Mothers Via Egg Donation - Frequently Asked Questions
Introduction
This information has been compiled by the members of the MVED listserv for use by other members. It is the compilation of our knowledge and experience, and is presented in the hopes that it will help others become more proactive in their own healthcare by asking the right questions and making educated decisions.
Although this information is correct to the best of our knowledge, we are not medical professionals, so please use the information as a reference only and confirm anything in question with your physician.
Updated 4/5/99 v1.2
Infertility and DE Specific Acronyms and Abbreviations
General Internet Abbreviations
The DE process. Step by step.
Insurance and DE
Selecting a Clinic
Finding an Egg Donor
Questions to Ask Egg Donors
Known Donor vs. Anonymous Donor
Giving Up a Genetic Link
How Long Does it Take To Find a Donor?
Is There an Optimal Number of Times a Young Women Should Donate Eggs?
How Do Age and Prior Pregnancy Status Affect the Choice of an Egg Donor?
Sample Egg Donor Contract
Gift for Donor?
Money-back Guarantee Programs
Shared-Cycle Programs
Cytoplasmic Transfer
Advanced Maternal Age
Tests You May Be Required To Take
Medications You and Your Donor Will Be Taking
Options for Obtaining Medications
Projesterone and DE
Methods of Easing the Pain of IM Progesterone Injections
Coasting
Methods for Increasing Thickness of Uterine Lining
Blastocyst Transfer
How Many Eggs To Expect at Retrieval
Fertilization Rates
Bedrest After Transfer?
Antiphospholipid Antibodies
RH Factor
Pregnancy Tests after DE
A Comparison of Home Pregnancy Tests
To Tell or Not To Tell?
How Do the Chances of Success Differ Between a Fresh or Frozen Transfer?
When to Cancel a Donor Egg IVF Cycle
After a Failure
When To Move On
DE In Other Countries Outside the US
Other Web Sites That Might Be Helpful
Infertility and DE Specific Acronyms and Abbreviations
ACA = Anti-cardiolipin Antibodies
ACTH = Adrenal Corticotropic Hormone
AF = Aunt Flo (menstruation)
AH, AZH = Assisted Hatching
AI = Artificial Insemination
ANA = Anti-nuclear Antibodies
APA = Anti-phospholipid Antibodies
APTT = Activated Partial Thromboplastin Time
ART = Assisted Reproductive Technology
ASA = Anti-sperm Antibody
ASRM = American Society of Reproductive Medicine
ATA = Anti-thyroid Antibody
AVA = Anti-ovarian Antibody
BBT = Basal Body Temperature
BCP = Birth Control Pills
BMS= Baby-making Sex
CAD = Carbohydrate Addict's Diet
CAH = Congenital Adrenal Hyperplasia
CASA = Computer-assisted Semen Analysis
CCCT = Clomiphene Citrate Challenge Test (Clomid Challenge)
CD = Cycle Day
CD56+ = Natural Killer Cells
CF = Cervical Fluid
CM = Cervical Mucus
CMV = Cytomegalovirus
CNM = Certified Nurse Midwife
CVS = Chorionic Villae Sampling
D&C = Dilation & Curettage
D&E = Dilation & Evacuation
DE = Donor Eggs
DES = Diethylstilbestrol (a synthetic estrogen)
DHEAS = Dihydroepiandrosterone Sulfate
DI = Donor Insemination
DIPI = Direct Intra-peritoneal Insemination
DOST = Direct Oocyte-Sperm Transfer
DPO = Days Post-ovulation
Dx = Diagnosis
E2 = Estradiol
EB, EMB = Endometrial Biopsy
ENDO = Endometriosis
EPT = Early Pregnancy Test
ET = Embryo Transfer
ETF = Embryo Toxic Factor
ETA = Embryo Toxicity Assay
FET = Frozen Embryo Transfer
FHR = Fetal Heart Rate
FSH = Follicle Stimulating Hormone
FTTA = Fertile Thoughts To All
GIFT = Gamete Intra-fallopian Transfer
GnRH = Gonadotropin Releasing Hormone
GP = General Practitioner
hCG, HCG = Human Chorionic Gonadotropin
HCP = Health Care Practitioner
HEPA = Hamster Egg Penetration Assay
hMG, HMG = Human Menopausal Gonadotropin
HP = Hannah's Prayer (Christian infertility / pregnancy loss group)
HPT = Home Pregnancy Test
HRT = Hormone Replacement Therapy
HSG = Hysterosalpingogram
IBT = Immunobead Binding Test
ICI = Intra-cervical Insemination
ICSI = Intra-cytoplasmic Sperm Injection
IF = Infertility
IM = Intra-muscular (WRT injections)
INCIID = International Council on Infertility Information Dissemination
IOR = Immature Oocyte Retrieval
ITI = Intra-tubal Insemination
IUGR = Intra-uterine Growth Retardation
IUI = Intra-uterine Insemination
IVC = Intra-vaginal Culture
IVF = In Vitro Fertilization
IVIg = Intravenous Immunoglobulin
LAD = Leukocyte Antibody Detection Assay
LAP = Laparoscopy
LH = Luteinizing Hormone
LIT = Leukocyte Immunization Therapy
LMP = Last Menstrual Period (start date)
LPD = Luteal Phase Defect
LUF, LUFS = Luteinized Unruptured Follicle Syndrome
MAI = Miscarriage After Infertility (mail list)
MC, m/c, misc. = Miscarriage
MESA = Microsurgical Epididymal Sperm Aspiration
MIFT = Micro Injection Fallopian Transfer
MMR = Measles-Mumps-Rubella Vaccine
MRI = Magnetic Resonance Imaging
NEST = Non-surgical Embryonic Selective Thinning
NK = Natural Killer Cells (CD56+)
NORIF = Non-stimulated Oocyte Retrieval In (office) Fertilization
NP = Nurse Practitioner
NSA = Non-surgical Sperm Aspiration
OB = Obstetrician
OB/GYN = Obstetrician/Gynecologist
OHSS = Ovarian Hyperstimulation Syndrome
OPK = Ovulation Predictor Kit
OTC = Over The Counter
PA = Physician's Assistant
PCO, PCOD = Polycystic Ovary Disease
PCOS = Polycystic Ovarian Syndrome
PCP = Primary Care Physician
PCT = Post Coital Test
PESA = Percutaneous Epididymal Sperm Aspiration
PG = Pregnant
PI = Primary Infertility
PID = Pelvic Inflammatory Disease
PLI = Paternal Leukocyte Immunization
PMS = Pre-menstrual Syndrome
POC = Products of Conception
POF = Premature Ovarian Failure
PROM = Premature Rupture of Membranes
PTSD = Post-traumatic Stress Disorder
RE = Reproductive Endocrinologist
R-FSH, R-hFSH = Recombinant Human Follicle Stimulating Hormone
RI = Reproductive Immunologist
RIP = Reproductive Immunophynotype
ROS = Reactive Oxygen Species
RPL = Recurrent Pregnancy Loss
RSA = Recurrent Spontaneous Abortion
Rx = Prescription
SPA = Sperm Penetration Assay
SA = Semen Analysis
SART = Society of Assisted Reproductive Technology
SCORIF = Stimulated Cycle Oocyte Retrieval In (office) Fertilization
SI = Secondary Infertility
SLE = Systemic Lupus Erythematosus
SPA = Sperm Penetration Assay
STD = Sexually Transmitted Disease
SUZI = Sub-zonal Insertion
TeBG = Testosterone-estradiol-binding Globulin
TESA = Testicular Sperm Aspiration
TESE = Testicular Sperm Extraction
TET = Tubal Embryo Transfer
TNF = Tumor Necrosis Factor
TORCH = Toxoplasmosis, Other, Rubella, Cytomegalovirus and Herpes test
TRH = Thyroid-releasing Hormone
TSH = Thyroid Stimulating Hormone
TUFT = Trans-uterine Fallopian Transfer
Tx = Treatment
US, u/s = Ultrasound
UTI = Urinary Tract Infection
WBC = White Blood Cells
ZIFT = Zygote Intra-fallopian Transfer
Back to Top of Questions
General Internet Abbreviations
AFAIK = As Far As I Know
AOL = America Online
BTW = By The Way
CGU = Can't Get Up (as in "I've fallen and can't get up")
DH = Dear Husband, Darling Husband
DHAC = Don't/Doesn't Have A Clue
DITD = Down In The Dumps
DW = Dear Wife, Darling Wife
FAQ = Frequently Asked Question(s)
FWIW = For What It's Worth
HTH = Hope This Helps
IIRC = If I Recall/Remember Correctly
IMHO = In My Humble Opinion, In My Honest Opinion
IMO = In My Opinion
IRC = Internet Relay Chat
LOL = Laughing Out Loud
MIL = Mother In-law (also FIL, SIL, BIL for the others)
NBD = No Big Deal
NG = Newsgroup
OTOH = On The Other Hand
POA = Plan Of Action
POV = Point Of View
ROTFL = Rolling On The Floor Laughing
ROTFLOL = Rolling On The Floor Laughing Out Loud
ROTFLMAO = Rolling On The Floor Laughing My A** Off
SO = Significant Other
TIA = Thanks In Advance
TTFN = Ta Ta For Now
TTYS = Talk To You Soon
WRT = With Respect To
YMMV = Your Mileage May Vary
Back to Top of Questions
The DE Process. Step by step.
Resolve of Northern California has a good web site with a wealth of information on the donor egg IVF process. To access their "Complete Donor Ovum Consumer Guide", go to http://www.ihr.com/resolve/ar-egg.html
This site provides articles on deciding whether donor eggs are appropriate in a particular situation, selecting a clinic, when to cancel a cycle, in addition to an excellent article entitled "What to Expect When You Go Through A Donor Egg IVF Cycle": http://www.ihr.com/resolve/articles/cycle.html
Although there might be a slight variance from clinic to clinic, in general, the donor egg process is as follows:
1. Locate a donor (see "Finding a Donor")
2. Complete medical screening for the recipient, the spouse of the recipient, and the donor: psychological (includes MMPI for donor, counseling for the donor and the recipient couple, individually and jointly, if the donor is a known donor) and physical (includes semen analysis, bloodwork to test the donor and the recipient for infection and sexually transmitted diseases, hysterosalpinogram for the recipient to allow the doctor to view the uterine lining to detect uterine polyps or other defects which could affect implantation or pregnancy, "mock transfer" to determine the best type and size of catheter for the embryo transfer, etc.).
3. Some clinics require a "mock cycle" for the recipient, where the recipient takes medications (generally lupron, followed by estrace and then progesterone) and has ultrasounds and bloodwork to ensure that the medication is effective and the uterine lining is appropriate to support a pregnancy.
4. Coordinate cycles of donor and recipient. For pre-menopausal recipients, this is accomplished by both the recipient and the donor taking medications such as lupron (shots), synarel (nasal spray), and/or birth control pills. For recipients past menopause, only the donor will be down-regulated using lupron or synarel.
