Hellobee

I’m writing this post anonymously because not all of our family members know that we’ve gone through the egg donation process previously and I’d prefer this story not to be searchable by my icon. My donations aren’t something I publicize, but there are a few people in my life who know that I’ve been an egg donor. While we often get to hear about experiences from the pregnancy/IVF side, it can be tough to find detailed information from the egg donor perspective and I thought it might be also interesting for anyone thinking about either side of the egg donor/intended parents (IPs) relationship.

I ended up doing five total egg donation cycles for four different sets of IPs. Three of these IPs were based in the United States and one lived in Asia. When I donated the first time, I honestly wasn’t sure whether I would go through it more than once, but I ended up really enjoying most of the experience and was happy to be quickly matched again.

Reasons for Donating

The egg donation process really made me think through my reasons for wanting to donate. Although egg donors are generously compensated, this compensation should not be the sole reason for donating. Egg donors are required to go through intense medical evaluation and screening prior to the donation cycle, including a psychological evaluation. I have heard that if your reasons are purely motivated by finances, you’re unlikely to make it through the psychological evaluation.

Now, obviously, because donors receive thousands of dollars, compensation is likely to be one motivating factor. It just should not be the sole reason. When I had my psychological evaluation, I was very honest and gave all of my reasons that I wanted to donate, including the compensation. As a relatively new graduate with a lot of student debt, the thought of making $6,000 or more for a single donation cycle was definitely alluring. However, I also had several other reasons for donating. One was that I genuinely did want to help those who couldn’t become pregnant on their own. Even though I thought I didn’t want to become pregnant myself at the time I donated, I felt saddened by the anguish some parents went through in unsuccessful attempts to become pregnant. I felt confident that if IPs had tried unsuccessfully to have children and then turned to donation, they would adore their children.

Additionally, I was interested in specifically helping other Asian parents. I know that for other medical donations, like bone marrow, there is often a shortage of Asian donors. This shortage is true for egg donation, as well. Although some IPs aren’t tied to finding someone that shares their ethnicity, many prefer to share an ethnic bloodline or have children that will look more like them. Asian donors are reportedly hard to find because of cultural factors. For example in some Asian cultures, the blood relationship is considered very important and it is not considered socially acceptable for that bloodline to go outside of the family.

Because at the time I donated I never intended to become pregnant, I felt that I was never going to use my eggs so why not give them to someone else? Some ego-driven part of me also enjoyed the idea that my genes would be passed on even though I hadn’t planned on having children.

All of these reasons for donating factored into my final decision.

Considerations

In addition to carefully thinking about the reasons for donating, there are several other factors to consider before going forward.

IVF and egg donation is a medical procedure and, as such, carries risks. I learned that the most common risks of egg donation are pregnancy, infection and ovarian hyperstimulation syndrome (OHSS). Bloating and cramping post-donation is very common. These were things I researched and were clearly spelled out for me by the really great doctor who did my first cycle.

Even though at the time I donated my eggs I thought I would never want to have kids and be pregnant myself, I still asked the doctor what studies have been done regarding women who have donated previously and then wanted to become pregnant. Because about twenty eggs can be retrieved in a donation cycle, I did wonder whether it would affect fertility. He reassured me that egg donation had been done for over thirty years and that donors had not reported fertility issues.

I was also married when I did the egg donation, so having my husband agree was imperative. We talked through our reasons for donating and agreed to go ahead with the first cycle.

Matching

The first part of the process for me after speaking with a case manager at the agency was to fill out a very long questionnaire. The first portion involved physical characteristics and descriptions, such as height and weight, eye and hair color, ethnicity and age (typically, if you are over the age of 30, you will not be matched by an agency, though there are several agencies specializing in Asian egg donation matches that permit donors up to the age of 32 due to the lack of sufficient egg donors). The education portion solicits information regarding your degrees, GPA, SAT scores if available, and favorite subjects. Another section goes through job history. A significant portion of the screening questionnaire involves personality traits, including self-descriptions, hobbies, strengths and weaknesses. Another large portion of the questionnaire, which gets sent to the fertility clinic, covers health and the donor and donor’s family medical history and asks for blood type (something that is very important to Asian parents, apparently). There are also personal questions that involve marital status and pregnancy history.

