TASC Legal Support Document*

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CONSENT FOR EGG DONATION

WHEREAS, _______________ (Wife/Recipient) and ________________ (Husband/Father) desire to conceive a child by receiving an egg or eggs from ____________ (Donor), through the services of _______________, ______________, M.D., or associates involved in this program (Infertility Clinic), this Agreement, based on the consideration of the mutual promises here contained, the sufficiency of which is hereby acknowledged, is made in order to fully protect the interests of the doctors involved, the Husband/Father and Wife/Recipient receiving the eggs, the woman donating her eggs (Donor), as well as Donor's Husband, ______________, the facility where the eggs are obtained and embryos replaced, and also any child produced as a result; as well as clarifying rights and responsibilities; and

WHEREAS, the purpose of this procedure here contemplated is to remove an egg or eggs from Donor, fertilize the egg or eggs with the sperm of Husband/Father, place the fertilized zygote/embryo/potential human child into the uterus of Wife/Recipient with the hope and expectation that Wife/Recipient will carry the potential child to term and give birth; and

1. WHEREAS, the events and acts contemplated under this Agreement may be novel and unconventional and that certain genetic assumptions and presumptions of law are not necessarily appropriate in this matter, including, but not limited to:

(a) That the woman (Donor) who provides the egg or eggs as genetic material for the potential human child may be considered the "mother," as the parties to this Agreement desire, and the parties here specifically agree, that the Wife/Recipient shall be considered the mother of the potential child for any and all purposes under the law;

(b) That Donor's Husband may be considered under any statement of fact or presumption of law to be the "father" of the potential human child, as the parties to this Agreement specifically agree that Husband/Father shall be considered the sole father of the potential human child under any and all circumstances;

(c) That the Egg Donor as provider of the female genetic material for the potential child has any ownership or privacy rights or expectations whatsoever in her egg or eggs once they are removed from her body, as the parties to this Agreement specifically agree that Wife/Recipient shall be considered the pregnant woman for any and all purposes under constitutional, statutory, regulatory, or case law, including, but not limited to, privacy expectations and rights as to any decisions to be made concerning, but not limited to, prenatal care and to carrying the child to term;

(d) That the Donor and/or Donor's Husband have any support obligation or parental rights whatsoever in or to the potential human child, as the parties to this Agreement agree and stipulate that the sole parental rights and support obligations to the potential child shall be restricted to Husband/Father and Wife/Recipient; that neither Donor, nor Donor's Husband, will in any way or manner expect to, nor will, attempt to form a parental relationship with any child or children born as a result of these procedures; and

(e) That Husband/Father and Wife/Recipient will be considered the sole parents of the potential child upon its birth, they shall have the sole rights to name any such child or children, and they shall be so listed as parents on any birth certificate or other vital document or record issued by the State of _________ upon the birth of the child. Donor and Donor's Husband agree that they have no parental rights or obligations to the potential child and will cooperate, if necessary, in assuring that all governmental records reflect that Wife/Recipient and Husband/Father are the sole parents of the potential child, even if it requires any legal procedures (the cost of which will be borne by Wife/Recipient and her Husband/Father).

Furthermore, Donor and Donor's Husband agree to cooperate in all ways necessary to assure that Wife/Recipient and Husband/Father are deemed to be the sole parents of the potential child, including, but not limited to, providing of affidavits, signing documents, consents, surrenders, relinquishments, and terminations and participating in legal proceedings, including adoption proceedings, if necessary, to so establish these facts and relationships, including the listing of Husband/Father and Wife/Recipient as parents on any birth certificates of the child or children to be born. Wife/Recipient and Husband/Father agree that they shall bear the reasonable expenses, including attorney's fees, to effectuate these above listed obligations of Donor and Donor's Husband in the event that such additional actions or proceedings are necessary.