5. Some clinics prescribe antibiotics for the donor, recipient, and recipient's spouse early in the cycle (often a 10-day treatment) in order to treat any undiagnosed infections that may exist.
6. Once both the donor and the recipient are down-regulated, the recipient begins to take estrogen supplements in some form - oral, patches, or shots. The dosage may be adjusted based on blood tests (measuring E2 levels) and ultrasounds to measure the uterine lining.
7. While the recipient is taking estrogen supplements to build a thick uterine lining, the donor begins her fertility medications. These medications are often taken for 8-10 days. Her progress is measured through bloodwork and ultrasounds.
8. The date of the egg retrieval will be determined based on the size of the donor's follicles, as measured by ultrasounds. At an appropriate time, she will be given a shot of HcG and the retrieval is generally performed approximately 33-35 hours thereafter.
9. On the date of the retrieval, the recipient's partner will provide a semen sample. The semen is processed and sperm are added to the eggs that same day. In some cases, ICSI will be performed. This is a process where a single sperm is injected into each egg.
10. The day after retrieval the lab will provide a fertilization report. The embryos remain in the laboratory until the date of the transfer, which can be between two and five days after the retrieval date. Periodic progress reports are provided to the recipient to keep her informed about number, size, and quality of embryos.
11. On or just before the date of the donor's egg retrieval, the recipient will begin taking progesterone supplements, available as injections, vaginal gel, vaginal or rectal suppositories, or in oral form.
12. Based on embryo quality and other factors, the recipient couple determines how many embryos to transfer to the recipient's uterus. The rest may be frozen at that time or kept in the laboratory for several more days before freezing. Often clinics will freeze only high quality embryos.
13. Some clinics will prescribe a steroid (often medrol or prednisone) and another round of antibiotics for the recipient to take for several days preceding the embryo transfer.
14. The embryo transfer is performed either at a hospital or in the clinic's office. The embryos are placed into a catheter and transferred through the cervix into the uterus of the recipient under ultrasound guidance. Some clinics prescribe valium for the recipient to take prior to embryo transfer, although the procedure is generally not any more painful than a pap smear or insemination.
15. Following the embryo transfer, the recipient will remain in the hospital clinic for 30 minutes to several hours, depending on the clinic's protocol. Then the recipient remains on bedrest for several hours to several days, depending on the clinic's protocol.
16. Several restrictions may be imposed for the period between transfer and the pregnancy test: limitations on exercise, heavy lifting (over ten pounds), sex, caffeine, etc. Again, this varies from clinic to clinic.
17. A blood pregnancy test may be performed 9-14 days from a day 3 embryo transfer (or sooner for a day 5 transfer). The HcG level in the blood is measured; if the test is positive, it is repeated two days later. HcG levels should double every 48-72 hours.
18. If the test is positive, the recipient continues to take progesterone and estrogen supplements as directed by her physician - often until the end of week 10 or 12 of pregnancy.
Back to Top of Questions
Insurance and DE
This information will cover the following questions:
1. Will my insurance cover donor egg IVF fully? In part?
2. Where can I buy insurance that will cover IVF or donor egg IVF?
3. Where can I buy insurance that will cover the donor in event of complications arising from her donation?
4. What states have mandated IVF coverage and does that mean that if I live in that states, I will be covered? Does mandated IVF coverage imply that donor egg IVF will also be covered?
1. Will my insurance cover donor egg IVF fully? In part?
To determine if your insurance will cover in vitro fertilization (IVF), you will need to review a copy of the actual insurance contract. What is provided to employees when they are hired is NOT the contract, but is a summary called a "Summary Plan Description." By law, your employer is required to make a copy of the actual contract available for your review, although the contract is generally large and the employer is not required to provide you with a personal copy. The relevant sections are generally called "Exclusions" or "Limitations of Coverage" or "Procedures Not Covered Under This Plan." Many contracts will cover diagnosis of infertility but specifically exclude procedures performed with the intent of achieving pregnancy, such as artificial insemination and in vitro procedures. Often, indictable medications are excluded from coverage as well.
Some plans have a dollar limit on the infertility coverage provided. If your plan will cover you up to a certain limit, be sure that you understand what is included in that limit (All diagnostic testing? All treatment? Laparoscopies to treat endometriosis?) and plan your treatment accordingly. Do not assume that expensive surgeries such as laparoscopies or tubal repair or removal are excluded from the coverage limit.
If your review of the plan indicates to you that some or all of the IVF procedures would be covered, you will still need to determine if donor egg IVF (IVF/DE) would be covered. In many cases, procedures and medications that would be covered for a standard IVF procedure will not be covered in a donor egg situation. With IVF/DE, many of the procedures are performed on the donor rather than the insured, and the most expensive medications are taken by the donor rather than the insured,. This may affect insurance coverage.
Some plans which cover ultrasounds and medications for insemination cycles will not cover these same items in conjunction with IVF. On the other hand, some plans which exclude IVF coverage will cover parts of the treatment - ultrasounds, hormone tests, medications, etc. Each plan is different and often though the plan wording may suggest that none of these will be covered, some may in fact be covered.
If, based on your review of the insurance contract and discussions with the insurance company or your employee benefits coordinator, you believe that part or all of the IVF/DE process will be covered under your insurance plan, be sure to obtain a confirmation in writing of the benefits to be covered. Also, be sure to find out if pre-authorization or a referral number is required for each procedure and for each cycle, and file the appropriate paperwork with the insurance company. Your clinic may be able to help with this process, but ultimately you are responsible for the bills, so keep in close contact with the clinic on these matters.
If you find that your plan covers IVF but does not cover the clinic or doctor that you would prefer to use, you may be able to change to another insurance option (e.g., a "point of service" plan rather than an HMO). Certain options provide partial coverage of an out-of-network doctor or clinic. Generally, changes between plans and plan options may be made only during the annual "open enrollment" period for employee benefits, often one month late in the year.
See section below for a discussion of the states with mandated infertility coverage. You may also wish to obtain a copy of the booklet published by Resolve (http://www.resolve.org ), "Infertility Insurance Advisor", which provides tips on reviewing your contract along with other insurance-related issues. Insurance coverage of infertility treatment is constantly changing as new states propose or pass legislation requiring coverage. You should become an advocate for coverage in your state of residence. Also, a recent supreme court ruling stating that reproduction is a "major life activity" under the Americans with Disabilities Act may have consequences in defining what must be covered by insurance plans.
2. Where can I buy insurance that will cover IVF or donor egg IVF?
If your employer's group insurance plan does not cover IVF, you will most likely be unable to purchase IVF insurance on an individual basis. In rare situations, individual plans will be available that provide this type of coverage. The best way to find these plans is by networking with other infertility patients.
The rationale for most individual plans not covering IVF or IVF/DE is as follows. For insurance companies to make a profit selling infertility insurance only to a group of infertility patients (others would not buy this kind of insurance), the premium would have to be higher than the average cost of treatment. Since no one would be likely to pay $20,000 per year in IVF insurance premiums, this type of insurance coverage is generally not offered on an individual basis. The concept works much better in a group setting, where everyone is covered regardless of his/her desire for this particular type of coverage. Then the cost is spread over a larger base of policyholders and can be reasonable, while still providing the insurance company with a profit margin.
3. Where can I buy insurance that will cover the donor (or the recipient) in event of complications arising from her donation?
Some clinics using anonymous donors require patients to buy a policy for the donor through the clinic. These policies are written by large insurance companies on a group basis. One such policy is underwritten by a company called American Insurance Group in Wilmington, DE and costs approximately $500 per cycle. These policies are generally not sold to individuals.
Although many policies exclude IVF from coverage, complications arising from IVF treatment will often be covered. Review your insurance contract to see if the exclusions list includes complications from uncovered procedures. Most insured donor egg recipients do not buy supplemental insurance to cover risks from IVF/DE.
However, in the event that the donor does not have medical insurance or for other reasons, it may make sense to buy a short term individual major medical policy to cover any catastrophic consequence (hospitalization of donor, etc.). Some companies offer short-term plans with limited underwriting (meaning that the donor will not have to undergo medical testing to qualify for coverage). These plans are generally intended to provide coverage for a short period between jobs or between school and a job. The plans are relatively inexpensive but there is a deductible and co-payment in the event that a claim is filed. Your contract with your donor should spell out who would pay the deductible and co-payment in the event of complications. One source for an inexpensive short-term policy is through Blue Cross/Blue Shield. However, each BC/BS is independent from the others, so short-term plans may not be available in all states.
Flexible Spending Accounts
Even if your insurance company does not cover IVF or IVF/DE, you may be able to offset the cost somewhat by putting money aside in your employer's "flexible spending account." The money put into these funds is pre-tax, so you never pay taxes on the portion of your income that is put into this type of fund. However, the funds must be spent during the calendar year during which you make a contribution to a FSA or the money is forfeited, so you need to be very certain that you will spend at least what you have withheld from your pay in the current year. Also, the IRS places limits on the amount of money that is placed in this type of account annually.
4. What states have mandated infertility coverage and does that mean that if I live in one of those states, I will be covered? Does mandated IVF coverage imply that donor egg IVF will also be covered?
Twelve states have mandates related to infertility coverage: Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New York, Ohio, Rhode Island, and Texas. Note that these mandates do not apply to federal employees and other self-insured plans as those plans are not subject to state mandates. Many (perhaps most) large employers are self- insured and therefore exempt from these mandates. In many states, the mandate is merely a requirement that insurance companies must offer an infertility benefit to the insurer, but the mandates do not require that the insurer accept (and pay extra for) the infertility coverage offered.
A summary of the mandates in each of these states is available at http://www.asrm.org. This site can also be accessed by a link provided from Fertile Thoughts (go to http://www.fertilethoughts.net, then click on "insurance info" then click on "Summary of State Infertility Insurance Mandates from ASRM").
Fertile Thoughts provides a good FAQ on insurance coverage for infertility treatment, which can be accessed at http://www.fertilethoughts.net (go to website, then click on "Infertility FAQs" then on "Infertility Insurance FAQs").
Even if an insurance plan provides IVF coverage, donor egg procedures may not be covered. Often medications taken by the insured (recipient) are covered, but the donor's medications may not be covered.
The most comprehensive mandate is provided under the laws of the state of Massachusetts. In Massachusetts, insured plans must cover IVF, including donor egg procedures. However, even in Massachusetts there are limits on coverage, and age limits may be imposed (examples from sample plans: 42 in one plan, 45 in another). In addition, if any portion of the treatment is to occur out-of-state, it may not be covered, and the fee paid to the donor may not be covered. If one company limits the number of cycles, it may be possible to change to another plan at the open enrollment period, and obtain coverage for additional cycles.