After I submitted my questionnaire and a photo, the agency made a donor page for me so that IPs could review my profile and determine whether they had interest. It felt a little bit like the college application process where you try to sell yourself and wait to see if anyone wants to pick you. My case manager predicted that I would be very popular, but gave one couple an inside track because they had been searching for months and hadn’t found a donor they liked yet.

Within a day or two, my case manager wrote to me to say that there were several couples interested and she e-mailed me a list of follow up questions from the various IPs. For example, I said that I had an A-type personality and one couple asked what my perception of an A-type personality was. One asked whether I was nervous or more calm. Another asked what my parents’ education level was. Although the questionnaire asked what my favorite or best subjects were in school, one couple wanted to know what my weakest subject was. Some asked for additional pictures of me, a couple asked for pictures of me as a child, and one asked for pictures of my parents.

I have to admit, I loved hearing that there were several couples interested in my profile. It’s what I imagine online dating might be like: it’s always nice to be wanted and when someone shows interest. Some of the things that probably worked in my favor as an Asian egg donor include educational background (advanced degree, high GPA and SAT scores), job (professional), lack of caffeine or alcohol use, low number of sexual partners, and list of achievements (including athletic and academic). Things that probably did not work in my favor include my mixed ethnicity (many IPs want someone that is 100% Chinese or 100% Japanese or 100% Korean, etc. rather than half and half) and unwillingness to go out-of-state for my cycle.

Although all of my donation cycles were anonymous at the request of the IPs (and would have been my preference anyway), I did receive some letters from the IPs informing me of their struggles and why they chose me as a donor. These letters were truly extraordinary to read and their suffering—but also hope—leapt off the page. As they described themselves, I could see a connection between their traits and interests and mine; a shared love of specific classical composers with one, similar interests in sports with another, for example. One gave me the advice to have children in life earlier, rather than later because it is “one of the most cherished blessings and achievements in life.” At the time, I didn’t know just how much I would agree with the statement several years later.

Screening

Once I was matched with a couple for my first donation, the screening process began. I went through medical screening and doctor consultation, including blood tests and disease/infection tests, a pap smear, drug screening and vaginal ultrasound. My husband was also required to have a blood draw to screen for sexually transmitted diseases. My height and weight were recorded during the medical screening because you are technically supposed to be at a “healthy” BMI: between 18.5 and 24.9. My BMI has always fallen below the 18.5 line, but the IPs and fertility clinic decided to go ahead with me.

Genetic screening was performed to see if I was a carrier of any genetic diseases. The great thing about this part of the screening process is that I was able to discuss my results with the fertility doctor. When I became pregnant with my first child, I was able to request my records from the egg donation agency and bring those records to my OB for him to review, as well. As a result, I elected not to do any additional genetic screening other than a first trimester blood screen for down syndrome.

The final portion of the screening is a psychological evaluation conducted by a psychologist. This evaluation is done for the benefit of the donor to ensure that she understands the psychological implications of the process and the risks. Before I did the psychological evaluation, I had to complete a personality test not unlike a Myers-Briggs test. During my discussion with the psychologist, I remember her asking who I had talked to about donating and who I had not, what my reasons were for donating, whether I had any concerns. I answered all the questions as truthfully as possible, and remember giving a lot of mixed donors. For example, I said that I hoped I could help IPs have children but that financial compensation was also a factor. I said that part of me had concerns about future fertility, but that the fertility doctor I spoke to and research I had done indicated that I would be able to successfully have children of my own. Ultimately, the psychologist makes a recommendation as to whether the donor is psychologically prepared and fit to become a donor. During my five donations, I had three psychological evaluations. My first three cycles all relied on the recommendation of the first psychiatrist who approved me. Because a couple of years had passed between my third and fourth cycle, I was required to undergo a new psychological evaluation. Much to my surprise as well as my case manager’s, I failed! We discussed possible reasons, such as the new job that I started, but I did not recall telling the psychologist that I was under any new stress and, in fact, loved my new job. The IPs wanted to go forward with me as a donor so they actually switched fertility clinics so that I could work with a new psychologist who did approve my cycle. I still don’t know why that one psychologist did not recommend me.