2. (a) Donor's Husband specifically stipulates and agrees that the egg or eggs to be removed from his wife (Donor) are unfertilized, that he has not provided any genetic material to the egg or eggs, and that Donor's Husband is not to be considered the father of the potential child for any purpose whatsoever;

(b) Donor and Donor's Husband stipulate and agree that they shall not form any parent/child relationship whatsoever with the potential child, as they relinquish any and all rights, conceivable rights, or potential rights which they could possibly claim to or in the potential child, and if necessary, they will sign additional formal relinquishments and termination of any potential parental rights in the future, if such actions are necessitated;

(c) Wife/Recipient and Husband/Father agree to bear the psychological evaluation and medical costs of egg removal from Donor, to the extent that these expenses are not covered by available medical insurance. Wife/Recipient and Husband/Father agree to be primarily, rather than secondarily liable for such expenses not covered by medical insurance.

(d) Wife/Recipient and Husband/Father stipulate that they have been informed there is some risk in this procedure of the transmittal of venereal diseases, including, but not limited to Acquired Immune Deficiency Syndrome. Donor here stipulates that she has undergone blood testing to determine whether she is infected with these diseases which could potentially be transmitted to Wife/Recipient, and ultimately to Husband/Father. Donor's test results have been made available to Wife/Recipient and Husband/Father, who have been informed of the results and have opted to proceed with the egg donation procedure, its fertilization, and placement in Wife/Recipient. Husband/Father and Wife/Recipient understand that there are certain risks of disease transmittal, yet have weighed the probabilities and have opted to proceed with these procedures. Husband/Father and Wife/Recipient hereby waive any claim or potential claim they might have against Donor for disease transmission. Wife/Recipient and Husband/Father agree to take full and complete responsibility for any child or children to be born pursuant to this Agreement regardless of whether the child is healthy, ill, handicapped, retarded, or otherwise adversely affected and regardless of whether more than one child is born.

(e) Donor and Donor's Husband acknowledge that at least some of the donated egg(s) may be fertilized and stored through a process known as cryopreservation of the fertilized embryos. As such, while Donor and Donor's Husband have agreed that they have no rights whatsoever to the eggs which are donated to Husband/Father and Wife/Recipient, they further acknowledge that some or all of the donated eggs shall or may be preserved, not in their original state, but in a fertilized state with the donated sperm of Husband/Father.

Accordingly, Donor and Donor's Husband acknowledge and agree that they have no claims whatsoever to any preserved embryos and they will not assert for any reason, now or in the future, any claim to any of the embryos, even if for some reason in the future, Donor and Donor's Husband are rendered infertile or incapable of conceiving children. Specifically, Donor and Donor's Husband waive any potential right or claim they might have to retrieve any of the donated eggs and/or genetic material.

(f) In the event there are any frozen embryos which are not immediately placed in the uterus of the Wife/Recipient, these embryos shall be frozen under the process of cryopreservation under separate contract with Infertility Clinic, and shall be retained for as long as possible for use by Wife/Recipient and Husband/Father. Such use would include (but would not require) bringing a viable child to term through use of a surrogate, in the event Wife/Recipient could not bring a child to term successfully through embryo implantation in Wife/Recipient.

In the event of the death of Wife/Recipient and Husband/Father, it is agreed by Wife/Recipient and Husband/Father that any frozen fertilized embryos being stored by Infertility Clinic in the process of cryopreservation shall be governed by and in accordance with the directives established by Wife/Recipient and Husband/Father under their last will and testament, or, if they have failed to do so, under contract or agreement with Infertility Clinic. If Wife/Recipient and Husband/Father have failed to provide any direction as to the disposal or preservation of the frozen embryos or if the proposed designated recipient fails to accept or is unable to accept the frozen embryos, then Wife/Recipient and Husband/Father hereby allow the destruction of the frozen embryos, but do not allow use of the frozen embryos for medical, scientific, or experimentation purposes.

3. Purpose of Treatment:

Donor agrees that the main objective of this treatment is to allow Wife/Recipient to carry and deliver a child that she could not otherwise conceive. This allows her the experience of pregnancy, childbirth, and motherhood by a treatment known as oocyte donation.

Donor understands that the child(ren) conceived by this method will have her genetic material and that of Husband/Father. Donor understands that she waives any right and relinquishes any claim to the donated eggs or any pregnancy or offspring that might result from them. Donor agrees that Wife/Recipient may regard the donated eggs and any offspring resulting therefrom as her own child(ren). Donor waives any rights to decision-making regarding the use of the donated eggs once given to the recipient couple, including the decision-making with respect to pregnancy termination, selective reduction and/or disposition of any of the donated eggs, fertilized embryos, or potential human children.