To determine if your employer provides coverage for IVF or IVF/DE, you will need to review the insurance plan document and discuss coverage with the insurance company. Once again, before initiating any treatment, you should request pre-authorization from the insurance company in writing, and ask if there are other procedures which must be followed before beginning treatment.
In states in which IVF coverage is mandated, if your insurance does not cover IVF, you may be able to obtain a discount by telling the clinic that you will be paying cash and requesting a discount. This approach generally does not work in states in which most patients are paying cash.
Back to Top of Questions
Selecting a Clinic
Questions to Ask A Clinic About:
- Statistics
- Clinic Operations and Philosophy
- Recruited Donors
- Costs
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Clinic Statistics
It is important to ask the right questions when requesting statistical information and success rates concerning the clinic's experience with IVF with donor egg. The following questions are suggested as a starting point for gathering specific and accurate information about a clinic's track record and having that information be meaningful when comparing it to other clinics under consideration.
1. How long have you been doing IVF with donor eggs at this location with the same assisted reproductive team (IVF doctors, embryologists, nurse coordinator)?
2. What are your statistics for IVF with donor eggs, fresh and frozen cycles, broken down by: year, number of attempts initiated, number of completed cycles (through transfer), ongoing pregnancies, live births, age range of donors, age range of recipients, infertility diagnosis of recipient (i.e., premenopausal and postmenopausal)
3. Survival rate for thawing frozen embryos
4. Ongoing pregnancy rate for frozen embryos
5. Live birth rate for frozen embryos
6. How do you account for multiple births in your statistics?
7. Do you report your statistics to the IVF-ET Registry?
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Clinic Operations and Philosophy:
Coordination with the clinic is more complex than IVF procedures because it requires the care and timing of two patients instead of one. Communication becomes critical to the overall success of the procedure. The following list of questions is suggested as preliminary to the selection of a clinic and/or physician.
1. How long will it take to schedule the first consultation?
2. What is the current ratio of physician to patient? Is this above or below average?
3. Does your program operate year round? How many doctors in the practice are trained to do IVF with donor eggs? To do just IVF?
4. How many IVF nurse coordinators and/or nurse practitioners are in the practice?
5. Do you provide weekend hours for appointments for those who work or come from out-of-town, and early morning ultrasound appointments?
6. Whom do we talk with if we have questions? Who is available on a 24-hour basis to answer questions and to deal with emergencies?
7. What is the office protocol for returning phone calls?
8. Does the clinic meet minimal standards as outlined by the American Fertility Society?
9. Is the clinic a member of the Society for Assisted Reproductive Technology?
10. What kind of medical screening does the recipient and her partner receive? Does it include a medical history, a psychological history, lab tests and a physical examination?
11. How many embryos do you recommend are transferred? What are the chances of multiple births if 3 embryos are transferred? What are the chances if 4 embryos or 5 embryos are transferred?
12. What are the risks of multiple pregnancy? If we desire and require it, what are the risks of selective termination and what are the indications for it? Will you provide us with the name of a doctor who will do selective termination if this procedure is necessary?
13. Do you have the capacity and experience to freeze extra embryos? If we want to try a frozen embryo cycle, how long do we need to wait after a failed cycle before we try again?
14. (For those out of area) Will you support our local doctor to work with us and/or our donor for the trial cycle and the first week of the donor's cycle?
15. Can you recommend a place for us and/or our donor to stay?
16. Is there an age limit for recipients?
17. As the recipient, how much work can I expect to miss? How about my partner and our donor?
18. What is the nature of the legal contract you have with the donor (and her partner)?
19. What is the nature of the legal contract you will have with me and my partner?
20. What is the nature of the legal contract between the donor (and her partner) and me and my partner?
21. Do you require psychological clearance with the donor and ourselves before the procedure?
22. Will you recommend a counselor for us if you don't provide counseling as part of the program?
23. Are other couples available to talk with us who have been through the process of IVF with donor eggs, and who have had both successful and unsuccessful cycles?
24. Will you arrange for our donor, if desired, to talk to other donors who have been through your program?
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Recruiting Donors
Attitudes about donors, accessibility of information about the donor, etc. vary widely from clinic to clinic. The following are some questions to consider when choosing a clinic. See also "Questions for Recruited Donors who are willing to meet with the Recipient Couple," as sample questions to ask a clinic about a recruited donor (whether known or anonymous) in order to elicit more specific information about the donor and her history.
1. Does your clinic have a pool of recruited donors?
2. If you don't have a pool of donors, do you work with a third party broker to recruit donors? Are they patients undergoing IVF with extra eggs who are willing to share them, or are they other women recruited through word of mouth or the media?
3. Do you offer several third party broker sources or do you have a contract with one third party broker?
4. Will you assist us in recruiting our own donor?
5. What is the age range of your recruited donors?
6. Will your donors be anonymous, or will they be known to us? What is your rationale for this policy?
7. If your general policy is to recruit only anonymous donors, are you open to recruiting a donor we can meet?
8. How accessible is the donor's pertinent medical history to the recipient couple? How long do you keep the records?
9. If your donors are known, do you accept relatives and friends of the recipient couple into the program?
10. Do you accept donors recruited by a third party broker?
11. Do you allow the donor and recipient to remain anonymous if they desire?
12. What is your screening process for recruited donors? Is the screening similar or different with relatives, friends or third-party recruited donors?
13. What does the screening process entail? Does it include medical, social, and psychological history, as well as lab tests and physical examinations?
14. Who performs the screening?
15. How do you know a new donor will stimulate adequately?
16. How long do we have to wait for a recruited donor?
17. What kind of flexibility do we have in selecting a recruited donor? Can we choose from a file of donors? Can we see pictures, or read a short history about each prospective donor?
18. Do you have recruited donors who have proven successful in being stimulated to provide follicles and resulting ongoing pregnancies?
19. Are your recruited donors required to carry and be covered by their own health insurance to cover any unforeseen medical problems that result from ovarian stimulation and/or retrieval?
20. Do you work with sperm banks or have sperm donors recruited to provide donor sperm if there is a male factor?
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Costs:
What are the costs for the:
1. Initial consultation
2. Donor recruitment and screening
3. Donor reimbursement
4. My and my partner's screening
5. Prescription drugs for the donor
6. Prescription drugs for myself
7. Ultrasounds and blood tests for the donor
8. Retrieval of the oocytes
9. Gamete lab
10. Transfer
11. What are the costs for freezing and storing embryos? If the embryos are frozen on different days, do we pay for each time the embryos are frozen?
12. What is the charge for embryo thawing and the subsequent transfer?
13. How do you bill my insurance company? In my name for all procedures for both the donor and myself, or in both the donor's name and my name?
14. If needed, will you bill my insurance separately for the different procedures?
15. How much of the payment is required before the procedure? How much is refunded if the donor stimulation cycle is canceled before the oocytes retrieval or before the embryo transfer?
16. Will you help us work with our insurance company?
17. Are there any other costs associated with this procedure that we have not discussed?
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This information taken from:
RESOLVE National Office
RESOLVE of Northern California
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Infertility Resources
Developed and maintained by Internet Health Resources
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Authors: the Howlands and D. Pettee and his wife
First posted 1/1/96
Updated 1/1/96
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Copyright 1996 RESOLVE, Inc.
Back to Top of Questions
Finding an Egg Donor
This area, like much of egg donation, is largely uncharted territory and preferred methods vary from one person to another. Using one's judgment and comfort level are the best guides. There are a variety of ways to identify egg donors.
a) Through your fertility clinic or RE's office. Programs offering DE usually have their own lists of donors. Waiting lists vary significantly from 0 to many months. Donors are either anonymous or "known" meaning you're using your own. Clinics vary in their rules about their donors remaining anonymous. Some allow pictures, some baby pictures, and other require total anonymity.
b) Donor egg brokers. These are independent persons, usually with a nursing, law, and/or counseling background who screen applicants, advertise, and set up fee structures for people seeking donors. The information provided varies, but usually includes a detailed medical/social history including family background and picture.
c) Family member or friends. People sometimes seek the assistance of a sister, cousin, aunt or other family member, or even a friend.
d) Personal advertisements in local newspaper, entertainment weekly, or college newspaper.
The following information provides some tips for finding donors and things to consider during and after your search. The information is directly from the RESOLVE of Northern California web site, www.ihr.com/resolve/nchome.html.
How To Choose a Third Party Donor Provider
Article provided by RESOLVE of Northern California
The doctor you have chosen may not provide donors, or you may have very specific requirements in a donor. You can use the services of a third party donor broker or provider. This is a very new service and there are no licenses or degrees required and there are no legal guidelines to determine what a donor broker should or shouldn't be required to do when matching donors and recipients. Here are some common guidelines and questions to ask that may make your search more effective:
1. What is the fee structure for the provider's services? Do you have to pay a fee up front? Is the fee refundable if you change your mind about a donor or don't want to work with any of the donors currently on file? What do all the fees cover? Do you have to pay a separate fee if you don't want to work with any of the donors currently on file and the broker needs to advertise? How long and how much effort will the broker put into finding a donor with specific characteristics? Does the broker charge differently if you pay cash, check or credit card?
2. What is the fee for the donor herself? Can she set her reimbursement herself? If she has provided eggs before has her price remained the same or gone up? If the recipient pays the donor's expenses, does the broker provide an itemized list of expenses?
3. What kind of screening does the donor need to have? What is the psychological screening and who performs it, the broker or a third party? Is there an extra charge for psychological testing (i.e. MMPI)? Can you see the results of the testing? Can you have the donor tested by a third party of your own choosing?
4. What kind of medical screening has the donor had? Who will do it if you choose a donor? Is the medical screening included in the cost or is it separate? Has the donor has a 3rd day FSH level blood test done? The FSH level gives an indication of how well a donor will stimulate with fertility drugs.
5. Does the broker facilitate a meeting between you and the donor if you wish to meet? Does the broker provide anonymous, known donors or both?
6. Does the broker work with the donor during the actual cycle and in what capacity? For example, the broker can get the donor's daily estradiol level from the doctor's office and then pass the information on to you.
7. What kinds of records and information are kept on anonymous donors, where and for how long? There may be some reason in the future to contact an anonymous donor.
8. What does the broker do to ensure that a donor hasn't donated too many times before in terms of resultant offspring? If the broker has screened someone out as a donor, does the broker provide this information to broker colleagues and/or recipient clients if they ask about this potential donor?
9. What is the legal contract the broker requires the recipient(s) to sign? Does the broker require that the recipient work only with him/her?
10. What is the legal contract the broker requires the donor to sign? Is the donor required to work only with that broker for any specific period of time? Has the donor worked with other brokers?
11. How long has the broker been in business under the current name or a different name? How many donors has the broker matched with recipients in a year? Out of the number of donors matched how many stimulation cycles, how many retrievals, how many pregnancies and live births have resulted (multiple fetuses/births count as one)?
12. Does the broker have recipient references? Is the broker on RESOLVE of Northern California's referral list, for how long? If not, why not? You can call the TAP network to find out more information too.