Legal Agreement and Compensation

After the screening process is complete, a contract is drawn up between the donor and the IPs. The IPs hire their own lawyer and also a second lawyer to represent the donor. For my first cycle, I actually waived representation and chose to represent myself. These contracts are fairly standard and I think I requested one small change in my second contract, but generally did not have any issues. To maintain the privacy and anonymity of both the IPs and donors, the contracts are signed separately and sent to the agency.

The legal agreement includes a number of provisions governing everything from the relationship between the eggs and the IPs versus the donor, what can be done with embryos not implanted in the intended mother, selective reduction, parental rights, commitment by the donor to update the agency with changes in contact information for the next eighteen years (in case there is a genetic issue and the IPs want to contact the donor through the agency, again preserving anonymity), compensation, personal injury and arbitration clauses and more. Every contract I signed involved explicit instructions to abstain from sex for at least one full cycle after the donation; the reason for this is pregnancy—and pregnancy in multiples—is one of the risks of egg donation and getting pregnant puts the donor in breach of the contract.

The agency I worked with allowed donors to set their own compensation and this factored in with the matching process. After I was matched, I was able to negotiate my compensation with the IPs (through the agency, of course). First time donors are advised not to ask for too much because they are unproven and the quality of the eggs are uncertain until after at least one donation cycle. At the agency I worked with (this was about eight years ago), they allowed donors to set their compensation between $6,000 and $10,000 (the maximum allowed by the American Society for Reproductive Medicine (ASRM), which states that amounts over $5,000 require justification and amounts over $10,000 are not ethically appropriate). For my first donation cycle, I requested $8,000 and was offered $6,500, which I accepted in part because I wasn’t sure whether I would even be accepted given my low BMI. For future cycles I received higher amounts because of the recommendations of the fertility doctor I worked with who noted that the number of eggs retrieved was high and egg quality was good. I was offered the maximum amount once (third cycle), but for my last two cycles I accepted a lower offer.

One thing that I want to make clear is that donors are not “selling” their eggs, but rather, are compensated for their time (many, many appointments) and the physical and mental stress that goes along with a donation cycle. Donors have to follow strict, often complicated injection schedules, have sometimes daily monitoring, go under anesthesia and have surgery performed to remove the eggs.

In addition to the compensation received for the cycle, the IPs also pay for two lawyers draw up the contract, travel if the fertility clinic is not local to the donor (including for a spouse or travel companion to care for the donor after the egg retrieval), any other out-of-pocket expenses associated with travel (including taxis, food, etc.), and donor insurance for medical bills that may arise as a result of complications. There are no out-of-pocket costs to the donor.

Egg Donation Cycle

The egg donation cycle involves taking birth control pills at the same time as the intended mother to get your cycle on the same track, before going off the pill on the same day. I met with a nurse and doctor at the fertility clinic who clearly explained what would happen, when I would need to come in for future appointments, how to use the medication, etc. I was then shipped a box of medications in a freezer box filled with ice packs with instructions on what needed to be refrigerated along with the initial injection schedule. This was the part of the cycle I was most nervous about because I hate needles. Initially, I thought I would enlist my husband’s help, but he ended up being out of town when I started the injections for my first cycle. Different clinics will provide different schedules, medications and instructions, but generally you measure out the amount of medication and inject it either into your stomach area or the muscle in your upper thigh. I ended up doing the stomach method, where you pinch your skin and quickly inject the medications. The first time I did it, it took me about six false starts before I had the courage to just do it. Overall, it wasn’t that bad, but I must have hit a blood vessel or something on the third day because that injection hurt a lot and stayed bruised for almost two weeks after.