Now, therefore: It is agreed by the above named Husband/Father and Wife/Recipient, and by Donor and Donor's Husband that the doctors will obtain one or more eggs from Donor due to Donor's desire to donate eggs on a completely compassionate basis.

Donor neither expects, nor has been promised, nor has received, any compensation or remuneration whatsoever for any of the actions, procedures, or donations for which Donor has agreed under the terms of this document. Donor does not consider her egg(s) donation to be in any way "baby selling," nor "parting with a child," nor does Donor consider herself to be parting with a potential child. Husband/Father and Wife/Recipient have agreed to bear the expenses of medical procedures, in the event the medical procedures are not covered by a policy of insurance or reimbursement and shall become primarily and exclusively liable for these expenses, and shall execute agreements with the provider of these services to so effectuate this provision. This constitutes the full extent of any financial obligation of Husband/Father and Wife/Recipient to or on Donor's behalf.

(a) Procedures Likely to be Followed:

The following is a likely course of medical treatment for Donor, the risks of which Donor assumes, and for which hereby releases Husband/Father and Wife/Recipient from any liability associated with such risks:

Injections of ovulation stimulating agents including, Pergonal (human menopausal gonadotropin), and Metrodin (follicle stimulating hormone) will be used to stimulate multiple egg production. Lupron, a GNRH agonist will be used in conjunction with these drugs to down regulate ovarian function. Human chorionic gonadotropin (HCG) is used to trigger ovulation, to assist in the maturation process of the eggs prior to egg retrieval. Donor will have blood samples collected and ovarian ultrasound examinations, a standard technique in which high frequency sound waves are used to form an image. The purpose of these tests is to identify the time at which the eggs are suitable for recovery. Surgery is scheduled near the time of projected ovulation.

Eggs are collected by the means of vaginal ultrasound guided aspiration of ovarian follicles. This involves the introduction of a specially designed needle through the vaginal wall under local anesthesia and intravenous sedation.

All of the eggs will be inseminated with the sperm from the Husband/Father. After approximately 27 to 50 hours, if fertilization takes place, the resulting zygote(s) or early embryo(s) will be either placed into the uterus of Wife/Recipient, or cryopreserved for her future attempts at pregnancy, or both.

(b) Reasons for Possible Failure:

(i) The time of ovulation may be misjudged or may be unpredictable, or ovulation may not occur at all in the monitored cycle, thus precluding any attempt at obtaining an oocyte.

(ii) An attempt at oocyte retrieval may be unsuccessful.

(iii) The egg(s), if obtained, may not be normal.

(iv) There may be other reasons.

(c) Discomforts and Risks:

The following are some of the risks and discomforts associated with the various procedures.

Note: Complications of some of the problems listed below may lead to serious permanent disability or death.

The Risks Include:

(i) Blood drawing: Mild discomfort and the possibility of developing a painful bruise at the needle site may occur. A blood clot in the vein may occur.

(ii) Ultrasound: This examination involves the use of a form of energy (sound waves) which at high energy levels may produce heat and tissue damage. At the extremely low energy levels utilized in diagnostic ultrasound no adverse effects have been observed to date.

(iii) Medications: The risks associated with taking hormones to stimulate multiple egg production are probably much less common than the known risks of pregnancy. Women may experience none to all of the following symptoms; nausea, vomiting, slight weight gain or loss, breast tenderness and enlargement, occasional vaginal bleeding, yeast infections of the vagina, vaginal discharge and wetness, menstrual period cramping, headaches and fluid retention. Much less common side effects include appetite changes, nervousness and fatigue, changes in sex drive. More serious but rare side effects include hypertension (high blood pressure), gallbladder disease, blood clots developing in the legs, lungs, eyes, brain, heart or elsewhere, heart attacks, and strokes.

Ovarian over-stimulation: Ovarian cysts may develop, causing pain, internal bleeding, and severe disturbances of fluid and chemical balances. This may require hospitalization.

(iv) Aspiration of oocytes under ultrasonographic guidance: Pain of short duration is likely. There is a possibility of seeing blood in the urine for a day following the procedure. Perforation of blood vessels, bladder, bowel, bleeding from the ovary, and pelvic infection are possible.

