What's the process for egg donation and is it safe?

Dear Laying Golden Eggs and Reader #2,

Egg donation can be a rewarding process, but it’s a bit more complicated than these newspaper ads probably let on (though researchers note that ads are where the majority of potential donors learn about donation). Infertile individuals, couples, or egg donation centers seek healthy, young donors willing to have their eggs cultivated and harvested by recruiting through these type of ads. Donors are compensated thousands of dollars and can help others start families, but it’s worth noting that the process itself is quite time-consuming, somewhat invasive, and is not regulated by the government in the United States. It’s also good to know that there’s little to no evidence of long-term risks for egg donors, but there are some short-term complications that may occur (more on those in a bit). Before deciding to embark on the egg donation journey, it's wise to consider how it could possibly impact your health, both physically and emotionally. That investigation starts with learning more about the process and the potential risks involved, so keep reading for more on those details.

From start to finish, the egg donation process can last up to a few months, depending on the program. Each program has its own criteria for donor screening and selection, including testing and age requirements (usually under 35, as the risk of birth defects is lower), policies, and release forms. Generally, the process begins with a comprehensive questionnaire to assess donors’ medical history, physical attributes, and personal characteristics. Donors then have a complete physical exam, including blood, genetic, and psychological testing to analyze the risk of birth defects or inherited diseases. Donors and recipients who look alike are typically paired up, but donors can also be chosen based on other factors such as education level or personality. After a donor is approved, they sign a variety of legal documents, including a medical release form waiving the donor’s rights to their donated eggs. Many programs have anonymous donation, where the donor does not know recipient and the recipient does not know the donor. However, sometimes recipients choose an open donation, where the egg donor could meet the potential birth parent(s).  

No matter how informed and emotionally prepared potential egg donors may be, the process itself can be complicated, uncomfortable, and even painful. Unlike sperm donation, which is relatively quick and easy, egg donation requires weeks of medications and an invasive procedure to retrieve the eggs. First, donors are put on weeks of birth control pills to align their menstrual cycle with that of the recipient. Selected donors are then taught how to give themselves daily injections of medications and fertility drugs for three to five weeks, overlapped with the birth control pills. One of these injectable drugs temporarily prevents the ovaries from releasing a single egg each month (which typically occurs with each menstrual cycle) and is taken for ten days. The fertility drugs then stimulate multiple eggs to develop, and their maturation is monitored by ultrasound examinations. The goal of the medications and hormones is to harvest multiple, fertile eggs. Menstrual activity resumes shortly after stopping these injections.

Once the eggs are ready to be harvested, a fertility specialist identifies the eggs to be retrieved. In a procedure called transvaginal ovarian aspiration, a needle is passed through the top wall of the vagina and is inserted into the ovary to remove an egg. This process is then repeated for each egg and usually takes 30 to 60 minutes total. After about 20 minutes of recovery, the donor can go home. Usually, donors are limited to donating up to ten eggs at one time, to keep the gene pool small, decreasing the chances that donor offspring will meet in the future. If the donor egg procedure is done correctly, it doesn't interfere with a donor's fertility. Once retrieved, the eggs may undergo testing; if they're deemed acceptable, they are fertilized with sperm, which can be from the recipient’s partner or a sperm donor. The fertilized egg is grown in the lab for two to three days before being inserted into the recipient's uterus.

Donors usually schedule a day off for the egg retrieval process. They also are advised to rest after the procedure to recover from the intravenous sedation effects. Donors may or may not feel discomfort for a couple of days afterwards. For their time, inconvenience, and discomfort, donors in the U.S. are commonly compensated up to $8,000 on average (compensation may be prohibited in other countries, as it is in parts of Europe). That said, it can also vary based on certain factors, including geographic location.

While many donors have reported that compensation is a significant factors in their decision to become a donor, understanding and discussing the risks involved in the process with a health care provider is wise. Some of these risks include:

• A higher risk of pregnancy while using fertility drugs, during which a donor may need to abstain from sexual activity
• Soreness, redness, and bruising around the injection sites
• Side effects from fertility drugs, such as mood swings, tender breasts, and enlarged ovaries
• Ovarian hyperstimulation syndrome, which may result from the injections in rare cases
• Bruising or hemorrhaging of the ovary from the needle used to retrieve the eggs during the egg retrieval procedure
• Short-term serious consequences such as abdominal bleeding, ovarian torsion, infection, and short-term decreased fertility may also occur due to the egg retrieval process
• Long-term physical consequences that are not fully known (in the few studies that have been conducted, some donors have reported infertility, fibroids, and weight gain)
• Emotional and psychological impacts — few studies have explored these, though many report overall satisfaction with having donated, despite any associated physical discomfort and some even report curiosity with end results of donation

As you both determine whether egg donation may be right for you, consider exploring your own reasons for donating. What compels you to consider donation? Financial compensation? The opportunity to help others build a family? The ability to share your genes? Whatever your main motivator(s) are, how do those reasons make you feel about being a potential donor? How would you feel about receiving or not receiving information about what happened with your eggs after retrieval? Also, after learning more about any particular donation program, specific procedures, eligibility criteria, potential risks, and support for the donor and the birth parent(s), it may be good to think about on how you might feel after the process is over.

The benefits can be rewarding, both financially and emotionally, for donors who are able and willing to participate in the process. Kudos to you both for seeking out more information as you consider becoming donors. Taking time to learn more and reflect on your own motivations may also help you make an informed decision. And, before moving forward with any program in particular, working with one that shares information about the process and associated procedures explicitly and clearly is key. All in all though, only you can decide for if pursuing egg donation is right for you.

Here’s to more egg-cellent questions in the future!