Once the injections are started, I had to return to the clinic for what seemed like constant monitoring via vaginal ultrasound. Each time, they would count the number of follicles and, once we got further along in the cycle, they measured the largest eggs. Based on this information, sometimes the medication dosages were changed and this information was used to estimate a retrieval date. Before the cycle started, I was given an approximate window of when the retrieval would take place, but that it would be scheduled either 24 or 48 hours after whenever the fertility doctor thought there were a sufficient number of mature eggs.

My retrieval experiences varied quite a bit depending on the clinic used. My first donation cycle was my favorite, likely because the doctor was really great, took the time to explain everything that was happening, and obviously cared about the donors. I had heard that some doctors care only about the person paying the bills—the IPs, and don’t take enough care to ensure that donors are comfortable and not overstimulated. Although I never had any serious complications, my subsequent cycles did not seem to have the same level of care. One of the differences was the first clinic was run by one doctor, whereas the two other clinics I used (I used one for my second and third cycles and a different one for the fourth and fifth) were practices so I wasn’t always seen by the same doctor.

For my first retrieval, the nurses did a lot of pre-op work, letting me change into a hospital gown, spraying a topical anesthetic on my hand where an IV line would go in, wheeling me in a hospital bed to where the retrieval would take place (in what was obviously a very sterile environment that looked like an operating room). They explained everything that was happening and one of the nurses even brought an extra blanket to cover me with once I got to the operating room because of how cold it was, even though I would be put under anesthesia momentarily.

Once I woke up, I felt very groggy. Apparently after each cycle, I responded very similarly telling the nurse and my husband that I was hungry and asking what time it was repeatedly. During one cycle, I hadn’t actually fully come out of anesthesia and kept saying, “Those crackers look good, can I have one?” Apparently, I was repeatedly told to wait (presumably because they could tell I was still out of it). My husband relayed this story to me once I actually woke up and told him that I was hungry; “I know you are. You don’t remember asking for crackers five different times?” I think the anesthesia was a bit heavier the first cycle than subsequent cycles—and recall actually telling future clinics to go easy with the anesthesia. I woke up with a headache and a very dry mouth, which didn’t happen in future cycles.

The doctor came in and told me how many eggs they retrieved and was very positive. He also warned me that if I donated again, I should be very careful to make sure the clinic does not overstimulate me. He said that the growth of the eggs happened very quickly and because of my petite frame and response to the medications, fertility doctors would have to be monitor me carefully. The clinic gave me post-care instructions and sent me home. Before I left, though, I brought a card (unsigned, and unsealed so that the clinic would be able to ensure that I did not breach any of the privacy/anonymity conditions) to give to the IPs wishing them luck and letting them know they would be in my prayers.

Post Egg Retrieval

Once home, I sent an email to my case manager to give her an update on the number of eggs retrieved. My case manager had donated previously and she gave me her own advice on after-care. She also forwarded me part of an email from the intended mother who had undergone IVF previously. The intended mother was thrilled to hear about the retrieval because the clinic had not updated them yet. The intended mother also gave me her advice and said that she was very concerned that I would be overstimulated and have OHSS symptoms, the most common symptoms of which include bloating and cramping. The fertility doctor put me on fluid restriction for the next 48 hours, advising me to drink only Gatorade and restricting the amount. Fortunately, I had no discomfort or soreness and no overstimulation. I spent the rest of the day taking it easy in bed, relaxing and catching up on movies and TV shows with my husband.

Part of the reason it was easy for me to make the decision to donate again was the fact that my retrievals were very low key and I had no symptoms of OHSS afterward. I was very lucky and never had any soreness, either. Really, other than feeling a little sleepy from the anesthesia, I felt totally normal.