(v) Anesthesia (General, Local, or IV Sedation): Numerous possible untoward reactions from various drugs and procedures used in anesthesia may result.

(vi) Certain aspects of the ethics of this treatment are controversial. Some members of the community, including my own family or friends, may not approve of this treatment. This disapproval may damage interpersonal relations between me and my family and/or friends.

(vii) There may be unknown, untoward medical events that may occur as the procedure becomes widespread in the future.

(viii) Risk to Potential Children: There are theoretical risks of the procedure which could potentially damage the embryo, with resultant later defects in the child. It is not known if the risk with this procedure (egg donation) is higher or lower than the risks associated with children conceived naturally. The risk in normal, spontaneous pregnancies is 2% to 3% of all cases. Experience with egg donation in humans to date, and in other mammals suggests that the risk may be no more than in natural pregnancies.

Donor and Donor's Husband acknowledge that they have had an opportunity to discuss the proposed course of treatment and any possible revisions or modifications to it with the physicians and medical services providers (Infertility Clinic), and comprehend the risks and complications, yet voluntarily and knowingly proceed with proposed procedures.

Donor is fully aware that little information exists concerning the true incidence of the above risks, both as they relate to hormone replacement and pregnancy. Donor accepts that the doctors believe that the likelihood of the above complications increased as a result of these procedures. Donor accepts these risks.

4. Wife/Recipient and Husband/Father realize, as the legal parents of the child or children to be born pursuant to this Agreement, that there are certain genetic conditions which contraindicate the conception of children. Furthermore, Donor realizes that as the provider of the egg(s)/ovum(ova) to be used in conception of the fertilized zygote/embryo/potential human child, that a full examination of the genetic history both of Husband/Father and Donor is in order. Donor and Husband/Father, therefore, state and affirm, that to the best of our knowledge, they do not possess, nor does anyone in their respective families possess, defects or diseases, genetic in nature, of the following type:

(i) TAY-SACHS DISEASE: A disease primarily found in Jewish East Europeans, which is characterized by a failure to thrive, hypertoxicity, progressive spastic paralysis, loss of vision and occurrence of blindness, usually with muscular degeneration and optic atrophy, convulsions and mental deterioration.

(ii) SICKLE-CELL ANEMIA: It affects 7-9% of the U.S. black population. Homozygous carriers of the sickle-cell gene are characterized by the presence of a crescent-shaped or sickle-shaped erythrocytes and peripheral blood symptoms including those of leg ulcers, arthritic manifestations and acute attacks of pain.

(iii) NEUROFIBROMATOSIS: A familial condition, characterized by developmental changes in the nervous system, muscles, bone and skin and marked superficially by the formation of multiple pedunculated soft tumors (neurofibromatosis) distributed over the entire body associated with areas of pigmentation.

(iv) DOWN'S SYNDROME: Frequently known as mongolism and trisomy 21 syndrome, it is a syndrome of mental retardation associated with a variable constellation of abnormalities caused by representation of at least a critical portion of chromosome 21, three times instead of twice, in some or all cells; the abnormalities include retarded growth, hypoplastic face with short nose, prominent epicanthic skin folds, protruding lower lip, small rounded ears with prominent antihelix, fissured and thickened tongue, laxness of joint ligaments, pelvic dysplasia, broad hands and feet, stubby fingers, dry, rough skin in older patients, and abundant, slack neck skin in newborns;

(v) POLYCYSTIC KIDNEY DISEASE: Characterized by numerous cysts of varying sizes, scattered diffusely throughout the kidneys, sometimes resulting in organs that tend to resemble grape-like clusters of cysts. This disease is congenital and may be transmitted by either parent, and probably represents the result of a dominant gene.

The parties acknowledge that any and all children born as a result of this egg donation Agreement shall be solely and exclusively comprised of the genetic contributions of Donor and Husband/Father. The parties further acknowledge that the child(ren) born as a result of this Agreement shall have health and developmental implications based on its (their) genetic constituency. As a consequence, it is in the potential child(ren)'s best interests to have provided medical and developmental histories which are as complete as possible of Donor and her genetic relatives, in order to assist the potential child(ren)'s physicians in rendering medical care. Donor provides such information by virtue of her completion of attached Exhibit "A."

