable with and advocate for yourself in an often confusing, sometimes overwhelming, process. Different clinics, agencies and egg banks may have different criteria for recruiting, screening and approving egg donors for their programs. Some are more restrictive than others, and many do not include things like genetic screening or testing. But from beginning to end, the egg donation process generally includes: Filling out an egg donor application, Including personal and family medical history If accepted, building a donor profile, with photos, education information and personal statement Getting selected by recipients Psychological screening Genetic screening or testing Medical pre-screening Signing legal contracts and consent forms More medical exams, blood tests, and screening Starting birth control and hormone injections Egg retrieval surgery under local or general anesthesia Post-retrieval recovery, payment and being asked to donate again As you can see, becoming an egg donor is not a quick and easy process. Some people considering egg donation think that as soon as they sign up with an agency, clinic or egg bank, they will start the process and receive a check-in as little as a few weeks. In fact, while some donors are chosen quickly, others may wait years before being selected, or not ever be selected at all. 1. Decide What Kind of Egg Donation Arrangement you Prefer The first step is identifying whether you want to choose to donate through a clinic, agency, egg bank or to a private party. If you plan to go through an egg bank, you will not need to wait to be matched with a recipient and will start the medical and psychological screening process right away. (You can read more about the difference between these options here: Becoming an Egg Donor: Agencies, Clinics & Private Arrangements). Once you decide which kind of egg donation practice is right for you, you can contact the clinic or agency of your choice to inquire and begin the application process. They will likely ask you to complete an application in person or online, with questions about your Body Mass Index (BMI), family health history, age, weight, height, education, and other criteria. Assuming you meet all the initial requirements, you will then proceed to the next step. Filling out the initial paperwork and forms can take about a week or so, depending on how much information you have to collect. Most agencies and clinics will connect you with an egg donor coordinator to facilitate the application process. 2. Creating an Egg Donor Profile The donor profile is often described as being like a Facebook profile or a profile for an online dating site. The idea behind the profile is to present yourself in a way that an intended parent chooses you to be their donor. For the agency or clinic—and even for donors—the profile can be seen as a marketing tool. Egg donor profiles used to be stored in physical catalogs and categorized by hair color and ancestry; for example, blondes, brunettes, Asian, African descent and so on. Now that most agencies and clinics have their profiles online, intended parents can search the database by donor characteristics they desire—whether hair color, eye color, ancestry, education level, and other traits. Your profile will have your donor ID number, and possibly a fake name, but not your real name. To create a profile, you will likely be required to upload current photos and photos of yourself as a child or infant. Some agencies have professional photographers do photoshoots with their donors. You will probably also provide a biography, about your likes and dislikes, height and weight, your hobbies, aspirations, what you study in school, any sports you may play, love for music, or other things that describe who you are. Part of your written information may include your reasons for becoming a donor, or any message you would like to give to the children born from your eggs. Once you finish your profile you can make it go “live.” When your profile is live, an intended parent could choose you the next day, or you may end up waiting a while. It is possible that multiple potential recipients will choose the same donor at the same time. If that is the case for you, it is advisable to not commit ahead of time to multiple recipients. If this is your first cycle, you do not know how your body will respond, or if you will want to donate again. It is ideal to go through the process first so you know how your body responds and to make sure that you like working with the people at the agency or clinic you chose. While recruiters may try to encourage you to commit to multiple cycles right away, this is likely not in our best interest, for the reasons mentioned above. 3. Matching With a Recipient When someone selects you to be their egg donor it can feel pretty exciting to know that someone wants your eggs. Most donors report that it feels like a huge compliment and how happy they are to be chosen. Some agencies/clinics require that you have little information about who gets your eggs. The recipients, though, may receive a lot of information about you from your profile and medical information. The amount of information you receive about them varies from practice to practice. Other agencies/clinics maintain that the selection process should be a two-way street, meaning that even if an anonymous