13. Does the broker keep a medical record of each stimulation the donor has done? Can you see her protocols? If not will the donor release her medical records? Specifically, how many ampules of Pergonal and/or Metrodin did the donor need, did she stimulate easily, how many mature and immature follicles were produced at the time of retrieval, how many eggs were retrieved, how many eggs fertilized and was there a male factor, what were the number and quality of embryos?
14. If successful pregnancies have resulted, in what general geographic area do the recipients currently live?
15. Does the donor broker help the uninsured donor find medical coverage?
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RESOLVE National Office
RESOLVE of Northern California
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Infertility Resources
Developed and maintained by Internet Health Resources
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Author: L. Howland
First posted: 4/30/95
Updated: 11/30/95
Copyright 1995 RESOLVE, Inc.
Back to Top of Questions
Questions to Egg Donors
This article is divided into several sections:
- General Questions for A Known Donor Whether Recruited, Friend or Family Member
- Specific Questions When the Donor is a Friend or Relative
- Specific Questions For a Recruited Donor
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General Questions for Either a Relative or a Recruited Donor:
Depending on whether the donor is a relative or friend, or a known recruited donor, there are a number of general questions that might be considered by a recipient couple.
1. Why do you want to participate in egg donation?
2. Why did you choose to be a known donor?
3. What are your feelings about being available in the future for the baby?
4. What are your expectations about how a child born would be raised?
5. Does it matter if the prospective parents are married?
6. Does it matter if I (as the recipient) am single or a lesbian?
7. What do you imagine how you will feel if the procedure does not succeed?
8. Are you aware excess eggs may be fertilized and may be frozen as embryos?
9. Do you expect any legal relationship with the baby?
10. What are your expectations, if any, around receiving a fee for your participation?
11. Are you willing to participate a second time if we desire siblings for our child, or if a pregnancy didn't result from the first transfer?
12. How do you feel about our decision to give embryos to another couple or make them available for scientific research?
13. Do you have any children of your own? How many do you have, and what are their ages?
14. Are you willing to participate in a counseling session with us to discuss relevant concerns? Are you willing to continue counseling indefinitely if the need arises?
15. Are you aware that you will need to sign a legal agreement detailing your willingness to sacrifice all parental claim or responsibility?
16. Do you have health insurance in the unlikely event of post-surgical complications?
17. Have you had the opportunity to thoroughly discuss the risks associated with the procedure and the medication?
18. If you have a husband/partner, how does he feel about your interest in donating eggs?
19. What is your understanding of the medical procedure that will be involved to stimulate your ovaries with medication and retrieve eggs?
20. Who will be your support person during the intensive weeks leading to the egg retrieval? Who will give you your injections?
21. Are you aware that we may have multiple pregnancies? How do you feel about this possibility?
22. Are there people with whom you have shared your interest to be an egg donor? If there were any, what were their reactions?
23. What are examples of intensive, complicated projects you have chosen to be involved in? What did you learn about yourself?
24. Why do you think you would be a good egg donor?
25. What do you believe your strengths and weaknesses are?
26. Do you have any ethical or religious viewpoints which might affect your decision to be an egg donor?
27. Can you accept the unlikely prospect that we might choose or need to abort a fetus?
28. Do you know anyone who has donated her eggs? Or who was a sperm donor? What was her or his experience?
29. Do you consider yourself to be a responsible person?
30. Where did you learn about this opportunity?
31. How do you feel about the possibility that embryos may be frozen for a long time, perhaps for years?
32. What are your feelings about selective termination or selective reduction?
33. Are you aware that the legal issues surrounding egg donor IVF and parental rights have never been established or challenged in court?
34. Are you aware that there is a possibility that a successful pregnancy from your donated eggs might be referenced in an article in the medical literature?
35. Do you want publicity about your decision to donate eggs if the possibility arises?
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Specific Questions When the Donor is a Relative or a Close Friend:
It is presumed that any donor who is a relative or a close friend will not be a real stranger to the recipient couple. Consequently, the questions do not need to be as expansive as with a recruited donor.
1. Is there anything significant about your relationship with your relative that contributed to your decision to donate eggs?
2. What do you imagine are the concerns associated with donating eggs to a relative?
3. How do you imagine your relationship will change by donating eggs?
4. How does your family feel about your decision to donate eggs to a relative?
5. Who will know about this decision and who will not?
6. If you have decided to keep this private, how do you expect to handle an unplanned disclosure?
7. If you have a husband or partner, how does he feel about the possibility of a baby born of this procedure? Will he participate in counseling if requested?
8. Have you discussed with your partner the risks associated with this procedure and with the medication you must take?
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Specific Questions for Recruited Donor Who is Willing to Meet with the Recipient Couple:
1. Does your family have a tendency towards any particular illnesses, i.e., allergies, intestinal problem, cancer, heart disease or psychological problems? Who had one or more of these illnesses, and at what age did the onset occur?
2. Are your blood relatives living, i.e., parents, siblings, grandparents, aunts and uncles? If not, how old were they when they died, and what did they die of?
3. Have you or any member of your immediate family ever smoked, drank or used illegal substances? To what extent are any of these, or have any of these ever been, a problem?
4. Have you ever been pregnant? What was the outcome?
5. Have you ever donated eggs before? If you have, how many follicles developed? How many eggs were retrieved? How many successfully fertilized? Was there a resulting pregnancy, multiple pregnancy, and live birth(s)?
6. What can you tell us about your family of origin? Who are they and what are their ages? What are their vocational and avocational interests, hobbies, talents and dispositions? What are their physical characteristics such as coloring, size, weight and height?
7. Do you have any children? If yes, how old are they now? When did they learn to sit up, walk and talk? Were there and are there any significant health issues we should know about? What are their sleeping and eating habits? What are their special abilities and interests? What was their birth weight and length?
8. If you don't have children, why do you want to help us have a baby using your egg(s)? Have you considered the unlikely circumstance where at a later date you might be unable to conceive?
9. What is your family's genealogical heritage or history? What country(s) did your ancestors come from, where did they settle here, and when?
10. Why do you want to be a donor? What do you think you will get out of it? If you have already donated, what did you get out of it?
11. If we get pregnant, will you tell your family members including your children? If so, how will you tell them, and when? Would you want your children to know that our child would share half of their genetic heritage? How will you handle their questions?
12. May we see or have pictures of your family, siblings and children? If we desire, may we meet with your immediate family, including your children?
13. Have you thought about how you'd feel if, after all this interaction and sharing, we don't get pregnant?
14. Have you thought about whether you would like any ongoing contact such as pictures, phone calls or meeting the child?
15. Is your job or school situation flexible enough to do this procedure? Do you have child care available, if you have children?
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Refer to: "Minimal Genetic Screen for Gamete Donors," Fertility and Sterility, Supplement 2, Appendix B, Vol. 53, No. 6, June 1990, pp. 885-895.
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RESOLVE National Office
RESOLVE of Northern California
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Infertility Resources
Developed and maintained by Internet Health Resources
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Authored by: the Howlands and D. Pettee and his wife
First posted 1/1/96
Last Updated 1/1/96
Copyright 1996 RESOLVE, Inc.
Back to Top of Questions
Known Donor vs. Anonymous Donor
Many of the decisions we face when doing IVF with donor eggs can be based on numbers: hormone levels, sperm counts, success rates, number of follicles, classification of embryos, etc. When we come to the question of whether to use a known or anonymous donor, however, things are not so quantifiable. It is an extremely personal, individual choice. For example, some people feel that knowing a donor intimately gives them a sense of control over the procedure; others get a sense of control by having as little contact as possible with the donor. Some people find the choice immediately obvious one way or the other; for others, choosing can be a difficult process. The following list of questions may help you focus your thinking when trying to decide which type of donor is right for you.
For the purposes of this list, donors are defined as follows:
"Familiar donor" is someone you know already such as a relative or friend who has agreed to be your donor.
"Known donor" is one you've chosen from a list, and you have agreed to at least one meeting. This option is not available at all clinics or in some countries. It's more common in the western USA.
"Anonymous donor" is one you've chosen according to her listed characteristics, or that the clinic has chosen for you based on their assessment. You may have access to a picture of her, but you are in agreement that you will not meet.
* Choosing a relative to be your donor provides you with the ability to contribute some of your family genes to the child. Usually you know the details of such a donor's family health history and genetic makeup. You and/or your child may see this person frequently and some type of relationship between the child and the donor will have to be forged. The closeness of that relationship will vary from situation to situation, but it is something that will need to be dealt with.
* With a friend as a donor, although you have given up the genetic link, you are able to choose someone whose characteristics are well known and appealing to you. You may already know or be able to learn her detailed family history and ethnic background. The same is true to some degree with a "known" donor. Again, in both cases, the donor's future relationship with you and your baby is an issue to be addressed.
* An anonymous donor appeals to those who do not wish to have any relationship with the donor once they become pregnant. For some, this is a way to avoid a constant reminder that the baby has a connection to someone else. Choosing this option usually means you will have less information about the donor and her family history, or perhaps no information. You will have to decide how important such information is to you.
QUESTIONS TO CONSIDER:
Do you want ongoing contact with a donor? To what extent? Birthday cards? Structured, occasional visits? Call or drop by any time? "Part of the family?"
Do you want a loving, mutually supportive relationship with a donor?
Do you want the donor to be someone your child can rely on in the future?
Do you want a warm, friendly initial meeting(s) with a donor before transfer, and little or no contact afterwards?
Do you prefer to think of contact with a donor as a one-time transaction, rather than any kind of relationship?
If you choose a relationship, yet with a limited degree of contact, can you maintain the "boundaries?" Are you willing to be flexible if, over time, the donor wants to be closer, or becomes more distant?
Does your clinic have a long waiting list for donors? Would a Familiar donor eliminate the wait? Are you willing to travel to another city for a shorter wait for a Known or Anonymous donor? Note: Sometimes a clinic with a long waiting list (i.e. a donor shortage) will put you on the top of their list for an anonymous donor if you bring a donor (commonly a Familiar donor) to their program.
Do you want the donor to be with you for the transfer? Birth? What about baby showers, baptism, bris, first birthday, and the like?
Will your donor be available in the future for another cycle? What if this one fails, or you have no embryos to freeze? Will you want genetic siblings for your child in the future?
Familiar: How will your current relationship be affected by the donor relationship?
Familiar: Will she undergo psychological testing/counseling before the procedure? Will you? (Note: clinics/brokers usually provide psychological screening of their donors as a mutually beneficial requirement of their program. They may advise the same for a Familiar donor, even though you already know something of her personality.)
Familiar: How will it affect your relationship if her commitment falls through, or if her ovaries don't produce? (Note: sometimes doctors are not able initially to select the best stimulation protocol for a first-time donor. Would you both be able and willing to try again?)
