Which young lady, when faced with crippling student debt and having to pay rent, hasn't (jokingly) contemplated donating her eggs? Well, maybe that's a generalization, but egg donation is often suggested for people who want to help out childless families — and make some money in the process. (In fact, one study found that most women donate their eggs for altruistic reasons, not financial ones.) But for many women contemplating the option, though, the realities of egg donation aren't actually clear — from the money involved to the process of donation itself, and the different medical and health consequences that need to be considered before going forward with it.
According to inviTRA, a community for people trying to conceive using IVF, egg donation is regulated on the state level in the U.S., not federally; it's based around recommendations by medical associations and the needs and wants of egg "customers" (people who will use the donations) themselves. Which means that you need to do a lot of research into the particular legal and medical structures of the state in which you're donating. If you're donating to somebody specific, called a "known donation," they need to be in the conversation too. All kinds of people want egg donations to help them become pregnant, and the eggs you donate, if viable, will go on to be used for IVF. It's an amazing process that was unthinkable less than 30 years ago, but it's more complicated than popping into a gynecologist's office and leaving with a check.
Not Everybody Is A Born Egg Donor
Unless you've been directly asked by somebody who wants your eggs in particular, you'll have to fulfill the needs of the particular agency or donation service you're using. Their criteria can vary widely, but often they want you to be over 21 and under 34, according to inviTRA. They also ask for a full medical history (to track the illnesses and cancers that run in your family), a relatively high education level (college is often a minimum), and a lot of photographs of yourself throughout your life. The National Gamete Donation Trust in the UK says that most donors need a BMI of less than 30, a lack of fertility issues, hereditary disorders, or medical disability. Donation agencies will ask questions you may find invasive or offensive, including about your ancestry. Even if you've been specifically picked by another person and have agreed, you'll still likely have to fulfill this testing or part of it.
It Involves Daily Injections & Surgery
The process of egg donation has several stages and is pretty intense on the body of the donor. Women who donate must have their menstrual cycles synced to that of the person they're donating to, whether they are a surrogate or the mother, which means daily visits to clinics to have several hormonal birth control medications administered until ovulation lines up at the same time. Egg donors must also go through a three-part process that hyper-stimulates their ovaries into producing as many eggs as possible so that there's a good amount to be donated. If you're not comfortable with daily injections in your butt, administered either by you or by a professional, egg donation is not the right route for you.
Once the eggs are ready, donors get a single dose of gonadotropin, which is often used in IVF, to stimulate ovulation, and the eggs are removed during surgery within the next day or so. Yes, egg donation does involve surgery: Unlike in sperm donation, women who donate are sedated while physicians remove eggs from their body using an aspiration needle, and then need to take time off to recover from the effects of the procedure. Egg donation doesn't mean one egg at a time; as many eggs as are available are taken, with an average of around 10 to 15.
The Health Risks Are Not Conclusively Known
This is a big stumbling block: it's not correct to say that egg donation is unsafe, but it's also not correct to say it's safe. The most accurate summary of the situation is that we don't actually know about the long-term health risks of the procedure. Part of this is because, unlike in the UK, the U.S. doesn't have a registry that egg donors are required to sign up with before they donate, and there are no formal procedures for follow-up on former egg donors. The science simply doesn't really exist to make a judgement one way or the other.
What we do have are anecdotal stories, which are valuable of themselves, but don't constitute evidence. Numerous news stories have raised the possibility that the extensive hyper-stimulation of ovaries might have a link to cancers in women that relate to hormones, like breast and ovarian cancer. This, however, has not been studied, and it would be very difficult to get an adequate sample of donors to study it. The same goes for anecdotes about egg donation causing endometriosis; there's little medical information to judge whether this is a credible risk.
One side effect we do know about is the possibility of ovarian hyperstimulation syndrome. It's known to be a rare side effect, and is basically explained as the ovaries going into overdrive and producing too many eggs at once; it's also found in women who've taken fertility drugs for their own IVF cycles. The syndrome, however, only causes some ovarian swelling and discomfort. The severe form of the condition is much rarer, but is extremely serious, causes high fluid build-up in the abdomen and can result in blood clots.
A survey by the Washington Post also found that calls for egg donors, which can range from newsletter ads to Craigslist, often don't mention any potential side effects or risks at all. Other risks include potential issues with the donation surgery itself.
The Prices Aren't Regulated
It may surprise you to know that the "egg marketplace" isn't actually regulated, and that suggested prices for an egg donation cycle are just that: suggestions. In 2000, the American Society For Reproductive Medicine suggested that any price over $5000 for an egg donor required "justification" and declared anything over $10,000 wasn't viable, but after a class action lawsuit in 2016 by egg donors who alleged that the ASRM was artificially suppressing their profits, they removed the pricing guidelines. In reality, any price between $8,000 and $10,000 is normal, but the nature of the industry — with state-to-state differences in legislation and an open market for donors and donor seekers — allows for prices to vary. "There is no benefit to being squeamish here," wrote the President of Barnard College for Fortune in 2015, "or in proclaiming that paying a young woman $5,000 for her time, risk, and genetic material is somehow morally superior to paying her $25,000 or $40,000 for exactly the same thing. We have identified this transaction and allowed it. Now we are only squabbling over the price."
In practice, this means that first-time donors will have to do research and work out the financial aspect on their own. It's also important to remember that insurance is often available for donors, often purchased for them by the company in charge of the donation, and it's worth scrutinizing it carefully to see if, for example, it covers long-term medical care for health problems resulting from the egg donation or surgery. A lot of egg donor insurance doesn't. Read the fine print and get a lawyer (and your primary care physician, if possible) to look it over too.
What Happens Afterward Can Be Emotional
Unless you personally know the couple who are using your eggs, whether you know about the results of your donation depends on the contract you've signed with the donation agency. A 2002 document called the Uniform Parentage act declares that an egg donor doesn't have any parental rights, but it's only followed in terms of egg donation by Alabama, Delaware, New Mexico, North Dakota, Texas, Utah, Washington, and Wyoming. Depending on what you've signed with the agency, they may be under no legal obligation to tell you what's happened with the eggs.
You also need to make sure you make provisions for your post-procedure care. Egg donation is hard on the body, and it's not the norm of the American fertility industry to offer much post-procedure care, either physically or psychologically, to donors after the cycle. Psychological care is an interesting one; Our Bodies Ourselves, an organization that's part of the call for a national egg donor registry, notes that a 2008 study found that nearly 20 percent of egg donors found the process psychologically difficult or challenging, and the lack of regulation in the U.S., once again, means agencies don't have to have the provisions to help with that.
If you're considering donating your eggs, you need to go in with your eyes wide open, your research done, and your finger firmly on the pulse of the latest news about its risks and difficulties. While you shouldn't believe scary stories about it, it's important to prioritize your own health and safety in all circumstances, even if it means looking askance at $8,000 paydays.