Fertility Treatment, Third Party Donation

Becoming an Egg Donor: Agencies, Clinics, Egg Banks & Private Arrangements

Dra. Diane Tober / April 25, 2018

So you’ve seen the ads, you’ve thought about it and now you’re seriously looking into egg donation. Take a look at Navigating the Decision to Become an Egg Donor for a good overview of what you might want to consider when deciding to donate your eggs. The next steps include deciding what kind of egg donation arrangement you prefer. There are multiple options to choose from if you are interested in providing eggs for someone else to have a child. Some of the main options include: An egg donation agency A clinic with an internal egg donation program An egg bank Using an online forum for people looking for “known” donors Which is the ideal arrangement for you? Each of these options involves different circumstances and requirements that may affect your experiences as an egg donor, legally, medically and emotionally. Let’s take a deeper look at the different options available for providing eggs and what you’ll want to consider. Egg Donation Agencies Egg donation agencies are businesses that act as go-betweens between donors, intended parents (or recipients) and medical clinics where egg donation is performed. Each business may operate differently and have different standards when it comes to looking out for their donors. Your agency coordinator is supposed to be your advocate throughout the process and help look out for your interests and medical care. But this does not always happen. It is important to ask around before signing up with any particular agency to find out about other women’s experiences donating through them. In some online forums, such as We Are Egg Donors, current and former donors may share their experiences—good and bad—with specific agencies and help you decide on a practice that is right for you. You can also see if the agency will connect you with other donors in their program. Once you sign up with an agency most will have you go through an initial screening process. In the screening process, they will want to know your family’s genetic history, such as any heritable diseases in close or distant relatives. You will probably also have to be within a particular weight and height ratios with a Body Mass Index between 18-29. They will want to know your hobbies, educational background, and other information as well. The process of gathering all of this information, and for them to sort through it, may take several weeks. The majority of women who apply to become donors—almost two-thirds—are rejected at this point. Once you are accepted into a program, they will ask you to create an online profile. This is similar to building a Facebook profile, and may include: Baby photos Current photos Your bio—or description of who you are and why you want to donate eggs Health information You should know upfront how much the agency pays per donation. You should also know in advance if they require donor anonymity. Some donors want to have their identity open, so any child can reach them at some point in the future. Some want to be known from the outset and exchange emails or phone calls with recipients. And some want anonymity. With genetic test kits, however, anonymity can never be guaranteed. It is also important to only agree to one cycle at a time. Some businesses try to get donors to agree to multiple cycles before they have ever done one. Since you may not yet know how your body responds to the hormones used to stimulate egg production, or if you will want to commit to more than one cycle, it is important to only agree to one egg donation cycle at a time, with plenty of time off between cycles so that your body can recuperate. Do not feel pressured to commit to more than what you are ready for. Egg donation agencies work with a number of different clinics. If you sign up with an agency, you may have different standards of care depending upon which clinic the agency and recipients decide to use. For example, some clinics or physicians use more aggressive hormone protocols than others and have higher rates of complications such as ovarian hyperstimulation syndrome (OHSS). Some physicians or their staff may make you feel more comfortable and well cared for than others. It is not uncommon for a repeat donor to have a good egg donation experience at one clinic and then go on to have a horrible experience at another. Not only do you have to do your background research on the agency, but also the different clinics they may send you to. They may not tell you, but most in the industry know which medical practices or individual physicians have higher OHSS rates. Some insurers now refuse to provide coverage for physicians with donors who have high rates of complications like OHSS. Private Fertility Clinics with Egg Donor Programs Some egg donors choose to go to a private fertility clinic with an internal egg donation program. Using a private clinic, rather than an agency, will improve your chances of having the same standard of care throughout each egg donation cycle, assuming you see the same physician every time and build a relationship with the clinic staff. Private clinics, or clinics in university hospitals, often offer lower compensation than some agencies, but not always. But if you are a donor at a clinic that has doctors you are comfortable with, and who closely monitor how many eggs you produce and adjust your hormone dosages accordingly, you should have a more consistent standard of care throughout repeat egg donation cycles. At the same time, if you are not happy with the clinic or physician at a particular practice, you should avoid them. Some clinics match a single donor to a single set of recipients—what is called a “one-to-one cycle.” Other clinics have different kinds of programs and fees for different kinds of cycles, including “shared cycles.” One type of shared cycle may include saving and freezing some eggs for yourself—at a reduced

