Egg Donor Series: #2

WHO CAN BECOME AN EGG DONOR?

Not all women can donate eggs. Programs vary in the qualities they prefer, but some criteria are fairly standard. Certain rules are set for legal reasons. Other policies are designed to increase the chance that a pregnancy will result and that the process will be safe for both donor and recipient.

Commonly, egg donors must be a certain age, usually 21, and be no more than 35. The lower limit ensures that a woman can legally enter into a contract. The upper limit reflects the fact that older women respond less well to fertility drugs. There is also a chance that an older woman's eggs will be abnormal, making pregnancy less likely or increasing the risk of a birth defect. Some programs prefer to use donors who have already given birth or successfully donated eggs. It is believed that they are more likely to be fertile and it is easier to anticipate their feelings about having genetic offspring born to someone else.

WHAT DOES EGG DONATION INVOLVE?

If you want to become an egg donor you may have several medical visits before you are accepted. These visits will include a physical and gynecological exam, a medical and family history, blood and urine tests, and a psychological evaluation. You will also discuss your rights and responsibilities with a program representative. A donation will not occur unless you are accepted and give your consent.

Using donated eggs to establish a pregnancy involves in vitro fertilization (IVF). First, you will take a series of fertility drugs (some of which must be injected) to stimulate your ovaries to produce many eggs at one time. While using the drugs, you will have frequent medical tests. Removing the eggs from your ovaries involves a minor surgical procedure. After you recover from egg retrieval, your part of the treatment cycle is finished.

Your eggs will then be mixed with sperm from the intended father in the clinic's laboratory. If embryos result, they will be grown in a lab dish before one or more are transferred into the uterus of the mother. If she becomes pregnant and delivers a child, she will be the birth mother and legal mother of that child.

Before you are screened, program staff should thoroughly describe the procedures and risks involved in donation. That way, if you decide not to proceed, you can avoid the screening process.

General medical screening: You will have a physical examination, including a pelvic exam. Blood will be drawn to check your hormone levels. Ultrasound (which uses sound waves, not X rays) will be used to examine your uterus, ovaries and other pelvic organs. These tests might reveal an existing health problem.

You will complete a detailed medical and psychological history about yourself and close blood relatives. It will include questions about your use of cigarettes, alcohol, and both prescription and illegal drugs. Many programs conduct unannounced drug tests during the screening and donation process.

Infectious disease screening: When blood or tissue is transferred from one person to another, it can carry viruses or bacteria. To minimize the risk that a donor egg could cause illness in the mother, donors are tested for a variety of infections.

STD Screening: During your pelvic exam, a small scrape from your cervix will be taken to test for gonorrhea and chlamydia. Blood will be drawn to test for syphilis, hepatitis B and C, and HTLV-1 (a very uncommon virus that is associated with some cancers).You will have a blood test to see if you have been exposed to HIV.

Although there has never been a report of this happening, a program should not accept any egg donor who is at increased risk for exposure to HIV or other infections. According to State regulations, you may not donate eggs if you have injected drugs or been engaged in prostitution within the last five years. You are not eligible to donate eggs if, within the last year, you have been diagnosed with syphilis or if you have received acupuncture, a tattoo or body piercing without being certain that sterile procedures were used. If you have had more than one sexual partner in the last six months, you are not eligible to donate eggs. The program may also require your sexual partner(s), if any, to be tested for HIV.

Before you are screened for infectious diseases, make sure you understand the tests, and whether and how you will be given the results. If you have an infection, seek medical treatment to protect your own health and fertility.

Screening for inherited disease: Most programs try to learn all they can about a donor's genetic make-up in order to minimize the chance that a baby will have a birth defect or serious inherited disease. You will be required to provide your complete medical history. You will be asked medical questions about your biological parents, grandparents, brothers and sisters. The program may tell you what information to collect, or they may have you work with a genetic counselor to identify:

• Any birth defects that required surgery or resulted in medical problems (such as a cleft lip, spina bifida or a heart defect).
• Certain genetic disorders (such as Huntington's disease, hemophilia, Tay Sachs disease or sickle cell anemia).
• Inherited diseases that are of special interest to a recipient because of her own family history.
• Any major medical problems, surgeries, mental retardation, or psychiatric problems.

For any close blood relatives who have died, you will need to know how old they were and the cause of death. Some common diseases (such as cancer or heart disease) that strike when people are middle-aged or younger are influenced, at least in part, by genetics.

Some programs do a large number of genetic tests on all donors. Others select specific tests for each donor. Some tests are required by state law. A program may check for disease genes that are common in the ethnic group of either you or the mother. You might be tested to address a genetic concern in the family of the mother, or to answer questions raised by your family history.

Psychological screening: Donating eggs requires you to confront complex ethical, emotional and social issues. The screening process should help you evaluate your desire to donate and to think through these issues.

You should have a chance to ask questions and express any concerns. In most programs, you will meet with a mental health professional to discuss your life circumstances, your support system, your feelings about the donation, and related issues. In addition, many programs ask donors to take psychological tests.

Another goal of psychological screening is to make sure that you will fulfill the complex requirements of egg donation. Failure to follow instructions can endanger your health and jeopardize the procedure. The program also wants to minimize the chance that you will have regrets or psychological problems, or find the procedures traumatic.

Before you decide to participate, you must try to foresee how you will feel about donating your eggs and the possibility that children will be created who are genetically related to you. You may want to discuss these issues with your spouse, a relative or a trusted friend.

The program should offer you psychological counseling and support throughout the decision making and donation process. Talking with an independent counselor can be helpful, too. If you need help finding one, the program should be able to refer you to an independent counselor who is familiar with infertility treatment issues. The goal of counseling is not to convince you, or help you "adjust" to the program's demands, but rather to better allow you to decide, of your own free will, whether you wish to donate your eggs.

The American Society for Reproductive Medicine suggests that a woman should not donate eggs if she:

• Has a serious psychological disorder.
• Abuses drugs or alcohol or has several relatives who do.
• Currently uses psychoactive medications.
• Has significant stress in her life.
• Is in an unstable marriage or relationship.
• Has been physically or sexually abused and not received professional treatment.
• Is not mentally capable of understanding or participating in the process.

If any of your close, blood relatives have serious psychiatric disorders, the program needs to know, because some psychiatric disorders may be inherited.