(a) Wife/Recipient and Husband/Father acknowledge that they desire Wife/Recipient become pregnant pursuant to the procedures to be implemented under this Agreement. Wife/Recipient and Husband/Father acknowledge and hereby accept that they shall bear all risks of the pregnancy which shall presumably ensue as a result of the procedures to be implemented under the auspices of this Agreement. All parties to this Agreement concur that neither Donor nor Donor's Husband bear any risk or responsibility for the pregnancy which shall hopefully ensue as a result of the procedures to be implemented pursuant to this Agreement.

For the benefit of Wife/Recipient and Husband/Father, the following risks of pregnancy shall be set forth in order to assure that Wife/Recipient and Husband/Father are making an informed and intelligent decision concerning the pregnancy.

Pregnancy is by no means a condition to be taken lightly. It is not without risks both from conditions caused by the pregnancy itself as well as from its effects on other non pregnancy related diseases and conditions. All known disease processes can affect the course of pregnancy and should be taken into account.

MATERNAL MORTALITY Definition of Direct Maternal Death:

"Death of the mother resulting from obstetric complications of the pregnancy state, labor, or puerperium, and from interventions, omissions, incorrect treatment, or events resulting from any of the above is considered a direct maternal death."

Maternal deaths per 100,000 live births have decreased remarkably in the past quarter century. In 1959, the maternal mortality rate was 83.3, or one per 1,200 live births; in 1960, 37.1; in 1970, 21.5; and in 1974, 20.8, or one in 4,800 births. There were only 462 direct maternal deaths reported in 1974, or one in 6,900 births. (Taken from Willims Obstetrics, edited by Pritchard & MacDonald).

For a complete accounting of the complications of pregnancy or the effects pregnancy may have on a given disease state, it is important that you discuss this matter with your own independent obstetrician. In the following paragraphs is a partial list of some of the diseases commonly seen during pregnancy, commonly complicating pregnancy, or caused by the pregnancy state. It is by no means complete, as all known disease states can be seen during pregnancy. If Wife/Recipient and Husband/Father have any doubts about these states or how they may relate to them, it is their responsibility to consult with their own independent obstetrician.

(i) BACTERIAL INFECTIONS; Scarlet fever, erysipelas and typhoid.

(ii) CARDIAC SYSTEM: Rheumatic heart disease, congenital heart disease, hypertensive heart disease, coarctation of the aorta, coronary thrombosis and ischemic heart disease, postpartum heart disease, kyphoscoliotic heart disease and bacterial endocarditis.

(iii) COLLAGEN DISEASES: Systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, scleroderma, polyarteritis nodosa, Marfan's Syndrome and rheumatic fever.

(iv) DISEASES OF THE NERVOUS SYSTEM: Carcinoma of the breast, diaphragmatic hernia, rupture of the spleen, otosclerosis, retinitis gestationis and separation of the symphysis pubis.

(v) DISEASE OF THE SKIN: Herpes gestationis, melanoma, pruritus, and abnormalities of pigmentation.

(vi) ENDOCRINE SYSTEM: Diabetes mellitus, diabetes insipidus, adrenal hypofunction, Cushing's Syndrome, Addison's disease, primary aldes terenism, acromegaly, pheochromocytoma, porphyria, hyperthyroidism, hypothyroidism, hyperpara-thyroidism, hypoparathyroidism and obesity.

(vii) HEMATOLOGIC: Anemia from blood loss, inadequate intake of iron, folic acid and other blood precursors, hemolysis, hemoglobin C trait, B thalassemia, A thalassemia, polycythemia, thrombocytopenia purpura, thrombotic thrombocytopenic purpura, Von Willebrand's disease, hemophilia A & B, leukemia and Hodgkin's disease.

(viii) LIVER AND ALIMENTARY: Viral hepatitis A & B & C, cirrhosis of the liver, acute yellow atrophy of the liver, obstetric hepatosis, cholelithiasis, cholecystitis, hyperemesis, gravidarum, appendicitis, peptic ulcer, pancreatitis, intestinal obstruction, carcinoma of the bowel, ulcerative colitis, regional enteritis and gingivitis.

