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Egg donation (also referred to as "oocyte donation") is the process by which a woman donates ovum to enable another woman to conceive as part of an assisted reproduction treatment or for biomedical research. For assisted reproduction purposes, egg donation typically involves in vitro fertilization technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use. Egg donation is a third-party reproduction as part of assisted reproductive technology.
In the United States, the American Society for Reproductive Medicine has issued guidelines for these procedures, and the Food and Drug Administration has a number of guidelines as well. There are boards in countries outside of the US which have the same regulations. However, egg donation agencies in the U.S. can choose whether to abide by the society's regulations or not.
Before this development, thousands of infertile women, single men and same-sex male couples had adoption as the only path to parenthood. The donation of human oocytes and embryos has since become a common practice similar to other donations such as blood and major organ donations. The practice of egg donation has sparked media attention and public debate, and has had a substantial impact on the field of reproductive medicine.
This scientific breakthrough changed the possibilities for those who were unable to have children due to female infertility and for those at high risk for passing on Genetic disorder. As IVF developed, the procedures used in egg donation developed in parallel: the egg donor's eggs are now harvested from her ovaries in an outpatient surgical procedure and fertilized in the laboratory, the same procedure used on IVF patients. The resulting embryo or embryos are then transferred into the intended mother instead of into the woman who provided the egg. Donor oocytes thus give women a mechanism to become pregnant and give birth to a child that will be their biological child, but not their genetic child. In cases where the recipient's womb is absent or unable to carry a pregnancy, or in cases involving gay male couples, the embryos are implanted into a gestational surrogate, who carries the embryo to term, per an agreement with the future parents. The combination of egg donation and surrogacy has enabled gay men, including singer Elton John and his partner, to have biological children. Oocyte and embryo donation now account for approximately 18% of in vitro fertilization recorded births in the US.
This work established the technical foundation and legal-ethical framework surrounding the clinical use of human oocyte and embryo donation, a mainstream clinical practice, which has evolved over the past 25 years. Since the initial birth announcement in 1984, there have been well over 47,000 live births resulting from donor oocyte embryo transfer recorded by the Centers for Disease Control (CDC) in the United States to infertile women, who would not have been able to have children by any other existing method.
The legal status and cost/compensation models of egg donation vary significantly by country. It may be totally illegal (e.g., Italy, Germany, Austria); legal only if anonymous and gratuitous—that is, without any compensation for the egg donor (e.g., France); legal only if non-anonymous and gratuitous (e.g., Canada); legal only if anonymous, but egg donors may be compensated (the compensation is often described as being to offset her inconvenience and expenses) (e.g., Spain, Czech Republic, South Africa, Greece); legal only if non-anonymous, but egg donors may be compensated (e.g., the UK); or legal whether or not it is anonymous, and egg donors may be compensated (e.g., the US).
Once the screening is complete and a legal contract signed, the donor will begin the donation cycle, which typically takes between three and six weeks. An egg retrieval procedure comprises both the Egg Donor's Cycle and the Recipient's Cycle. Birth control pills are administered during the first few weeks of the egg donation process to synchronize the donor's cycle with the recipient's, followed by a series of injections which halt the normal functioning of the donor's ovaries. These injections may be self-administered on a daily basis for a period of one to three weeks. Next, follicle-stimulating hormones (FSH) are given to the donor to stimulate egg production and increases the number of mature eggs produced by the ovaries. Throughout the cycle the donor is monitored often by a physician using blood tests and ultrasound exams to determine the donor's reaction to the hormones and the progress of ovarian follicle growth.
Once the doctor decides the follicles are mature, they will establish the date and time for the egg retrieval procedure. Approximately 36 hours before retrieval, the donor must administer one last injection of HCG hormone to ensure that her eggs are ready to be harvested. This hormone will produce a LH hormone concentration peak and induce Folliculogenesis. The oocytes are then retrieved from developed Ovarian follicle via ovarian punction. This extraction must occur before ovulation, as oocytes are too small to be identified once they leave the follicle, and if the appropriate time window is missed the donation cycle will need to be repeated.