Familiar: There may be future gatherings of mutual friends or family where you, your child, and your donor would be present. Would you be uncomfortable with that?
Familiar: Can you, the donor, and your partners agree about whether/when to tell other family members, friends, the child?
Familiar: Are there existing family jealousies that may come into play?
Familiar: Would your costs be different than if you choose from a list of donors?
Known/Familiar: What happens if you feel you must terminate a pregnancy, for example in the case of chromosomal abnormalities?
Known/Familiar: If you have older children, in what way will they be affected by this new relationship?
Known/Familiar: Do you/will you have a comfortable relationship with the donor's partner and children, if any?
Anonymous/Known: Will you want and have access to the donor's continuing health history?
Anonymous/Known: How would you feel about your child's physical resemblance to the donor, if any? Would your feelings be different with a Familiar donor?
Anonymous: Are you comfortable allowing your doctor/nurse coordinator/broker to choose a donor who is a "perfect match" for you? How much detailed knowledge of a donor's characteristics do you require? Would you prefer to "be surprised" by your child's unique talents and traits?
Anonymous: Would you want to correspond with the donor, with your clinic or broker as intermediary? More than once? After the transfer?
Anonymous: Do you want to see a photo of the donor?
Anonymous: If you don't see a photo of your donor, will you ever wonder what she looked like? If you do see a picture of her, will she be less anonymous to you, more of a presence?
AND REMEMBER: While this decision looms large once you've decided to go ahead with DE, the identity of your donor is likely to be less of a presence in your thinking as your pregnancy progresses and after the child is born. Many women with anonymous or known donors have said they thought of their donors rarely as time went on after a successful embryo transfer.
Back to Top of Questions
Giving Up Your Genetic Link
For some women, one of the most painful experiences in moving to the DE process is giving up your genetic link. Some Dear Husbands (DH) find sadness in giving up the genetic link to the wonderful women they married. This is an accumulation of responses from MVED members on how they moved through this difficult emotional issue. Some women offered processes they used to move through their grief and others offered realizations that led them to accept, then rejoice in DE. We sincerely hope that you find something here that speaks to you.
* When we went into the DE process, our clinic had us visit with a therapist who specialized in infertility issues. This was just after having our last failed IUI with my eggs. It was emotionally wrenching and stressful. Some days I wanted to scream at the injustice of having to move on to DE. The counselor suggested that I keep a journal of my thoughts and feelings on the subject. In addition, she suggested that I allow myself one hour or some specified amount of time every day (you pick the time) to focus on the infertility issue...what it meant to lose the genetic link and the other related issues. She felt that rather than obsess about it all day it was better to allow myself time to focus on my thoughts about the situation-to give myself permission to actually grieve. In the meantime, I also found MVED. The combination did wonderful things for me. I was finally able to move out of my "mourning" period and put my energies into the DE process.
* I focused on the downsides of a pregnancy with a mature-aged egg. The rates of so many conditions in pregnancy go way down as the egg age goes down. Reduced egg age is something I could never offer our baby, but DE could. I focused on that thought. My RE felt VERY strongly about egg age and the integrity of a pregnancy. It really helped me.
* For me it never mattered. It does, however, matter to my husband. He wants a genetic child. I've been thinking about this and I think the reason it never mattered is that in our family we didn't think genetic. If you married into the family, you were a member. Even if your spouse died, you were a member. Even if you divorced, you were often still a member.
* I'm fortunate to live in a high population area (Northern California) and was able to get into a Resolve support group specifically for DE. We had a counselor lead the first 8 meetings with 5 couples. After the 8 counselor led sessions, we decided to continue meeting. It's been tremendously helpful to have others to lean on and learn from. By listening to the other couples' sadness and concerns, my DH and I were able to give words to our own feelings, and really open up and talk about what this meant to us, and how we felt. With the help of this group and counselor, I got to suppress my embarrassment about my inner fears, and express my concerns that my husband and his family would have more rights with a DE baby than I would. And once I got that out, I was able to deal with my fears and discard those thoughts. The fears sound silly to me now, but they were very real at the beginning of this journey.
* A counselor suggested this one and it really worked for me. Grieve the loss of your "dream baby" by getting out your baby and toddler pictures. Put them around your family room and every time you look at them grieve for the loss of your genetic connection...of that "dream baby" that will never be. Sometimes just look longingly at those pictures, and sometimes just cry. I did this for I don't know how long, but I'm finished grieving and they are back in the drawer. You can add your DH's baby and toddler pictures to the process.
* I am a VERY optimistic person - I have two children from a previous marriage (I was 20 and 23 when I delivered them!), and my face and body do not give my age away, so I was very confident that I would get pregnant. But the more I read, and the more I talked to different doctors, and the longer we tried without becoming pregnant, I began to realize that my optimism could keep me from ever having a baby with my new husband (who has no children). So I asked myself, "Are you that optimistic that you are willing to give up ever having a child again?" I decided no, and jumped into DE full speed ahead (my husband and I continued trying on our own as everything is still working). I am very excited as we continue on our DE cycle.
* Giving up my genetic link has been a struggle for me too. It helps to remind myself of that beautiful saying that our children come "through" us, not "from" us - that is, they are separate people whom we parents spend 18 years letting go of anyway. (As the parent of a teenager conceived naturally, I am well aware that the child becomes very separate indeed!) Also, it helps me to remember that we are all interconnected in the universe, so any woman who chooses to donate eggs is really not all that different from me and my family. The gifts she provides through her eggs may be different from what I would provide through my own eggs, but they are valuable nevertheless.
* As an adoptee, I have learned that there does not need to be a genetic link to pass on "parts" of one's parents or grandparents. I am my mother and father's daughter in so many ways that it is eerie sometimes. So much of what we are as humans is NOT genetic, yet we often focus on that connection because society has conditioned us to think in terms of "having Dad's nose." I have my mother's knack for managing finances well and her love of family and tradition. I have my father's old-fashioned work ethic as well as his kindness and compassion for others. My sister and I are not genetically related but we use the same gestures and share so many mannerisms that people can tell we are sisters despite the fact that we do not look like we are related. The point here is that we are all products of the people that raised us and they are products of the people that raised them. As the parent of an adopted son and a DE son, I am passing on a little bit of my parents to them. What made my parents the incredible people they were is not lost just because there is no genetic link.
* DE is a very, very wonderful option and I thank God that it's available because it is my only hope in having a child. I just can't help but feel sad because my Father passed away unexpectedly this past May and I would have loved to have had a child with a little part of Dad mixed in. He was an incredibly caring and wonderful man. If he were still here, he would have encouraged me and would have loved the child just as much, genetic link or not. I know in my heart that if I am lucky enough to succeed in having a baby that I will still look for any similarities. Who knows, maybe my baby will be "heaven sent."
* How did I come to terms with the loss of my genetic link? I suppose, in part, it is a matter of looking at options: Adoption was one option we were seriously looking at last spring before we decided to try DE "one last time." In fact, we were looking at Chinese adoption and had begun the process. However, once the process was under way, I found I was having trouble visualizing the outcome. I hate to admit it, but I just could not "see" myself with a Chinese daughter. That was losing too much of the genetic link, for me. Something inside of me "snapped" around that time and I decided I had to try DE again. My husband had been supportive of the adoption but he "lit up" when I told him I was thinking of trying again. I knew he wanted a genetic child and I also knew I wanted to try to give birth to a child that was automatically ours. I wanted a process that did not require 6-12 months of paperwork, FBI fingerprints and home visits to qualify. (It was frustrating for us when we realized what a happily married, educated, middle class couple has to go through before they can qualify t o adopt a child. It doesn't seem "fair".) Of course, I looked for a donor that resembled me, both from a physical standpoint and a personality standpoint. I feel very lucky that I found such a donor. I learned that when we choose donors who look like us and have similar ethnic backgrounds (or in some cases are actually related to us) we have to be honest with ourselves. We need to realize that we are holding onto something like a genetic link - we are not really giving it up entirely. However, this argument can be made for anyone who decides to have "biological" children (however the biology comes about). The urge to further your own heritage/line is stronger in some than in others, I suppose. After years of infertility treatment, I think the urge for some of us just gets stronger. DE is as close as we will ever come to NOT losing the genetic link. Therefore, can we say that we have given it up if we are pursuing DE? I don't think we can say so honestly. As mothers, we have certainly given up our own, personal, genetic link. But we are still furthering the link that is represented by the donor who has our coloring, has our ethnic background and, in many cases, shares our values...and, of course, if the DH is the sperm donor as well, his genetic link remains "intact." I have this sneaking feeling that, once I give birth, I will learn that this "genetic link" stuff I have been grappling with is much less important that I once thought. Those of you out there who have adopted already have said it very well. It just doesn't matter - once the child is in front of you and you see that this child is an individual. From a logical standpoint, I know that had we gone through with the Chinese adoption, we would have been happy with the outcome. However, in the meantime I am happy that I am getting the chance to go through a pregnancy, that my husband will be the genetic father, and that I will have a daughter (yes, we know the sex already) that resembles me (at least somewhat). But most importantly, I am happy that, after all these years, it appears we are actually going to be parents!
* We have a 3-year-old through adoption and are pursuing DE with a cousin donor. Building a family despite infertility is a very personal thing and choices should never be dictated by society or social workers as "socially responsible." We did not adopt to be socially responsible - we adopted to be parents and that situation felt right for us personally. We had pursued adoption in China at the same time as we pursued adoption in Canada. We were presented with a possible adoption scenario about 2 months before our actual adoption and it was a situation (not based on race) that made us quite uncomfortable. The social worker flipped out on us and told us that we were possibly not candidates for adoption. That is not how we felt at all. When our son was born and presented to us - nothing could have felt more right in the whole world. Now our DE situation also feels very " right" for us. Infertility takes many things from us - but it also asks many things of us. I think feeling that we are making the choices that are right for "US AND OUR FAMILY" is so important because that means we are listening to the voice of our soul and thus the voice of God and what he ultimately WANTS for us.
* I have struggled with the loss of the genetic link, but the following rationalization has helped me:
1) If ED succeeds, I will get 2.5 out of 3 - 1 is the desire to parent, 2 is experiencing pregnancy, and 3 is passing on your genes. With ED you get 1 and 2, and half of 3 (at least in my case), since the husband still throws in his genes. In terms of the other half of 3, I feel my donor resembles me quite nicely. My background is German and Swedish, hers is Scottish, Dutch and Italian. Well, Scotland and Holland are Northern Europe, so that covers Sweden. My father is Bavarian, which is in the South of Germany, so Italy covers that part!
2) One of my closest friends said to me once, that "passing on your heritage" is not just about your genes, but the way you raise your children. It's the stories you tell them, how you keep them connected with their ancestors, etc. (telling them about Sweden and Germany, teaching them those languages etc.). I am less and less unhappy about ED. I am so comfortable with my donor that she almost feels like relative, although I have never met her (and most likely won't, our choice and hers). I think once you have that baby you almost start forgetting where he/she came from, because they could not have come into this world without you!
