Egg Donor Series: #1

Knowing that Jeri & I want to go the route of egg donation I've decided to do a series of posts related to the donor and recipient sides of the donation process.

This article gives some great basics of egg donation:

1. KNOW WHY YOUR EGGS ARE NEEDED

Before you start hunkering down into your nest to produce some eggs, you should take a minute to get a refresher course in basic human biology. All egg donors usually have the following body parts:

1. Eggs. Female reproductive cells (oocytes). Women are born with a finite amount of eggs (hundreds of 'em, but finite nonetheless).
   
   
2. Ovaries. The glands producing eggs and hormones. You have two: one located on each side of your pelvis.
   
   
3. Follicle. A fluid filled sac in the ovary that releases the egg at ovulation.
   
   
4. Uterus. The hollow, muscular female reproductive organ that houses the fetus (a.k.a. the womb).
   
   
5. Estrogen. A female hormone that directs the reproductive cycle; levels are particularly high from puberty to menopause.

If you remember 7th grade sex education class, you'll recall that fertile women ovulate approximately once a month. During this time, a healthy egg (or sometimes two) travels out of an ovary and down the fallopian tube to the uterus, where it attaches itself to the uterine wall and eventually turns into a baby (if it was fertilized). There are many women out there who are perfectly healthy and are physically capable of ovulating, except there is one problem: no eggs. So these women often seek out egg donors. The doctor removes your egg, fertilizes it with the father's sperm, and surgically implants it into the mother's uterus, where it grows into a fetus and pops out 9 months later as a healthy bundle of joy.

Donating your eggs is one option in what the medical profession calls "assisted reproductive technology," or A.R.T. A.R.T. offers a wide variety of choices for infertile couples to achieve pregnancy, such as sperm donation or in vitro fertilization.

Why would a woman not have eggs of her own? Perhaps she lost her eggs due to chemotherapy, disease, menopause, or genetic abnormalities such as being born without a uterus. In the US, approximately 2% of women of reproductive age are infertile, and receiving donated eggs fertilized in a lab by their partner's sperm can offer as much as a 65% chance of pregnancy. Naturally, the success rate for this method of A.R.T. depends on many factors, including the age and health of the egg donor. So let's move on to how you know if you qualify to be a donor.

2. MEET THE DONOR REQUIREMENTS

To be a donor:

• You must be a woman in your peak reproductive years, generally considered in the fertility profession to be between 21- 35 years of age (depending on the clinic).
  
  
• You must be healthy, including the appropriate weight for your height. Your family history must be clear of hereditary diseases (such as cystic fibrosis or heart disease), and birth defects.
  
  
• Some infertility clinics prefer that you have already conceived at least one pregnancy, but this is generally not an absolute rule.
  
  
• You should be a paragon of "low-risk behaviors": not at risk for STDs, not an addict, and not an alcoholic.

If this describes you, proceed to an infertility clinic or donor agency to begin the screening! However, we should warn you that there are other factors which, while not required, do make for more attractive candidates. Just think of what most people look for in a date: proof of intelligence, attractiveness, and athleticism.

3. FIND A CLINIC

There are several ways to find a clinic to which you'd like to donate an egg.

Make sure that the doctors at the clinic or agency you choose are board certified ob/gyn specialists or reproductive endocrinologists. Remember, this is your body we're talking about. Be confident about the professional qualifications and ethics of the people who will guide you through the egg donor process. Ask tons of questions, and make sure that you feel completely comfortable with the clinic. Before you sign anything, interview the doctor. Ask how many egg donation surgeries he/she has performed, what kinds of complications you could suffer from, and if he/she has any referral patients to whom you could speak. ANY hesitancy on any of these points should be a hint that you should fry your eggs at another clinic.

4. FILL OUT A QUESTIONNAIRE AND GET A MEDICAL EXAM

The questionnaire

The clinic you choose will require you to complete a questionnaire about your height, weight, general medical history, ethnic background, religious heritage, and your interests. You'll also be asked to reveal personal tidbits such as "Are you athletic?" "What's your level of education?" "Is that your real hair or are you a natural blonde?" They may also want to know your reasons for wanting to be an egg donor.

"Hey!" you holler, "can they ask about my ethnicity and religious preferences?" Yep. This isn't a job application -- it's a way to present your anonymous donor profile to a recipient couple who may not want the eggs of a 6 foot tall high school basketball star who went to church summer camp. They might prefer, say, a Chinese-American sculptor or a professional juggler from a double-jointed circus family. This is assisted reproduction, and the goal of many families is to find a donor that matches the family itself as closely as possible.

The exception to this "personal questions" rule is if you are a "Compassionate" donor (though we know that you are a very very nice person, no matter what), which means that you and the recipient know one another and have agreed to the arrangement prior to contacting a fertility specialist. This is often the situation when one sister donates to the other. But even if you're a compassionate donor, you must fit the health, age and weight specifications.

The medical exam

Regardless of whether you are a compassionate or anonymous donor, you must:

• Get a complete physical examination
• Get a pelvic exam
• Get tested for STDs
• Get blood tests
• Get at least one psychological consultation
• Get a full record of your own and your family's medical history
• Be able to give yourself injections

The presence of any problems at the time of the exam or in your medical history will make you an extremely unlikely candidate. For instance, if you or anyone in your family now or ever had Tay-Sachs Disease, Sickle-Cell Anemia, or Down's Syndrome, you're guaranteed to be rejected.