Results

The agency I worked with was really great at keeping me updated on the status of the IPs and I was grateful to know what the final outcomes were. For my first cycle, which was very typical of future cycles, 20 eggs were retrieved, 17 were mature, 13 were fertilized successfully, 2 embryos were transferred to the intended mother, and 3 were able to survive until Day 6 for preservation. In subsequent cycles, 17-25 eggs were retrieved and usually there were 5-6 viable embryos, two of which were transferred and the rest cryopreserved for future chances of pregnancy. There was one outlier where more than 30 eggs were retrieved and, unfortunately, due to a contamination issue in the lab there were no viable embryos.

After my first cycle, before we even found out whether the IPs had become pregnant, other IPs were inquiring into whether I might do a second cycle. While I was still recovering, my case manager told me about couples in the state interested in reserving me; I let her know that I needed a few days to see how recovery went and how I felt before making this commitment. Ultimately I did two more cycles that year (the maximum number of cycles recommended for a twelve month period), then took several months more off before returning for another cycle.

Of the five cycles I completed, there were three successful pregnancies. My first cycle was a success. My second cycle failed to result in a positive outcome and I later found out that the IPs, who were in their 50s, had tried egg donation three times prior to my cycle and none resulted in pregnancy (my case manager said that they probably should have been advised to seek an alternative path). My third resulted in a successful pregnancy for the IPs. Unfortunately, my fourth cycle also failed, but not due to egg quality or the IPs. Instead, there was some issue at the lab and at day 5 the embryos were contaminated with bacteria so nothing was viable. I was devastated to hear this news, as were the IPs, I’m sure. The clinic informed the IPs and my agency that the egg quality was good and they would still recommend me as a donor. I agreed to do one more cycle for these IPs because I really wanted to help them and didn’t want to put them through having to match with another donor. For my fifth and final cycle, the IPs successfully became pregnant and I was informed eight months later that they delivered twins!

ASRM ethical rules allow six donation cycles and I intentionally stopped at five. I probably would have stopped at four, but given what happened during the fourth cycle, I didn’t want to turn down the request to try one more time for the same couple. The reason I stopped before the maximum was twofold. First, even though I was generously compensated for the donation cycles, the cycles do take a toll mentally and physically and I didn’t want to put my body through it again. The bigger reason, however, was that I wanted to leave one or two cycles remaining in the event that one of the IPs I donated to previously wanted to try for another child and wanted to use the same donor. I didn’t want to close that door to them. Although none of the IPs I donated to went this route, I’m glad I left it open as a possibility.

I really enjoyed my experiences donating and am grateful to have the opportunity to help three couples become pregnant. I will admit, however, that after I became pregnant with my oldest I felt a little strange about the donation cycles I completed. Before I wanted children, I was happy to give up my eggs and thought it was nice that some part of me was out there in the world even if I would never know these children. It’s hard to articulate exactly why I felt strange or how I felt—it wasn’t regret—but I had thoughts wondering if my own child would ever meet the IPs’ children. How weird it would be if they met in the future, a possibility (however remote) given that we live in the area where I completed my last cycle which resulted in twins and I became pregnant less than two years after completing my last cycle, even if they wouldn’t know the significance.

Ultimately, I would do it again. And, while financial compensation was certainly a motivating factor the first time I completed a donation cycle, this aspect became less important to me with each cycle I completed. I still have the letters the IPs wrote me when we matched and the small gifts of appreciation they gave me after the retrieval of the eggs was completed (before they even knew the results). I treasure them, even if it’s mostly in secret, because I feel that I shared something special with these IPs and now knowing the joy of pregnancy and having children, I can better understand the motivation to go through IVF and seeking an egg donor. Having a child (whether without any interventions, through IVF, through donation, through surrogacy, or through adoption) truly is a gift and I do feel lucky to have shared in that gift with other parents.