* My mother, a genealogist, without knowing that I'm even considering DE, sent some e-mail to me this past week informing me that she and dad are 9th cousins once removed. This occurred by virtue of the fact that they are both direct descendants of some very famous Mayflower pilgrims. This makes my siblings and I cousins; we are our parents' cousins and our own children's cousins. Family trees are amazing. We are all related somehow. Direct genetic link or not. It's there! Even if it is 10 generations or more.
* I was thinking again about the genetic connection issue and decided that despite the lack of genetic connection, we MVEDs are more mothers of the child that anyone else could be. After all, we are the ones who decided to create the child! We paid for its complicated conception, we suffered all kinds of agonies over months and years with IVF, we drained our savings, we mortgaged our homes, and we soldiered on in the face of numerous obstacles to create the child and give it life. The child's very existence on earth is due to us, to our wills, to our efforts and desire (okay, some doctors helped and so did a donor, but they wouldn't do it without us needling them and paying them!). Surely that makes us just as much the 'real mother' as any normally fertile young woman who found herself pregnant and decided to keep the child. And of course it makes us far more the 'real mother' than the wonderful women who agreed to be either a gestational surrogate or an ovum donor for us. And none of that is to speak about the raising of the child after its birth. Hence, I no longer have the slightest doubt or anxiety, when the child arrives (knock on wood I reach that point), it's mine and DHs and just let the nay sayers and puritan wackos and ethical crazies try and tell me different!
Back to Top of Questions
How Long Does it Take To Find a Donor?
Recipients find donors in one of several ways:
- a. through friends, siblings, other relatives (known donor)
- b. through the clinic (often an anonymous donor)
- c. through an agency
- d. over the Internet
- e. by advertising for their own donor
See "Finding a Donor" for more information.
Known Donor
Often people who use a known donor can find one right away, though there can be some wait while a sister or friend educates herself and decides if she is willing to be an egg donor.
Donor Recruited by Clinic
Using a donor recruited by a clinic can be the easier method to find a donor, but often takes the longest. Many clinics have waiting lists of 6 - 12 months, and sometimes longer. There are clinics that have immediate access to donors, but they tend to be more expensive. If time is of the essence, it is recommended that you call several clinics to determine what their current waiting periods are.
Some clinics do not recruit egg donors and do only shared cycles between IVF patients desiring reduced cost IVF and egg recipients. These clinics often have a smaller selection and a longer wait than the clinics with a specific program for recruiting egg donors. In countries where donors cannot be compensated, there is a donor shortage, which results in even longer waits.
Donor Recruited by an Agency
There are a number of agencies that specialize in locating and matching donors. These agencies generally have immediately available donors, although if a recipient is interested in a particular donor, there could be a several month wait.
Donor Recruited Over the Internet
Recruiting your own donor over the Internet can be a quick process, or it can take a number of months. This will depend on the quality of the donors who are currently advertising on the Internet and whether these donors meet your criteria for selecting a donor.
Advertising For Your Own Donor
Some people place advertisements for a donor in college newspapers or other publications that young women may read. This could involve several personal interviews and the time period for finding a donor could range from very quickly to not at all.
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Is There an Optimal Number of Times a Young Women Should Donate Eggs?
The answer may be three cycles, according to a group of New York researchers who presented their data at the recent annual meeting of the American Society for Reproductive Medicine in Cincinnati, Ohio, 1997.
In a study conducted at the egg donation program at the Mount Sinai Medical Center in New York, women who underwent a fourth stimulation cycle showed a significantly poorer ovarian response than they had during the first three cycles, according to Alan B. Copperman, M.D., director of infertility at the Mount Sinai Medical Center in New York. "The donors' ovaries responded equally well in each of the first three cycles," he said. "But the response was significantly worse when the young women were stimulated a fourth time." In four women who donated eggs four times, peak E2 was significantly lower in the fourth cycle (2,198 pg/ml Ò 687) compared with the first three cycles (3,070 pg/ml Ò 584). The incidence of ovarian hyperstimulation dropped to zero during the fourth cycle, as compared to a baseline incidence of almost 30%.
Infertility clinics often use the same donors over and over again because it is hard to find egg donors, and it is cost-effective to use the same ones repeatedly, according to Dr. Copperman. "You don't have to rescreen them genetically, psychologically or hormonally," he said. The absence of guidelines regarding the optimum number of times an egg donor should donate has led to a situation in which some clinics limit it to two cycles, while others allow an egg donor to donate as many as 10 times, according to Dr. Copperman.
The study results indicate that IVF centers using donors multiple times should analyze their data so that they can inform infertile couples using donor eggs of any potential decreased response of the donors, according to Dr. Copperman. "Until we analyze what's out there, we should be limiting the donors to three attempts," he said. In addition, there may be an association between the decreased ovarian response seen in the New York study and donors' future reproductive potential, the New York researcher added. "It's important that we make sure this is safe," he said.
G. David Adamson, M.D., director of the Fertility and Reproductive Health Institute in San Jose Calif., agreed with Dr. Copperman. "Because egg donation is still relatively new, it behooves us to be conservative and cautious in the protocols that we follow," he said. "I would support the recommendation for all programs pursuing egg donation to look at their own data to see if it supports the conclusion of this small study. It may be a consideration for collecting data on a national basis." --S.F.
Egg Donors Show Reduced Ovarian Response After Three Cycles [Medical Tribune: Obstetrician & Gynecologist Edition 4(12): 1997. (c) 1997 Jobson Healthcare Group]
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How Do Age and Prior Pregnancy Status Affect the Choice of an Egg Donor?
The American Society for Reproductive Medicine issued guidelines in 1997 that egg donors should be less than 34 years old. However, a recent extensive study suggests that this age should perhaps be lowered. Faber et al. (1997) (Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk) examined 568 DE cycles. They found that the previous birth record of the donor did not make a difference. The pregnancy rates and delivery rates with donated eggs were the same whether or not the donors had given birth previously or not. The age of the donor, however, did make a difference. They began to see a decrease in successful pregnancies beginning when the donor hit 33-34 years old. If the donor was less than 33 years old, the pregnancy rates in this study were around 45% and the delivery rates were 35%. If the donor was 33 or older, then the pregnancy rates dropped to 27% and the delivery rates dropped to 22%. So they recommended a cut-off age of between 32 and 33 years old. Note however, those of you might be considering older donors, the rates did not drop to zero. The top age of donors examined was 38 years old.
Reference:
Faber et al., "The impact of an egg donor's age and her prior fertility on recipient pregnancy outcome" Fertility and Sterility, 1997 68:370-372.
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Sample Egg Donor Contract:
This is a sample contract only. It is not endorsed by MVED and has not been approved by a lawyer. Your situation may be different in particular areas, but this contract should serve as a useful guideline for information that should be included in any such document. Many clinics have a contract of their own (which has been reviewed by their lawyers) for your use. It is always a wise idea to have your own attorney review any contract which you develop yourself. Oocyte Donor/Recipient Contract
Statement of the Parties' Intention:
I ____________________ (egg donor) and __________________ (husband/none)
desire to donate oocytes (eggs) to the prospective parents (names withheld to protect
anonymity). I hereby do voluntarily consent and authorize (name of physician) and the
(name of clinic or hospital), their officers, doctors, agents, employees, successors,
assigns, and the in vitro program personnel and associates to perform ovulation
induction and oocyte retrieval.
I (we) warrant that all written representations and information provided to
(name of clinic or hospital) and to any professional physician, physician's
assistant, nurse or embryologist or to the prospective parents are true, accurate,
and complete.
I (we) do not desire to have a parental relationship with any child born
pursuant to this agreement. Further, we believe the child to be morally and
legally the issue of the prospective parents.
______________________________________________________
Purpose of the Procedure:
The purpose of this procedure is to provide a means for the prospective
parents to achieve pregnancy.
______________________________________________________
Requirements of the Procedure:
I (we) represent that the following requirements for participation in this
procedure have been met:
* the oocyte donor is between age 18 and 35.
* the oocyte donor has some form of medical insurance, or
provisions for medical care via the prospective
parents and their health insurer.
I (we) acknowledge and agree that my ( our) acceptance into the program and
our continuing participation is at the discretion of (physician name).
The egg donor agrees to abstain from any unprotected sex and agrees to use
condoms at all times.
The egg donor agrees to adhere to all medical advice given related to this
procedure.
The egg donor agrees not to use any alcoholic beverages, not to use any
illegal drugs, not to use any prescription or non-prescription drugs, without
the knowledge and consent of (clinic or hospital name), commencing 28 days
prior to donating eggs.
______________________________________________________
Description of the Procedures:
I (we) understand that egg donation involves hormone injections to stimulate
the egg donor's ovaries and the removal of eggs from the donor's ovaries by
a needle and the fertilization of those eggs with the husband's/donor's sperm
in the laboratory. If fertilization occurs, the pre-embryos may be placed into
the prospective mother's uterus and/or cryopreserved. Subsequently, at the
discretion of the prospective parents, the resultant cryopreserved pre-embryos
may be later transferred to the prospective parents' uterus and may be
disposed of as the recipient mother sees fit.
I (we) consent to the following medical/surgical/diagnostic procedures:
Pre-IVF screening: determination by medical history and physical
examination that I am a good candidate for this procedure. Screening includes
a workup to rule out any venereal diseases or STD's including the AIDs virus;
Ovulation induction: the use of fertility drugs (usually pergonal, metrodin,
follistim, gonal f, lupron, humegon, and human chorionic gonadotropin (HcG),
to stimulate the growth and maturation of ovarian follicles (eggs) in the ovaries;
Laboratory tests: frequently, blood samples may be taken to monitor hormone
secretions from the ovary and the pituitary gland;
Ultrasound: this is a diagnostic procedure using sound waves to provide a
picture of the ovaries and the follicles to monitor the development of the
eggs and uterine lining;
Egg retrieval: the introduction of a needle into the ovary to obtain eggs.
This is performed with ultrasound guidance. A local anesthetic and/or
painkiller is used to minimize discomfort;
Fertilization: placing the eggs and sperm together in a suitable medium to
allow fertilization. If there is no fertilization after 72 hours of
incubation, the oocytes and sperm will be disposed of in an ethically
acceptable manner;
Embryo culture: development of the fertilized eggs and pre-embryo formation;
Embryo transfer: placement of the embryos into the recipient mother's uterus
by means of a plastic catheter inserted through the cervix into the uterus;
Cryopreservation: if there are more embryos than can be safely transferred,
the excess embryos are frozen for future use by the prospective parents.
______________________________________________________
Success Rate:
I (we) understand that no guarantees have been made regarding the success
of ovarian stimulation and the ability to perform egg retrieval.