Fertility Treatment, Third Party Donation

Navigating the Decision to Become an Egg Donor

Dra. Diane Tober / March 19, 2018

Egg donor advertisements are everywhere. On popular music streaming sites. On Craigslist and Facebook. In campus newspapers or even fashion magazines. Most egg donation advertisements mention the thousands of dollars you can receive to provide eggs, and how your sacrifice can bring joy to people who desperately want a child but have been unable to conceive on their own. You might think egg donation is a good way to make money in a short period of time while helping someone have a baby. But before becoming an egg donor, there are a lot of things you should consider. The egg donation process is complicated. From first thinking about becoming an egg donor to being selected and going through hormone injections and retrieval surgery and recovery, there is a lot of information you will need to know in order to best advocate for yourself. You will be undergoing medical tests and procedures, psychological counseling, possibly genetic testing and counseling, negotiating legal contracts and having surgery under anesthesia. Here, you will find out more information about navigating the initial decision to determine if egg donation is the right choice for you. Why Do Women Become Egg Donors? Most women first think about becoming an egg donor when they see or hear an advertisement that states they can get paid thousands of dollars for their eggs while helping someone else have a baby. Some may find out about it from a friend or co-worker. Or see an article in a fashion magazine or online. Or perhaps they know someone who has struggled with infertility and feels a personal calling to help ease the trauma of involuntary childlessness. Some women do not intend to have children of their own and see egg donation as a way of not letting their eggs “go to waste” and of continuing their genetic contribution without the responsibility of parenting. While most donors receive substantial financial compensation, others do not get compensated at all and do it in order to help a friend or relative, like a sister or aunt who cannot use her own eggs. Whatever the reason, it is a personal decision that deserves serious consideration from all angles. What Should You Consider Prior to Becoming an Egg Donor? Current You vs. Future You When you are considering egg donation, it is difficult to know how your perspective might change over time. While some women who donated years prior remain happy with their decisions to donate, some have mixed feelings, and others express regret. Former donors who later have their own children may have a change of perspective over time. They may wonder about the children out in the world conceived from their eggs, may want their own children to be able to meet their biological half-siblings, or may perceive their donations differently after having their own children. Some worry that their donor-conceived children will find them when they do not want to be found, but most hope to someday meet the children born from their eggs. Once you provide eggs for another person’s child, it is a decision you will never be able to take back. Some former donors—for whatever reason—are not able to conceive their own child after helping other families have children with their eggs. Before deciding to provide eggs think about how you might feel about having genetic children being raised by other people in the event you are unable to have your own children? Potential Health Factors Most advertisements and information about egg donation on agency or clinic websites emphasize that egg donation is safe. Agencies and clinics advertising for egg donors often provide information on their websites that state the "risks are less than 1%." But there is no evidence derived from research with egg donors to support this claim. Different types of complications do occur and the most truthful thing an egg donor recruiter or physician could tell you is that no one knows what the risks are or how often they occur. This is important to understand when you fill out the informed consent form before becoming an egg donor. Immediate complications directly connected to egg donation include things like Ovarian Hyperstimulation Syndrome (OHSS), which is characterized by extreme bloating and in its severe form can be life-threatening. Ovarian torsion, when the ovary twists in the body, cutting off blood supply, is another immediate complication that can occur. The frequency of these complications in egg donors has not been sufficiently studied. Potential long-term complications are even less well known. There have been no studies comparing reproductive cancer rates, endometriosis, infertility or other disorders among egg donors compared to women who have not donated their eggs or undergone hormone injections for fertility treatment. Realistic Understanding of Egg Donor Compensation One of the main reasons women decide to provide eggs for compensation is to pay college tuition or student loan debt. If financial need is your primary motivation for becoming an egg donor, it is important to know that while many advertisements state very large dollar amounts for an egg donation cycle—$10,000, $30,000 or even $50,000 or more—when you actually sign up at an agency advertising these amounts, they will probably offer you a much lower compensation than was originally advertised. Very rarely do agency advertisements apply to a specific set of intended parents or recipients who are ready to pay $50,000 for someone to provide eggs. A more likely scenario is that once you sign up, your profile will be put into an egg donor online catalog and intended parents will choose from there. The going rate—regardless of the advertised amount—is usually between $5,000 and $10,000 in the United States and may vary from agency to agency, clinic to clinic and state to state. Some women with specific, high-demand traits may get paid more, as well as experienced donors whose eggs have resulted in a successful pregnancy. While it is rare to get paid more than $10,000 for a first egg donation cycle, some agencies do specialize in “high-demand

Fertility Treatment, oldposts

Are Egg Donors Patients Too?