The egg retrieval itself is a minimally invasive surgical procedure lasting 20–30 minutes, performed under sedation by an Anesthesiology, to ensure the donor is kept completely pain free. Egg donors may also be advised to take a pain-relieving medicine one hour before egg collection, to ensure minimum discomfort after the procedure. A small ultrasound-guided needle is inserted through the vagina to aspirate the follicles in both ovaries, which extracts the eggs. After resting in a recovery room for an hour or two, the donor is released. Most donors resume regular activities by the next day.
With egg donation, women who are past their reproductive years or menopause can still become pregnant. Adriana Iliescu held the record as the oldest woman to give birth using IVF and donated egg, when she gave birth in 2004 at the age of 66, a record passed in 2006. According to a 2002 study, egg donations had a 38% success rate in cases of women past their reproductive years.
Egg donation process in European countries is more cost effective compared to the US, especially in Cyprus where the success rates are higher.
Women who produce healthy eggs may also elect to use a donor egg so they will not pass on genetic diseases.
Two men who are in a homosexual relationship and wish to have a biological child may choose to fertilize a donor egg so as to have a child without a woman's involvement.
Although the donors may be motivated by both monetary and altruistic reasons, egg agencies desire and prefer to choose donors that are strictly providing eggs for altruistic reasons. The European Union limits any financial compensation for donors to at most $1500. In some countries, most notably Spain and Cyprus, this has limited donors to the poorest segments of society. In the United States, donors are paid regardless of how many eggs she produces. A donor's compensation may increase for each additional time she provides eggs, especially if the donor's eggs have a history of reliably resulting in the recipient becoming pregnant. In the United States, egg-broker agencies are known for advertising to college students who are more likely to be in financial situations that motivate them to participate for the financial compensation. It is not unusual for one student to donate many times. Often, this is done without consideration of potential long-term health consequences. Such a student is arguably not making the decision to donate her eggs autonomously due to her unfavorable financial situation.
According to Jansen and Tucker, writing in the same assisted reproductive technologies textbook referenced above, the risk of OHSS varies with the clinic administering the hormones, from 6.6 to 8.4% of cycles, half of them "severe". The most severe form of OHSS is life-threatening. Recent studies have found that donors were at less risk of OHSS when the final maturation of oocytes was induced by GnRH agonist than with recombinant hCG. Both hormones were comparable in the number of mature oocytes produced and fertilization rates. A larger study in the Netherlands found 10 documented cases of deaths from IVF, with a rate of 1:10,000. "All of these patients were treated with GnRH agonists and none of these cases have been published in the scientific literature."
The long-term effect of egg donation on donors has not been well studied, but because the same medications and procedures are used, it is likely similar to the long-term effects (if any) of IVF on patients using their own eggs. The evidence of increased cancer risk is equivocal; some studies have found a slightly increased risk, particularly for those with a family history of breast cancer, while other studies have found no such risk or even a slightly reduced risk in most patients.
1 in 5 women report psychological effects—which may be positive or negative—from donating their eggs, and two-thirds of egg donors were happy with the decision to donate their eggs. The same study found that 20% of women did not recall being aware of any physical risks. In accordance with the American Society for Reproductive Medicine guidelines, female donors are given a limit of 6 cycles that they may donate in order to minimize the possible health risks. Initial evidence suggests that repetitive oocyte donation cycles does not cause accelerated ovarian aging, evidenced by absence of decreased anti-Müllerian hormone (AMH) in such women.
The recipient must also trust that the medical history provided by the donor and her family is accurate. As American donors are paid thousands of dollars, such compensation may drive deceptive behaviors from donors. However, a full psychological evaluation is required by most IVF clinics, providing some evaluation of donor trustworthiness.
In most cases, there is no ongoing relationship between the donor and recipient following the cycle. Both the donor and recipient agree in formal legal documents that the donation of the eggs is final at the time of retrieval, and typically both parties would like any "relationship" to conclude at that point; if they prefer continued contact, they may provide for that in the contract. Even if they prefer anonymity, however, it remains theoretically possible that in the future, some children may be able to identify their donor(s) using DNA databanks and/or registries (e.g., if the donor submits her DNA to a genealogy site and a child born from her donation later submits its DNA to the same site).