If you pass the medical and psychological criteria, you will be asked to sign a Donor Agreement, and the doctors will start to prepare your body to pump out super-strong eggs.

5. SIGN A DONOR AGREEMENT

The donor agreement

When a program accepts you as a donor, you will be asked to sign a Donor Agreement. The specific details of the laws vary depending on what state you live in, but they uniformly address the fact that in signing the donor agreement, you also agree to the following:

• You agree that you have no parental claim or rights to a child born from the egg/s taken from your body (even if you want those rights). The child legally belongs to the recipient couple 100%.
  
  
• The donor agreement must also clearly state that the financial responsibility for the procedure, as well as for raising the child belongs to the recipient couple; they're paying for the cost of your hormone shots, your clinic visits, your psychological counseling, and the egg retrieval procedure (unless agreed upon to be covered by your insurance).
  
  
• The donor agreement must state that the recipient couple has legal and financial responsibility for the child throughout his/her life. You are never required to give child support.

The donor agreement is a legal document, and as with anything you're signing your name to, make sure you read it carefully and understand it. If you have questions, ask the clinic and see if you can get a lawyer friend to skim it too. Again, specific laws vary from state to state, but you can find guidelines and sample agreements through The American Surrogacy Center. You'd be especially smart to read over this sample agreement so that you know exactly what to ask when you visit the center.

6. UNDERGO THE DONATION PROCEDURE

All those cranky hygiene filmstrips in junior high told you that that every month, you develop and lose an egg, which washes out of your body with the lining of your uterus during your menstrual period.

While you're an egg donor, you will be producing more than one egg per month. With your ovaries on overdrive from daily injections of gonadotropins (hormones that are self-administered, unless you can talk someone into giving you shots) you'll produce about 15 to 18 eggs in a menstrual cycle.

The biggest risk to you as an egg donor (besides the bloating) is unplanned pregnancy. This is a real danger -- with all of those eggs ripe for pregnancy, your chances of pregnancy dramatically increase. So be sure to follow the instructions your clinic gives you about being intimate with your partner, as you are mega-fertile while on the hormone cycle.

A donor cycle takes three to four weeks, and though the procedure varies from clinic to clinic, this is a standard approach:

1. When you begin your menstrual period before the scheduled donation, you will begin 7-10 days of injections of a drug called Lupron, which suppresses your natural cycle. Remember, you are getting these shots at home, administered either by your own hand or the hand of a brave friend.
   
   
2. After the Lupron, you will begin about a week of injections of a gonadotropin hormone such as Pergonal. Gonadotropins are "super ovulating drugs" that induce your ovaries to make many, many eggs.
3. After about five days, you will be scheduled for a transvaginal ultrasound. This ultrasound will produce images of your follicles on a small video monitor. It's not painful. During this procedure, the clinic is checking to see how big your follicles are getting, which is a way to tell how many eggs you're making.
   
   
4. You will begin daily blood tests to monitor your estradiol level, which is the fluid in your follicles. Again, the clinic is checking to see how the eggs are progressing.
   
   
5. Depending on your estradiol levels and other considerations, the doctor will prescribe Human Chorionic Gonadotropin, or HCG, the night before the retrieval procedure is scheduled -- HCG triggers ovulation. Timing is crucial at this point. Do not be late for the retrieval appointment, or the whole process may go down the tubes.
   
   
6. Do not eat, drink, chew gum or do the wild thing the night before the procedure. It is surgery, after all. Have someone drive you to the clinic or medical office, and drive you home. Your clinic will tell you specifically how to prepare for the procedure.
   
   
7. Retrieval usually takes less than 30 minutes and takes place in a surgical suite. You will be asked to empty your bladder, remove your jewelry and eyeglasses/contact lenses, and put on a paper hospital gown. You will then be given a general anesthetic. Once you're rested and numb, the doctor will remove your eggs carefully with a needle that he/she guides by watching an ultrasound monitor. Again, this varies from clinic to clinic, but you can expect this minimally invasive surgery.
   
   
8. Once harvested, you will spend about an hour in a recovery room, and then you can go home later the same day. You may feel sleepy and/or nauseated from the anesthesia. You will be prescribed antibiotics to prevent infection from the surgery, and most women return to work/school the following day.

What happens to the eggs? They're placed in a petri dish with chemical solutions, and are mixed in the lab with the recipient dad's sperm. A few of the fertilized eggs will be implanted into the recipient mom, and their journey towards family life will begin. The additional eggs can be frozen at the clinic for use by the recipient couple if this pregnancy does not progress to full term, or to access at a later date for an additional pregnancy.

As with anything having to do with your own body, becoming an egg donor is your decision, and it does have its fair share of risks. You are injecting yourself with hormones, you are undergoing surgery, and there will be a baby running around out there that has half of your genetic makeup. So don't take this entire procedure lightly; it can be extremely emotional.

By the way, it's a fantastic present to give. We salute you!