Dra. Diane Tober / January 16, 2018

Over the past several years, I have had conversations with almost 100 egg donors for my egg donor research project and my documentary film. In these conversations I’ve heard repeated complaints from the young women who provide eggs for someone else’s children: “I don’t feel like I’m the real patient.” “I feel like I’m just a product to them.” For anyone using an egg donor—or any professional who works with egg donors—it is important to ask: Do egg donors have a legitimate point? If so, how does “feeling like a product” affect young women’s experiences as egg donors and what can be done to improve donor care? Some minor adjustments can vastly improve egg donors’ experiences. These are young women who take on considerable risk so someone else can have a child. Is there a way to do better by them? As a researcher, I spent many years talking to people about their experiences with infertility. In my early 30s, I was also concerned about my own ability to conceive when, after surgery to remove two dermoid cysts, I was left with a single, patched up ovary. I am not unfamiliar with what it feels like to face the trauma of involuntary childlessness and failing ovaries. I thought, “If worst comes to worst, I’ll have to use an egg donor who looks like me.” In that space, I had no concept of what that actually might mean for the hypothetical woman who might have helped me have a child. I understand how someone might become so fixated on achieving the joy of a successful pregnancy and the birth of a newborn baby—whether an intended parent who has struggled for years or a professional in the industry wanting to help them—that it is possible to lose sight of the humanity of young egg donors in the process. Not the Real Patient In a recent online article, donor egg IVF was defined as: “An in vitro fertilization (IVF) process that uses the eggs of a donor rather than those of the patient.” In response to the post, I asked: “Are egg donors patients too?” The language on the post has changed since I first responded—which is a good thing—but it reflects an underlying perspective that needs to change, that a donor is somehow different than the real patient. Unfortunately, many egg donors’ experiences reflect the “not a real patient” experience. After waking up from her egg donation cycle through The World Egg Bank, Rae—a 26-year-old donor—asked her egg donor coordinator for a copy of her medical records. Her coordinator refused to provide her with any records from her cycle. Since egg donors are not seeking treatment when they donate/provide eggs, HIPAA laws requiring access to medical records do not necessarily apply. Kate, who I interviewed for my documentary film, was 19 when she donated in an open donation to a single intended mother. She started one cycle, which the doctor quickly canceled stating she wasn’t producing enough eggs. On the second cycle, he increased her dosages of fertility drugs. Still, she produced very few eggs and they died off quickly. The physician knew before he even started Kate’s cycle that she had low ovarian reserve from her lab results, but never shared that information with her so she could decide if donating eggs was the right decision. “My intended mother told me the doctor didn’t want to put bad energy into the cycle, so they didn’t tell me. And they still haven’t told me. Nobody contacted me after I donated my eggs—not the agency, not the doctor, not anyone,” Kate said. “I absolutely feel like I have a right to my medical information. They shouldn’t have kept that from me.” These stories are unfortunately not uncommon. In my research, many donors have told me how they were refused copies of their medical records or were denied information or explanations about their anomalous genetic tests results after frantically calling to find out what the results meant. “The doctor said my medical records didn’t belong to me. They belong to the intended mother, so they wouldn’t even tell me what the results of my genetic test meant. I kept calling because I was scared and no one would talk to me,” Jenna, a first-time donor at 21, told me. In some clinics, even donor follow-up care is lacking: Several days after her third donation, Brittany, 22, was rapidly gaining weight, and it was getting hard for her to breathe. In one of her earlier donations, she was given a check-up the week following her egg donation. With this new clinic, she was surprised that not only did they not schedule a follow-up visit for her, but she could not even get them to respond: “This last time I donated my eggs I was in a lot of pain, and I was swelling up with a lot of fluid. I couldn’t even breathe,” Brittany said. “But the clinic didn’t care. They didn’t even return my calls. When I finally got a hold of the nurse, she just said, ‘Oh, that’s normal,’ and brushed me off. Since when is gaining 10 pounds in less than a week normal? I ended up having to go to the emergency room. I was literally passing out.” Feeling Like a Product “The doctor told me I’m an egg-making machine because I produce a lot of eggs. I feel like I’m just a product to them.” – Amanda, 27, 6-time egg donor Most articles written about egg donation are aimed at helping intended parents—especially intended mothers—sort through their feelings about using an egg donor, and how to find the right donor. Although unintentional, the language used in many of these blogs and articles highlight exactly why egg donors feel more like products and like their humanity is dismissed. Their looks, test scores, and body measurements come under online scrutiny, with women some considered more valuable than others. One advertisement announced a “Black Friday Special”,” with $500 off an egg donation

Author name: Dra. Diane Tober

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