Multiple birth is a common complication. Incidence of twin births is very high. At the present time, the American Society for Reproductive Medicine recommends that no more than 1 or 2 embryos be transferred in any given cycle. Remaining embryos are frozen, whether for future transfers if the first one fails, for siblings, or for eventual embryo donation.
There appears to be a slightly higher risk of pregnancy-induced hypertension in pregnancies of egg donation.
In countries that prohibit compensation there is an extreme dearth of young women willing to go through this procedure. Additionally, in most countries where it is legal and compensated, the law places a cap on the compensation and that cap tends to be in the vicinity of $1000–$2000. In the US, no law caps the compensation, but the American Society for Reproductive Medicine requires member clinics to abide by their standards, which provide that "sums of $5,000 or more require justification and sums above $10,000 are not appropriate." The "justification" for payments over $5000 may include previous successful donations, unusually good family health history, or membership in minority ethnicities for which it is more difficult to find donors.
As a result of these legal and financial differences around the world, egg donation in the US is much more expensive than it is in other countries. For instance, at one top US clinic it costs more than $26,000 plus the donor's medications (another several thousand dollars).
Having an attorney draft a contract is recommended in order to ensure that the donor has no possible legal rights or responsibilities over the child or any frozen embryos. Hiring an attorney who specializes in reproductive law is thus strongly recommended, at least in the United States; other countries may have other procedures for clarifying the parties' rights, or may simply have legislation that defines the parties' rights. In the US, before the egg donor's IVF cycle begins she typically must sign the Egg Donor Contract, which specifies the rights of the donor and the recipient(s) with respect to the retrieved eggs, the embryos, and any children conceived from the donation. Such contracts should specify that the recipients are the legal parents of the child and the legal owners of any eggs or embryos resulting from the cycle; in other words, while the donor has the right to cancel the cycle at any time prior to egg donation (although if she does so the contract generally provides that she will not be paid), once the eggs are retrieved they belong to the recipient(s). In individual cases the donors and parents may also wish to negotiate terms relating to any unused embryos (e.g., some donors would prefer that unused embryos be destroyed or donated to science, while others would prefer or allow them to be donated to another infertile couple). Some states have also adopted the Uniform Parentage Act, which provides that the recipient or recipients have complete parental responsibility of the conceived child.
In Buzzanca v. Buzzanca, 72 Cal. Rptr.2d 280 (Cal. Ct. App. 1998), the court held that both the recipient and the father of a child conceived through anonymous sperm and egg donation and carried by a surrogate were the legal parents of the child by virtue of their procreative intent. Therefore, the father was required to pay child support even though he sought a divorce before the child was born.
Some donors are non-anonymous, but most are anonymous, i.e. the donor conceived person does not know the true identity of the donor. Still, they may get the donor number from the fertility clinic. If that donor had donated before, then other donor conceived people with the same donor number are thus genetic half-siblings. In short, donor registries match people who type in the same donor number.
Alternatively, if the donor number is not available, then known donor characteristics, e.g. hair, eye and skin color may be used in matching.
Donors may also register, and therefore, donor registries may also match donors with their genetic children.
The largest registry is the Donor Sibling Registry- with more than 25,000 members, the DSR has matched almost 7,000 donor conceived people with their egg and sperm donors, as well as with their half siblings. Alternate methods of providing an information link between the donor and recipient (both agreeing to stay registered on the DSR) are often provided for in the legal document (referred to as the "Egg Donor Agreement".)
Quality of parent-child attachment in early infancy has been recognized as a crucial factor of a child's socioemotional development. The formation of a quality and secure attachment is largely influenced by parental representations of the parent-child relationship. Concern regarding relationship quality and attachment security in egg donor families is understandable and typically stems from the absence of genetic material shared between the mother and child. However, it has been discovered that the mother's endometrium can generate epigenetic changes in the embryo. Therefore, the embryo from an oocyte donation will have something from the mother who has received the donated oocyte. Specifically, embryos can uptake miRNAs from exosomes secreted by endometrium, so, Hsa-miR-30d secreted by the human endometrium, is taken up by the pre-implantation embryo and might modify its transcriptome. In recent years, researchers have begun to question if lack of genetic commonality between mother and child inhibits the ability to form a quality attachment.