I (we) understand that I (we) may not be informed of the ultimate outcome,
i.e., whether pregnancy and/or viable birth was achieved as a result of this
procedure, or any subsequent transfers.
______________________________________________________
Financial Consideration:
The prospective parents and their insurer will be responsible for any and
all medical costs related to complications which may arise as a result of
this procedure.
The egg donor will receive a total financial consideration of (insert amount)
for her expenses associated with participation in this procedure.
Payment will be dispersed as follows:
(Insert amount) to be paid upon the prospective parents receipt of this
signed/notarized document.
The balance of (insert amount) to be paid after egg retrieval, on the date of
retrieval.
In the event of the donor's voluntary withdrawal from the procedure, prior
to egg retrieval, the egg donor will be deemed responsible for all of her
medical expenses. A voluntary withdrawal by the donor, prior to retrieval will
also result in a forfeiture of all financial consideration.
______________________________________________________
Possible Risks and Hazards Associated With IVF/Egg Retrieval:
Potential fertility drug side effects: along with their intended benefits,
fertility drugs have a potential to cause side effects. The most common side
effect is hyperstimulation of the ovaries. Occasionally, abdominal
enlargement with symptoms of abdominal discomfort can occur.
Mild to moderate uncomplicated ovarian enlargement, sometimes accompanied
by abdominal distention, and/ or abdominal pain occurs in about 20% of those
treated with pergonal, metrodin, and HcG.
This is generally reversed without treatment within approximately 2 to 3
Weeks.
Severe ovarian enlargement, known as ovarian hyperstimulation syndrome, is
also a potential adverse side effect of therapy. This syndrome is characterized
by sudden enlargement of the ovary and an accumulation of fluid in the abdomen.
This fluid can also accumulate around the lungs and may cause breathing
difficulties. If the ovary ruptures, blood can accumulate in the abdominal
cavity. Complications of ovarian hyperstimulation syndrome can also include
a blood clotting disorder which can be life threatening. Fortunately, this
syndrome only occurs in about 1.3% of all patients. Treatment consists of bedrest,
correction of fluid imbalances, and the prevention and/or correction of blood
clotting disorders.
Other adverse reactions that have been reported with the use of pergonal,
metrodin, lupron, humegon, and HcG are: allergic sensitivity, pain, rash,
and swelling at the injection site, and ectopic pregnancy. Adverse reactions
with HcG have also been reported to include headache, irritability, restlessness,
depression, and fatigue. Patients taking lupron may experience hot flashes. I(we)
understand that we must report these symptoms immediately.
Blood tests may cause discomfort and a risk of developing a bruise or
infection at the injection site.
Discomfort may also be caused by ultrasound procedures.
During egg retrieval, there is also the possibility of bleeding, infection,
and/or injury to the bladder and/or abdominal organs. These complications can
require surgery and or other interventions. Infection
may impair future fertility of result in a loss of fertility potential.
If I (we) should fail to avoid intercourse during the period preceding egg
retrieval and for at least one week after, I may become pregnant.
______________________________________________________
Treatment Decisions:
I (we) understand that all treatment decisions regarding each step of the
procedure involved will be made by (insert physician name) based on his
independent medical judgment.
I (we) understand that the physician may decide not to proceed with the
procedures and I (we) agree to abide by his decision in this regard.
______________________________________________________
Legal Status Of Children:
I (we) understand that many legal issues surrounding the procedure have not
been resolved and the legal status of children born as a result of this
procedure has been widely debated. It is my (our) intent and understanding
that any children resulting from this procedure will be the legitimate
children of the prospective parents , and that neither I _____________ nor
my husband ever attempt to form a parent-child Relationship with any child or
children born as a result of this procedure.
I (we) accept egg donation as my (our) own act and acknowledge the
child(ren) so produced to be the legitimate child(ren) of the prospective
parents. I (we) waive forever any rights I (we) may have to claim such
child(ren) as mine (ours).
This agreement contains the entire agreement between the parties with respect
to the subject matter hereof. All agreements, covenants, representations, and
warranties, express or implied, oral or written, made by any party with respect
to the subject matter of this agreement are embodied herein. All prior agreements
and representations, of whatever nature, which relate to this agreement are
waived, merged, and superseded. This is a fully integrated agreement and the
terms and conditions of this agreement are to be governed by (insert state) law.
______________________________________________________
Medical Expenses In The Event Of Complications:
I (we) have been informed that if I should suffer any physical injury as a
result of this procedure, that all of the necessary treatment facilities will
be made available. We understand, however, that all of the payment for
medical care as a result of complications related this procedure will be the
responsibility of the prospective parents and their health insurer.
I (we) have also been informed that the prospective parents and their health
insurer, (insert name of insurance company) has agreed to cover the
reasonable and customary charges as well as all medically necessary
expenses related to this procedure.
______________________________________________________
Confidentiality:
We understand that unless otherwise compelled by law, the physician and his
associates will make reasonable efforts to keep information obtained about me
(us) during the course of treatment confidential.
I (we) agree that specific medical details may be revealed in professional
medical publications so long as confidentiality is maintained.
I (we) also agree not to disclose the identity or any other identifying
information about the prospective parents without their consent.
______________________________________________________
Indemnification:
I (we) do hereby agree to indemnify and hold harmless, (physician name)
And the (name of clinic or hospital) and all of their respective employees
and agents, from and against any and all such actions, claims, costs, and
liabilities, including but not limited to attorney's fees, court costs,
damages, settlements, compromises, judgments, and any other losses or
expenses they incur or for which they may be responsible with respect to
any claim or legal action arising out of egg donation.
______________________________________________________
Arbitration:
Any and all disputes arising under or relating to this agreement, shall be
first submitted to the prospective parents' health insurer for resolution
and mediation.
If the parties are unable to resolve their dispute, then the parties may
submit their claims to binding arbitration. The arbitrator shall be an
independent third party as agreed to by the parties or shall be appointed by
the laws in accordance with the state of (insert state name).
Said arbitrator, in his or her discretion, shall be authorized to award costs,
including attorney fees to the prevailing party.
______________________________________________________
I (we) acknowledge by the signatures below that I (we) have read this
instrument and that all questions I (we) have been answered to my (our)
satisfaction. I (we) understand the answers to my (our) questions and
acknowledge that I (we) have received a copy of this informed consent document.
_______________________________________________________________________________
Donor signature Donor husband's signature/none.
Date:_______________ Date:__________________
______________________________________________________________________________
Witness Witness
Date:_______________ Date:__________________
Notary Seal:
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Should I Give My Donor a Gift?
Many of our MVED members did decide to give their donor a gift. They felt that donors like to be recognized as the compassionate women they are, donating to help an infertile couple achieve a pregnancy that they could not otherwise achieve. The donors take a number of medications, then go through a surgical procedure to have the eggs retrieved. This requires a sacrifice of their time and a small risk to their health. While it is true that they are compensated for their time, we all like a "thank you" and a pat on the back for a job well done. Typical gifts might be flowers in the recovery room, a card or letter telling you how important her contribution is to you, a charm for a necklace, or something else special. It doesn't have to be expensive, just a token of appreciation.
Some MVED members chose not to give their donor a gift, preferring not to establish any emotional connection with their anonymous donor.
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Money-back Guarantee Programs
In an effort to expand the options for infertility patients, some clinics offer a money-back package. These are called such things as Warranty, Shared Risk, and Refund Programs. The idea is that a couple can undergo a Donor Egg cycle at a fixed rate, with a guarantee that part or all of the fee will be refunded if the cycle is unsuccessful. In most cases, couples are eligible to use the Program for up to 3 attempts. The Programs are usually not available to people with insurance coverage. The bill is not itemized, and cannot be submitted for reimbursement.
The fee for a complete cycle with these Programs is significantly higher than a standard single IVF cycle. They range in price from $13,000 to $20,000, with the refund being anywhere from 80% to 100% of that fee. The refund is given if no pregnancy occurs, a pregnancy is not sustained for more than 12 weeks, or there is no live birth - depending on each Program's guidelines. A complete cycle is considered to be a fresh cycle and however many frozen cycles are needed to use all embryos created from a single egg aspiration. A complete cycle is limited to a time frame of 12-18 months.
In order to participate in these Programs, both the Donor and the Recipient Couple must meet certain criteria. Usually, there is an age restriction for the donor. Most programs limit the donor age to 34 or 35, but some will go up to 45. Also, she must have normal Day 3 FSH and E2 levels. The Recipient Mother must have a healthy and normal uterus. The male must have adequate sperm production, or be willing to undergo PESA (Percutaneous Epididymal Sperm Aspiration) or TESA (Testicular Sperm Aspiration). Or, the couple can use Donor Sperm. Some Programs have you sign a contract agreeing to their terms, and some insist that you go through their screening process first.
A cycle fee usually includes the following: all IVF in-cycle medical monitoring, including ultrasounds and lab work (blood tests) for both donor and recipient; egg retrieval from donor, fertilization of eggs, and embryo transfer to recipient mother. Some Programs include an initial pregnancy test, and some cover cryopreservation and short-term storage of unused embryos (12-18 months). Also, these services must be given at the clinic offering the Program. If an outside Provider is needed to perform a service, e.g. IVIG or anesthesia for the donor, it most likely would be an additional charge.
In general, the fee does not cover: pre-cycle medical exams and lab tests, including hysteroscopy to examine the health of the uterus; fertility drugs; and ICSI or Assisted Hatching. However most programs will refund the cost of ICSI, and sometimes Assisted Hatching, at the same percentage as the flat fee refund. Also not included in the fee are the costs of Donor Agency screening and fees, and any egg donor and/or sperm donor fees. Any pregnancy-related treatments or genetic testing is not covered.
The money-back programs give couples the opportunity to participate in multiple IVF cycles at a lower combined price than that of numerous single IVF cycles. The "risk" to the couple is that if they become pregnant on the first attempt, they do not get any refund, and have thus paid a significantly higher fee than if they had done a "normal" cycle plan. Also there has been criticism of these Programs, suggesting that there might be more incentive for the clinic to devise a separate protocol for participants in order to raise their success rates. An example would be to transfer a greater numbers of embryos, which would also most likely increase the number of multiple births. In addition, by offering these Programs, the clinic is playing the role of both medical provider and insurer, which could be construed as a conflict of interest. It is important that you carefully research the Program you are interested in, and feel comfortable about the services you will receive. Also, fully explore in detail which services are included in the fee, and which are not, as well as what limitations or additional charges are added.
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Shared-Cycle Programs
A shared program allows a couple to share eggs, and share expenses, with another couple. Different clinics offer different options, but, generally the programs work like this.
There is usually a primary couple and a secondary couple. The primary couple is the first couple to choose a particular donor (or have that donor selected for them). They, then, must wait until another couple chooses the same donor (or is matched with that donor). The second couple then becomes the secondary couple. The resulting eggs will be split evenly between the couples. Usually, if there is an uneven number of eggs, the extra one goes to the primary couple. If the number of eggs retrieved is below a pre-set number, then all the eggs go to the primary couple. In this case, the primary couple usually becomes responsible for most, or all, of the donor expenses.