(ix) OBSTETRIC DISORDERS: Obstetric hemorrhage, acquired coagulation defects, placental abruption, placenta previa, amniotic fluid embolism, hemorrhage with abortion, ectopic pregnancy (tubal, abdominal, ovarian and cervical), hydatidiform mole, choriocarcinoma invasive mole, tumors of the placenta, diseases of the amnion and amniotic fluid, varices, inflammation of Bartholin's glands, condylomas, relaxation of the vaginal outlet, vaginal tumors (Gartus or mollerian), cervicitis, carcinoma of the cervix, sacculation of the uterus, acute edema of the cervix, hyperthropy of the cervix, salpingitis and tubo ovarian abscess, ovarian and uterine tumors, endometriosis, preeclampsia eclampsia, chronic hypertension, uterine dystocia, cephalopelvic disproportion, traumatic injuries to the birth canal, uterine rupture, genital tract fistulas from parturition, postpartum hemorrhage, retention of the placenta, placenta accreta, inversion of the uterus, puerperal infection superficial thrombophlebitis, deep inversion of the uterus, puerperal infection, superficial thrombophlebitis, deep venous thrombosis, pelvic thrombophlebitis, ante partum thrombophlebitis, pulmonary embolism, subinvolution of the uterus, postpartum cervical crosions, prolapse of the uterus, puerperal hematomas, urinary incontinence, engorgement of the breasts, mastitis, galactocele, enlargement of super numerary breasts, complete hysterectomy and cesarean section.

(x) PROTOZOAL, PARASITIC AND FUNGAL INFECTIONS: Toxoplasmosis, malaria amebiasis and coccidioidomycosis.

(xi) RESPIRATORY SYSTEM: Pneumonia, thromboembolism and pulmonary infection, asthma, tuberculosis and sarcoidosis.

(xii) URINARY SYSTEM: Cystitis, pyelonephritis (acute & chronic), renal insufficiency, urinary calculi, acute and chronic glomerulonephritis, nephrosis, polycystic disease of the kidney, acute tubular necrosis, cortical necrosis and postpartum acute renal failure.

(xiii) VENEREAL DISEASES: Syphilis, gonorrhea, granuloma inguinale, herpes, lymphosathia venereum and chancroid.

(xiv) VIRAL INFECTIONS: Rubella (German measles), cytomegalovirus disease, herpes virus Hominis infections type 1 & 2, varieella, coxsackievirus disease, mumps, measles (rubeola), influenza, common cold and poliomyelitis.

(xv) RISKS OF USE OF NON-FROZEN EGGS: Use of fresh donated eggs may increase the possibility of transmission of HIV/AIDS to Wife/Recipient, as there is a latency period of detection in the event the PCR method of detection and analysis is not utilized.

5. The cost of the entire operative procedure and all procedures involved in preoperative ovarian stimulation and monitoring will be covered by the Wife/Recipient and Husband/Father.

6. No payment for expenses is expected from Infertility Clinic or the doctors or associates involved in the program.

7. Donor has been assured all information about her obtained during treatment will be handled confidentially and neither her identity nor specific medical details may be revealed by her doctor without her consent. Specific medical details may be revealed in professional publications or forms as long as Donor's identity is withheld. Photographs taken during various procedures may be used professionally, as long as Donor's identity is withheld.

8. The parties to this Agreement acknowledge that they have employed no adoption agency or other child "placement" agency or similar organization and that no individuals are entitled to any compensation whatsoever, nor to any reimbursement, except for referenced medical charges. In no way have either Donor, nor Donor's Husband, parted with a child or children.

9. Donor and Donor's Husband have had the opportunity to have this document reviewed by an attorney of their own choosing, and if they have opted not to have the agreement reviewed by an independent attorney prior to their signing it, Donor and Donor's Husband realize that this is a knowing and conscious waiver of any rights that Donor and Donor's Husband might have to independent counsel in reviewing this document.

The lawyers of the firm of _____________ have been retained solely to give Husband/Father and Wife/Recipient legal advice in connection with this procedure and to prepare such documents as are necessary to facilitate this matter. None of the lawyers of the firm of _________________ represent either Donor or Donor's Husband.