In a recent study, quality of infant-parent relationships was examined among egg donor families in comparison to in vitro fertilization families. Infants were between the ages of 6–18 months. Through use of the Parent Development Interview (PDI) and observational assessment, the study found few differences between family types on the representational level, yet significant differences between family types on the observational level. Egg donation mothers were less sensitive and structuring than IVF mothers, and egg donation infants were less emotionally responsive, and involving than IVF infants. No differences were found in relationship quality between egg donor fathers and IVF fathers representationally or observationally. Due to the developmental implications of forming healthy parent-child relationships in early infancy, the finding that egg donor mothers were less sensitive and structuring towards their infants raises concern about attachment styles among egg donor families, and the impacts it may have on infants' future socioemotional development.
Telling the children that they were donor conceived is recommended, based on decades of experience with adoption (and more recent feedback from donor-conceived children) showing that not telling children is harmful to the parent-child relationship and to the child psychologically. Even parents who would normally be extremely reluctant to tell the child should consider telling if any of the following scenarios applies:
Conversely, when the child is being raised in a religion or a culture that strongly disapproves of donor conception (e.g., a Catholic country where egg donation is illegal), that may counsel against telling the child, at least until the child is much older and clearly capable of understanding why they were not told earlier and of keeping that information to themself.
A systematic review of factors contributing to parental decision-making in disclosing donor conception has shown that parents cite the child's best interest as the main factor they use to make the decision. Parents who disclose donor conception to the child emphasize the importance of an honest parent-child relationship, while parents who do not disclose express their desire to protect the child from social stigma or other trauma. Health care staff and support groups have been demonstrated to affect the decision to disclose the procedure. It is generally recommended that parents who disclose should do so in age-appropriate ways, ideally starting well before the age of five with a discussion of the fact that their parents needed help to have a child because certain things are needed to make a child—namely, sperm and eggs—and because the parents did not have one of those things, a nice woman gave it to them.
Donor profiles presented on agency websites are their primary marketing tool to find recipients and learn what these future consumers want. On the donor profiles listed on the agency website for recipients, or "clients", to peruse for their desired egg match, "physical characteristics, family health history, educational attainment (in some cases, standardized test scores, GPA, and IQ scores are requested), as well as open-ended questions about hobbies, likes and dislikes, and motivations for donating" are included. Donors are encouraged to submit attractive photos and are advised of what the recipient finds as desirable. Profiles that are at some point deemed unacceptable are deleted, whether it be because their personalities did not stand out or their portrayals were viewed as negative in some way. Overweight volunteers for donation are also most often not accepted, not just because of conventional views on physical attractiveness but also because women with a higher body-mass index tend to respond differently (less well) to ovarian stimulation drugs and IVF clinics thus generally recommend that patients not use donors with higher BMIs. Egg donors also have a higher standard of physical appearance than sperm donors; many sperm donors are not required to provide adult photographs of themselves, or in some cases, any photographs.
There are also some Christian leaders (especially Catholic) who are concerned about all in vitro fertility therapies because they disrupt the natural act of conceiving a child where gamete donations, both egg and , are seen to "compromise the marital bond and family integrity". and they encourage infertile couples to consider adoption instead.
In the Orthodox Jewish community there is no consensus as to whether an egg donor needs to be Jewish in order for the child to be considered Jewish from birth. In the 1990s religious authorities said that if the birth mother was Jewish that the child would be Jewish as well, but in the past few years rabbis in Israel have begun to reconsider, which in turn is causing more debate around the world. Conservative Rabbi Elliot Dorff has suggested that there are arguments for both sides (birth mother or genetic mother) in religious scripture. Dean of the Center for the Jewish Future at Yeshiva University believes that any child where the birth mother or the genetic mother isn't Jewish should go through a conversion process in infancy, to be sure that their Judaism isn't questioned later in life. This is not an issue in the reform community for two reasons. First, only one parent must be Jewish for the child to be considered Jewish; thus, if the father is Jewish, the mother's religion is irrelevant. Second, if the mother who carries the pregnancy and gives birth is Jewish, reform Jews will generally consider that child to be Jewish from birth because it was born of a Jewish mother.
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