As a nurse practitioner, Monica received advanced nursing education in addition to being a registered nurse. She is a fully licensed registered nurse and Advanced Practice Nurse Practitioner in the state of Connecticut and is certified by the board of the American Academy of Nurse Practitioners. Monica’s nursing work experience spans nearly two decades in the field of fertility treatment. Monica’s passion lies in taking care of the whole patient. Monica works with patients and stresses the importance of integrating comprehensive care – including yoga, acupuncture, massage therapy and nutrition – with fertility treatment.
You are sitting across the desk from your doctor trying to absorb the sobering news that, “Using donor eggs is your best option.” You have known for some time that you don’t make many eggs during an IVF cycle, and perhaps your cycle has been cancelled more than once for only making one or two eggs, but donor egg? Are there any other options? Where do you even find an egg donor?
If you’re confused, scared and unsure, you are not alone. Hearing that using donor eggs is an option can be both reassuring and disheartening. The success rates for recipients using donor eggs are usually the highest in any fertility clinic, often approaching 70%, depending on other reproductive factors, such as sperm quality and the health of the uterus. There is no doubt that the move to using donor eggs often increases your chance of you getting pregnant, but this technology also unleashes a torrent of questions, concerns and difficult emotions.
First, let me say that not only is it common to grieve, it’s necessary. Even if you haven’t had a pregnancy loss that led you to this point, you have still potentially experienced the loss of a dream, probably one that you’ve had since childhood. I’m pretty sure that when we played house with our friends, we never factored in ovaries that aged before the rest of our body did. I’m pretty sure that even though we may have daydreamed about our ideal partner in middle or high school, that that dream didn’t include a person whom you’ve never met contributing her eggs to you in order to conceive. So, of course it’s understandable that news like this can open a floodgate of emotions: uncertainty, shame, anger and guilt are often among them.
Not only are you allowed to feel them, we encourage you to, as it’s necessary to go through these stages in order to make the decision to use donor eggs.
The Donor Egg Process | How to Find an Egg Donor
It’s helpful to start by unpacking the donor egg process. First, you are not alone, about 12% of IVF cycles in the United States involve the use of donor eggs. Not too long ago, egg donation was only indicated for women who had surgical removal of her ovaries or premature ovarian failure. At present, the use of donor eggs is mostly offered after a woman has been diagnosed with diminished ovarian reserve either by diagnostic testing; by having had multiple, failed cycles with an indication of poor egg quality; or by creating blastocysts with a very high rate of chromosomal abnormalities (aneuploidy) as evidenced by abnormal preimplantation genetic testing (PGS or PGT-A) results.
Egg Donor Screening & Recruitment
Egg donors are often recruited in-house by a fertility center. The applicants undergo a rigorous screening process that culminates in only about 10% who make it to the screening stage. A young woman (age 21-32) who is interested in donating is first asked to complete an application, then screened by phone and, if she meets criteria, a meeting is set up with the Third Party Team, which often consists of the medical director, nurses, patient navigators and financial coordinators. The medical screening day consists of the prospective donor having ovarian reserve, infectious disease, genetic and psychological testing done, as well as undergoing a complete physical exam with an ultrasound. If she is accepted by the program, her profile, inclusive of relevant information and pictures, is then listed in a database for singles and couples who are in need of donor eggs (these parties are often referred to as the recipients or intended parents).
I am ready to review egg donor profiles, now what?
The method for choosing a donor differs by person/couple and there is no manual for the correct way to proceed, or “how to choose the right egg donor.” Most couples start the egg donor selection process based on desired physical characteristics, such as hair and eye color or height. The next set of criteria can vary depending on the interests, concerns, and values of the couple. Some, for example, decide what they don’t want vs. what they do want. For example, if a male partner has a strong family history of diabetes, they may decline a donor with a similar strong history as the child will have a greater chance of developing this disease. Many couples value some evidence of intelligence. In my experience, this is difficult to measure. Most fertility centers do not do IQ tests, but you will have access to information such as highest level of completed education. I caution couples who base intelligence solely on this measure, as many women have not had the financial means to pursue higher education. In fact, some egg donors whom I have gotten to know use their compensation to pursue college or other degrees. Other couples seek someone with whom they feel a connection, maybe she has a quality that they either have or desire, such as athletic ability or musical skill, or loves animals.
When choosing an egg donor, you may also wonder about her personality and mental health. Since the questionnaire is completed by the donor, you will get a feel for what she is like just by reading her application. Usually, the internal recruitment team gets to know her pretty well and can provide you with some additional insights. She also meets with a mental health professional who interviews her and administers a personality test. Any concerns that the mental health professional has after meeting her, scoring her test and/or any serious psychological or mental health issues in the donor’s past would exclude her from becoming an egg donor. We also look for signs that she may not be compliant, such as not responding to phone calls or emails in a timely manner, etc.