In some clinics, you are automatically a secondary couple if this is your first attempt, and become a primary couple on subsequent attempts.
There are also clinics that offer a flat 50/50 split on the number of eggs retrieved, no matter how many or how few are produced. In this case, all expenses are also split evenly.
There are some clinics now offering shared cycles with people undergoing IVF themselves who wish to share expenses. This is primarily women who cannot get pregnant for some other reason than because of their eggs. In these cases, the primary couple would be the couple undergoing IVF and you would be the secondary couple, receiving eggs only if there were a pre-set number produced.
Clinics differ in expenses, but most require a flat fee up front. (This fee seems to currently be around $10,000 at several of the clinics MVED'ers have used.) You would be responsible for your own medications. Rather than a flat fee, some clinics simply divide up all the donor's expenses between the two couples including donor fee, meds, monitoring and retrieval fees.
The advantage of using a shared program is that you can save considerably on expenses. The disadvantage is that, now there are three people to coordinate, rather than the usual two, and this leads to a greater chance that the cycle may be canceled for some reason.
Since this is a relatively new opportunity, some clinics are "learning as they go" and don't really provide any protection to you as a consumer. Therefore, it's important to ask questions and get their policies in writing. Try to anticipate things that could go wrong and ask what the outcome would be if that happened. Some questions you will need answers to...
1) Expenses: who pays for what and what are you still responsible for if you don't receive any eggs? What exactly is included in the flat fee you pay up front? The donor fee? Donor's meds? Your's and donor's monitoring?
2. Distribution of eggs: what is the minimum number that must be produced in order for a split to occur? Who gets the extra egg if there is an uneven number? How will the eggs be split up quality-wise?
3. What happens if you must pull out of a cycle?
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Cytoplasmic Transfer
This is an exciting new procedure which uses cytoplasm from a donated egg to improve the quality of the recipient's own eggs...thus allowing the recipient to retain her own DNA within the egg. The idea behind this process is to make your vintage eggs behave like a younger woman's egg and increase the chance of pregnancy/implantation.
A woman is a candidate for this procedure if she can be stimulated successfully. The recipient mom and donor are stimulated simultaneously and retrieval is performed on the same day, or within one day of each other. All eggs are prepared for ICSI. A sperm is drawn up into a needle, which then pierces the donor egg. A small amount of cytoplasm is taken into the needle, and then the donor cytoplasm and sperm are injected into the recipient egg as in an ICSI cycle. One donor egg can supply cytoplasm for two recipient eggs, usually, so there will be leftover donor eggs that can be fertilized and cultured as well.
The recipient mom can choose to have only her own genetic embryos transferred, or a combo of donor embryos and genetic embryos. The donor embryos can be frozen for later use.
With this procedure, the DNA of the donor is usually gone from the embryo by the 16th week according to the research done. Also, this procedure transfers mitochondria (which produce the energy for a cell to do all its activities) from the younger woman's egg to the older woman's eggs which have "tired " mitochondria. This is why women with old eggs either can get pregnant but miscarry early as their embryo doesn't have enough energy to keep growing, don't get pregnant at all as again their embryo doesn't have enough energy to implant in the uterine wall, or the eggs fertilize poorly.
The thinking is that for women with elevated FSH, a history of poor response or poor embryo development, there is a problem with the eggs that is probably related to the mechanical function of the cell. Since cytoplasm contains the equipment that makes the cell work, a "boost" from a younger woman's cytoplasm may help the flawed egg to divide properly. Although the nuclear DNA isn't transferred, there is DNA in the cytoplasm associated with mitochondria, and some RE's (including Jacques Cohen) are a little anxious about the implications of this procedure. The one live baby he reported about in his study was the genetic offspring of his patient, not the donor. There is a good essay about this topic at INCIID's fact sheets.
A few tidbits of info from MVED members:
(1) It is still in the experimental stages, so a clinic that is doing it is probably a good one
(2) It does not use the donor's DNA/genetic material, your embryos retain all your own DNA.
3) It can cost mucho bucks; it's an extra $5,000 at the Jones Institute in Norfolk.
(4) At Jones, you need at least to put out eight mature eggs to participate...reasoning behind this is that just as with ICSI, they can actually LOSE some eggs in the process (mistake, rupturing the egg, etc.) so they want a minimum of EIGHT to work with.
(5) It's generally offered to women over 35 or 40, using their own eggs, because younger women generally don't need that type of help.
This Cytoplasm injection is being done at quite a few clinics on the East Coast, Jones, St. Barnabas in NJ, Cornell in NY, GIVF in Fairfax, VA... It might be worth asking your clinic about.
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If I am over 45 years old, what problems can I expect with a pregnancy achieved through egg donation?
A recent article by Sauer et al., (1996) (Columbia-Presbyterian Medical Center and Univ. of Southern Cal), provides some answers to this question. All information in quotes ("text") is from their article. Items in square brackets are remarks by the author.
Sauer et al., (1996) transferred up to five pre-embryos per IVF-ET (egg transfer) patient into carefully selected women between 45 and 59 years old. They eliminated women with gross distortion of the endometrial cavity, abnormal treadmill stress (ECG) tests, diabetes, cancers, psychological instability and multiple sclerosis. The 162 women that passed the tests underwent 212 cycles where there was successful fertilization of donor eggs and 48.6% established pregnancies. Of the 212 cycles, there were 74 deliveries (34.9%). The rest were various types of spontaneous and clinical abortions. Out of the 74 deliveries, 45 were singletons, 24 were twins and 5 were triplets. The age of mothers who delivered infants was not different from those who failed to conceive. Of those who delivered, 38% had antenatal complications (28 out of 74 deliveries). These complications included preterm labor, hypertension, diabetes, pre-eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets), carpal tunnel syndrome, premature rupture of membranes, placenta previa, placenta acccreta. Only 5% (5/108 infants) of the delivered children had problems (growth retardation (2/108), Downs (1/108), ventricular septal defect (1), small bowel obstruction (1). There were no maternal or neonatal deaths.
According to the authors of this study, "Fertility potential decreases with advancing maternal age, and it is expected that most older women will be unsuccessful in their efforts to reproduce. Numerous reports document that advanced maternal age does not diminish pregnancy rates in women undergoing oocyte donation (Navot et al., 1991, 1994; Lydic et al., 1996). In fact, as noted by our present study, the implantation and pregnancy rates are the same in perimenopausal women as those rates experienced by younger women undergoing oocyte donation (Sauer et al., 1994). With proper hormone preparation, the endometrium retains its receptivity to embryo implantation, suggesting that the decreasing fecundity normally seen in older women is primarily due to ovarian rather than uterine factors."
"Medical and obstetrical complications occur with increased frequency in pregnant women of advanced reproductive age, whether the conception is spontaneous or assisted (Cnattingius et al., 1992). It is often difficult to determine if the observed increase is due to age alone or to other confounding variables such as pre-existing disease, obesity, parity and socioeconomic factors. Glucose intolerance clearly increases with age and may present as pregestational or gestational diabetes. This risk is further influenced by obesity. In a review comparing pregnancy in women over the age of 40 years with women under 30, Spellacy described a 4-fold increase in diabetes, complicating up to 7% of the pregnancies in the older age group (Spellacy et al., 1986). Similarly, hypertension also occurs with increased frequency, and advanced maternal age is associated with an increased incidence of pregnancy-induced hypertension (PIH). However, a significant proportion of this risk is based upon the presence of pre-existing disease or obesity."
Sauer discusses the fact that older maternal age has been reported to impact perinatal morbidity and mortality. However, other studies dismiss the association of age and complications when the pre-existing diseases and prenatal care are considered. Sauer says, "Information from oocyte recipients has not indicated an increase in neonatal morbidity or mortality. This may be attributable to the excellent health of women prescreened to receive donor oocytes, and the high risk obstetrical care with which they are provided."
"Recipients of donor oocytes experience a high rate of operative delivery [Cesarean section]. Many patients undergo elective induction of labour which is not always successful."
1. The high frequency of Cnattingius, et al., Delayed childbearing and risk of adverse perinatal outcome. 1992. JAMA, 268:886-890.
2. Lydic et al., Success of donor oocyte in in vitro fertilization-embryo transfer in recipients with and without premature ovarian failure. 1996. Fertility and Sterility 65:98-102.
3. Navot et al., Poor oocyte quality rather than implantation failure as a cause of age related decline in female fertility. 1991. Lancet 337:1375-1377.
4. Navot et al., Age related decline in female fertility is not due to diminished capacity of the uterus to sustain embryo implantation. 1991. Journal of Reproductive Medicine 36:839-845.
5. Sauer et al., Extending reproductive potential in the older woman. 1994. In: Lobo, RQ (ed), "Treatment of the Postmenopausal Woman: Basic and Clinical Aspects." Raven Press, NY, NY pp. 35-46.
6. Sauer MV, Paulson RJ, Lobo RA. Oocyte donation to women of advanced reproductive age: pregnancy results and obstetrical outcomes in patients 45 years and older. 1996. Human Reproduction, 11:2540-2543.
7. Spellacy et al., Pregnancy after 40 years of age. 1986. Obstetrics and Gynecology 68:452-454.
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Tests You May Be Required to Take
DONOR AND RECIPIENT:
Blood Studies
- Blood Type-RH (blood type and RH factor)
- CBC (complete blood count)
- Chlamydia Ab - tests for antibodies against Chlamydia trachomatis, a sexually transmitted disease.
- Cytomegalovirus (CMV) - is an infection is caused by a common virus. It is harmless to most people. CMV is a member of the herpes group of viruses. Most people catch CMV at some time in their lives. Most adults and children who catch CMV have no symptoms and are not harmed by the virus. The danger is if you get this virus in your 1st trimester it can severely deform the fetus. This is only a concern if you are negative for the virus, and your donor is positive. Currently, there is no research that shows a donor's egg can/has infected the recipient.
- Ranges in Elisa Units (for the Elisa diagnostic test)
IgG < 15 test is negative for IgG antibody
IgM <= .9 test is negative for IgM antibody
IgM .91 - .99 test is inconclusive, should be repeated
IgM >= 1.0 test is positive for IgM
- Hepatitis B (HBV, HbsAG, HcAb) - Hepatitis B is a highly infectious virus that attacks the liver. HBV is found in blood and certain body fluids of people infected with HBV, fluids such as serum (blood), semen, vaginal secretions, and saliva. It can be transmitted by contact with these fluids. The blood is tested for the presence of antibodies and antigens to the hepatitis B virus.
- Hepatitis C - Hepatitis C is a viral infection, which causes inflammation in the liver. Hepatitis C is transmitted by exposure to the blood of a person with hepatitis C or by sexual contact. The blood is tested for the presence of antibodies
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