10. Husband/Father and Wife/Recipient agree that the child(ren) so produced are legitimate child(ren) of the marriage of Husband/Father and Wife/Recipient and are their heirs, considered in all respects, including descent of property; and that Husband/Father and Wife/Recipient completely waive forever any attempt to disclaim such child(ren).

The undersigned have read this form and understand it fully. They understand that some of the language in this consent form may be technical. They have been given an opportunity to ask any questions they may have. All questions and inquiries have been answered to their satisfaction. Donor has been informed that she may contact the office of Infertility Clinic regarding further questions about this treatment and her rights as a patient. Donor is 18 years of age or older.

11. This Agreement shall be construed under the laws of the state of __________.

The parties to this Agreement acknowledge that there are novel aspects to this procedure in terms of medical techniques and procedures, as well as legal issues. Essentially, medical technology has outstripped the traditional legal framework on family law issues, and the Courts and legislatures have not yet fully responded to new family arrangements including the egg donation procedure, fertilization, and implantation of embryos.

As a result, the parties to this Agreement acknowledge that they are engaging in practices and endeavors which have not been fully tested, nor explored by either the Legislature of the State of _________, nor by the courts in _________, as __________ is the state where this Agreement shall be performed.

Accordingly, the parties to this Agreement acknowledge that there are risks both as to the procedures and in the determination of the legal rights and responsibilities of the respective parties to this Agreement. The parties to this Agreement realize that there may not have been a legal test of an agreement such as they are now executing, and the parties to this Agreement acknowledge that the Courts of The State of ___________ have most probably not issued definitive rulings or guidelines concerning arrangements such as the present one embodied by this Agreement.

As a result, the parties to this Agreement concur that they are willing to undergo both the medical and legal risks associated with this procedure.

12. While the parties to this Agreement are aware of the actions and procedures contemplated under this Agreement, in no way may Donor, nor Donor's Husband, be considered to have "consented" to any potential interpretation that what is contemplated under this Agreement constitutes "artificial insemination." Accordingly, neither Donor, nor Donor's Husband, "consent" as that term is utilized under O.C.G.A. ß 19-7-21 to any "artificial insemination," as neither Donor, nor Donor's Husband, consider the potential child or children to be born to Husband/Father and Wife/Recipient under this procedure to be the legitimate offspring of Donor and/or Donor's Husband.

13. The parties to this Agreement concur that all presumptions, obligations, waivers, renunciations, responsibilities, and actions to be undertaken are in the best interests of the child or children to be born pursuant to this Agreement.

14. (a) This shall constitute the sole and entire agreement between the parties, is binding on the parties, their heirs, administrators, and personal representatives, and no representations or promises not contained herein shall be in any way binding. Revisions or amendments to this Agreement shall only be effective if they are in writing, signed by all parties to this Agreement.

(b) In the event that any of the provisions of this Agreement are deemed to be invalid or unenforceable, the same shall be deemed severable from the remainder of this Agreement and not cause the invalidity or unenforceability of the remainder of the Agreement. If such provisions are deemed invalid due to their scope and breadth, the provisions shall be deemed valid to the extent of the scope or breadth permitted by law.

(c) The parties to this Agreement acknowledge that their remedies at law are inadequate and that specific performance and other equitable relief and remedies are specifically contemplated and so agreed to.

(d) This Agreement may be executed in multiple counterparts, each of which shall be an original, but all of which shall constitute one and the same agreement.

15. (a) Donor agrees, agrees to adhere to all medical instructions given to her, including abstention from sexual intercourse as directed by the Infertility Clinic, agrees to follow a transfer and prenatal medical examination schedule set by the Infertility Clinic, and except in an emergency, agrees to adhere to all medical instructions given to her by the Infertility Clinic, her obstetrician and any consulting physician, selected by the Infertility Clinic or the obstetrician. In the event that any such instructions are inconsistent, Donor, Husband/Father and Wife/Recipient and such physicians shall confer to determine how to proceed.