Still, others may choose to have an agency find their egg donor. This is a more expensive option, but agencies are able to recruit a larger pool of donors, often with more culturally diverse backgrounds. For example, the highest percentage of egg donors recruited by Illume Fertility categorize themselves as ‘white,’ with ancestry tied to Europe, so if you would like a donor with Asian or African lineage, for example, you might choose an agency to help you find one. Your fertility center can guide you and give you a list of reputable agencies with whom they have a close, working relationship. We’d be happy to connect you with our network here at Illume Fertility.
Connect with us today to learn more about egg donation.
How to Get “Un-stuck” When Selecting an Egg Donor
So, you reviewed a few profiles (It’s unlikely that you will choose the first donor who is presented to you) and now you feel stuck. How do you choose someone without meeting them? You don’t even buy a plant without seeing it, touching, comparing it to other plants, etc., and this decision is infinitely more important. This is a common and reasonable question, and my advice is that ultimately, you need to go with your instincts. ‘But,’ you say, ‘I am spinning. I don’t know how to make a decision like this…’ I will offer you the same piece of advice I have given to many – go to a quiet space, close your eyes and visualize the person that is described on the application (not her physical appearance, but the essence of her as a person). Do you like her? When you sit with the image of her as your donor, how does that make you feel? If the feeling is positive and feels ‘right’ then that is your answer. If something bothers you about accepting her, even if you can’t completely describe what is concerning, then that is an important clue that she is not the right donor for you, and I encourage you to honor that decision.
Why do people decide to donate their eggs?
I find that although the compensation for their time and effort during the donation process is important, their reasons that young women donate eggs aren’t solely financial. Most donors mention an altruist reason, such as having a friend or family member that has struggled with infertility. Many have reported a sense of joy by realizing that they are helping someone build their family, and I have experienced this first-hand. At some fertility centers where I have worked, the couple was allowed to write a card to their donor and I, as the nurse, was often the one who gave it to her. The moment when she reads the card is both touching and priceless, and confirms my belief that she is not just “doing it for the money.” Egg donors are typically emotionally invested in helping another family.
Fears and Concerns When Using Donor Eggs
I am happy to say that I can alleviate one concern pretty quickly – that being the safety of using donor eggs. The process of utilizing donor eggs is strictly regulated by the American Society of Reproductive Medicine (ASRM) and the US Food and Drug Administration (FDA), and includes rigorous testing for infectious diseases and recessive (unseen or hidden) genetic mutations. Also, there has never been a case reported where an infectious disease has been transmitted via donor eggs.
After safety, the most common concern that I hear is the fear of not bonding with your baby since donor eggs were used. Although this concern is theoretically understandable, I have seen the opposite to be true. All of the families who have used donor eggs are just as happy, bonded and complete as those who haven’t, and as a Nurse Practitioner in the field of Reproductive Medicine, I’ve seen (and kept in touch with) a lot of families.
When we transfer an embryo that is made using a donor egg, we are essentially providing you with a new opportunity, and the genetic building blocks of a baby. The nurturing, growth and development, though, is your contribution. This concept is helpful to most women who experience self-doubt due to many years of dealing with infertility. It is not uncommon to feel that you can’t trust your body anymore. I can reassure you that just because your ovaries aren’t behaving, doesn’t mean that your uterus is any less capable than anyone else’s when it comes to carrying a pregnancy. There is even some evidence that the maternal environment has the ability to alter the expression of some genes, meaning your maternal environment can ultimately positively affect the genetics of your baby.
There is no doubt that the decision to proceed with donated eggs is not an easy one. Since the need to use donor eggs may follow months or years of the trauma of trying and undergoing many failed cycles or pregnancy losses, you are already emotional exhausted and discouraged. I can’t emphasize enough the importance of allowing yourself to feel tough emotions. I once read that suppressing emotions is like pushing a beach ball underwater, it’s a lot of work and always pops back up again in a different way or location. Talk to your partner, trusted friend, or mental health professional. To all the women who are fighting for their fertility, I offer you my support and this open letter to fertility warriors.
Finally, I feel that the best perspective is from someone who has a similar experience, so I will leave you with the words of a blogger (and recipient of donor eggs) Becky as she describes her perspective of motherhood:
“I have come to realize that, whether they were genetically mine or not, I could still have these experiences and be all of these things to my children. Although they may not have my eyes or smile, these feelings are way more important than the passing down of a family trait. Without the gift of donated eggs, I would have never been able to truly define and experience what is to be a Mum.”