(b) Donor agrees that Husband/Father and Wife/Recipient shall be entitled to direct communication with the Infertility Clinic, with Donor's obstetrician and with any other physician Donor may consult, and she hereby authorizes each such physician to release to Husband/Father and Wife/Recipient all information concerning the health of Donor. Donor warrants that all information that Donor has provided to Husband/Father, Wife/Recipient, Infertility Clinic, and Donor's obstetrician is true and correct, and that all representations contained in Exhibit A to this Agreement are true and correct, and that all parties to this Agreement are relying upon Donor’s statements and representations.

(c) Donor further agrees, during the course of treatment contemplated by this Agreement, not to smoke tobacco products, drink alcoholic beverages, use illegal drugs or, without the prior written consent of the Infertility Clinic, or obstetrician, use any nonprescription or prescribed medications, other than Tylenol, except in an emergency.

(d) Donor, Husband/Father and Wife/Recipient, agree that they neither will, with respect to the events surrounding or contemplated by this Agreement, do any of the following without prior written consent of the other: write about or otherwise describe, discuss, or confirm such events with a view to publication or other dissemination to the media of any account of them, documentary, fictional or otherwise. This provision shall survive any termination of this Agreement.

_______________________________ _____________________________

, WIFE/RECIPIENT Date

_______________________________

WITNESS

_______________________________ _____________________________

, HUSBAND/FATHER Date

_______________________________

WITNESS

_______________________________ _____________________________

PHYSICIAN, INFERTILITY CLINIC Date

BY:____________________________

_______________________________

WITNESS

_______________________________ _____________________________

, DONOR Date

_______________________________

WITNESS

_______________________________ _____________________________

, DONOR'S HUSBAND Date

_______________________________

WITNESS

Exhibit "A"

BACKGROUND INFORMATION ON EGG DONOR

NOTE: ALL RELATIONSHIPS ARE TO THE EGG DONOR

EGG DONOR'S AUNTS & UNCLES

SOURCE OF INFORMATION:______________________________________________________________

Egg Donor's Sibling

SOURCE OF INFORMATION:______________________________________________________________

EGG DONOR'S GRANDPARENTS

GREAT AUNTS & UNCLES

Maternal Paternal

SOURCE OF INFORMATION:______________________________________________________________

EGG DONOR'S FAMILY HISTORY

Check YES or NO to each of the following diseases or conditions. If the answer is YES, please indicate on the last page of this form the following: number and corresponding letter of condition, the family member, and brief description of the disease/condition, its effect, age of onset, age if cause of death.

Biological mother's age at onset of menses: _________________

Code number and letter when describing disease/condition (Attach additional page if needed)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SOURCE OF INFORMATION:_________________________________________________________________

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PROTOTYPE EGG DONATION CONTRACT
WITH COMMENTARY

ABOUT THE AUTHOR

Mark A. Johnson conducts an active surrogacy and reproductive law practice in the metro-Atlanta, Georgia area. He represented the parents in the first gestational surrogacy in the state of Georgia, as well as the parents in the first artificial insemination surrogacy in the state. He continues to represent a majority of the third party assisted reproductive technology (A.R.T.) and surrogacy arrangements in the state of Georgia, including drafting and analysis of egg donation, embryo donation, surrogacy, and cryopreservation contracts, as well as representation in required court proceedings in the metropolitan Atlanta area and throughout the state.

The author is a Phi Beta Kappa graduate of the University of North Carolina (Chapel Hill), and holder of JD and MBA degrees from the University of Georgia and an LLM degree from Emory University Law School.

He has authored papers published by the American Surrogacy Center, Inc. (TASC) at www.surrogacy.com, including "Observations of Laws of Surrogacy in the U.S." (April 1996), "The Legal Status of Surrogacy in Georgia" (April 1996; updated 1998), and "Recent Court Decisions Concerning the Law of Surrogacy" (August 1996). He is cofounder of TASC.

Mr. Johnson is a frequent speaker on surrogacy and third party A.R.T. issues, most recently at seminars sponsored by Professional Development Network (a division of Medical Educations Services, Inc.) and the Family Law Institute.

He is a co-founder and Legal Advisory Board Memeber of the Academy of Assisted Reproductive Technology (A.R.T.) Professionals, Inc. a non-profit, Internet-based multi-disciplinary think tank, comprised of world-renowned doctors, lawyers, psychologists, agencies and service providers in the A.R.T. field.

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