Increasing infertility rates combined with technological advances in egg and sperm donation have created an ever-increasing market for desirable gametes. This has provided us with an invaluable opportunity to offset the decline in our "natural" procreation.
As much as 33 % of heterosexual couples of childbearing age are infertile, and many can only reproduce through the use of donated gametes. Desperate infertile couples collectively spend over two billion dollars each year on infertility and ART treatments.
Egg Donation Overview:
The explosion in the use of donor eggs as a viable method of assisted reproduction occurred in 1983, when the first woman with ovarian failure delivered a child conceived from a donated oocyte. Since 1983, the use of donor eggs, and the number of egg donation programs has dramatically increased. Recent medical advances have provided infertile couples a previously unavailable opportunity to have a child genetically related. Moreover, couples also have the option, in some cases, to contribute to the gestational development of their own child. We now have the opportunity to simultaneously help infertile couples through the use of our donated egg, and promote the interests of the gay agenda by assuring that there will be a Gay future.
Egg donation remains a relatively new reproductive procedure, involving the removal of one or more eggs from a donor and the transfer of those eggs to either the intended mother or a surrogate. Developments in the field of egg donation have offered to over 100,000 women in the United States, the opportunity to have a child who has a genetic relationship to her spouse. These women are often otherwise unable to produce healthy eggs due to premature ovarian failure, anatomically inaccessible ovaries, abnormal eggs, or lack of ovarian function due to radiation, chemotherapy, or surgery.
Egg donation has been a burgeoning field since the '80s when the first egg donors received a scant few hundred dollars for their troubles and tissue. In recent years an increasing number of infertile couples have looked to technology to fulfill their dreams of a biological family and buyers have flocked from Canada and Europe, where the transaction is illegal. Hence, the price of eggs in America has steadily risen. Demand for egg donors has outstripped supply, creating a marketplace for human eggs. When the initial fees stopped attracting enough donors, market forces prevailed and the rates went up. Soon, fertility clinics were at war, competing for donors by increasing their fees. It is currently not uncommon for clinics to advertise payment of $5,000 or more for a clutch of donated eggs. Classified ads have started appearing in campus papers across the country offering as much as $50,000 for eggs from women of a particular height, athletic ability and SAT score.
Today, matching egg donors with recipients is a booming industry. Dr. David Adamson, past president of the Society for Assisted Reproductive Technology (SART), estimates that in his clinic, a donor egg cycle costs the recipient around $20,000 with about $9,000 going to brokers. He estimates that approximately 6,000 women attempt donor egg in vitro fertilization every year. There is an annual industry of $120 million for egg donation alone. Of the approximately $20,000 paid by the recipients per donation cycle, between $2,500 - $5,000 goes to the donor.
Egg donors are typically paid between $2500 - $5000 per procedure, although certain women with especially desirable characteristics (beauty, high IQ, and education) are often paid significantly more.
Because patients are willing to invest huge sums of money in treatments that did not exist a few years ago - and because about ten percent of American couples have trouble conceiving - infertility is an estimated $2 billion industry annually in the United States. Pharmaceutical companies are investing millions in fertility-related drugs. Clinic management corporations traded on Wall Street are in the business of making a profit on infertility treatment for investors. Brokers are charging fees to help couples find egg donors and surrogate mothers. The number of U.S. clinics offering IVF has been racing upward since the mid-1980s, to about 330 today. Infertility programs compete fiercely for patients, advertising high pregnancy rates or offering patients financial incentives. Patients who do sign up for such plans are essentially gambling. For instance, at Pacific Fertility, a woman under 35 pays $13,400 for three attempts at IVF. If she bought each procedure separately, it would cost more like $25,000 (again, not counting drugs). If she takes three tries to get pregnant, she's saved a lot of money; if only one try, she's paid $13,400 for an $8,300 procedure.
Risks to the Egg Donor:
There are some hypothetical risks to life from complications. They arise from possible surgical damage or anaesthetic complications, although those occur infrequently even to a minor degree. Another remote risk to life is from unusually severe Hyperstimulation of the ovaries by the hormones used to induce multiple ovulation.
There are some possible negative reactions to the medications. Apart from rare local reactions at the gonadotrophin injection site, the only side effects are exaggerated symptoms like those experienced in the menstrual cycle, due to the extra activity of the ovaries. These side effects last only while taking the medication and are uncommon. They can include hot flushes, premenstrual type symptoms including bloating due to salt and water retention, moodiness, and restlessness at night, though only during the cycle of treatment. Since the aspirating needle is inserted many times, there is a risk of bruising or hemorrhaging. If the donor becomes pregnant during the time she is giving herself injections, the donor may experience hot flashes. There is also an increased risk of ovarian cancer associated with repeated use of the drugs.
The numerous follicles stimulated can also cause some temporary discomfort in the ovaries while they are active. Sometimes, despite careful monitoring, the response to superovulatory drugs may be excessive, and occasionally a more serious condition may develop, rarely ever threatening life, called the ovarian Hyperstimulation syndrome. It usually begins a few days after eggs have been collected, due to the sharp change in hormonal activity of the follicles which occurs at that time. This condition results from the overstimulation of cells. The ovaries become more permeable to fluid, which can lead to fluid collection in the abdomen, as well as around the heart. The symptoms can include nausea, vomiting, pain, abdominal swelling and shortness of breath. If you develop symptoms of this sort it would be important to contact the medical or nursing staff at the clinic for advice. In most cases, rest, drinking plenty of fluids and taking simple pain relievers are all that is needed, but in severe cases admission to a hospital may be required. The symptoms usually subside within a few days.
There are also some risks associated with egg collection. Up to 10% of women receiving superovulatory drugs experience mild symptoms, and 1-2% of women experience severe Hyperstimulation symptoms requiring treatment. Severe problems are only likely to persist in women who conceive as a result of treatment, due to continuing stimulation of their ovaries by the pregnancy hormones - but that would of course not occur in egg donors.
The operation to collect eggs through the vagina under ultrasound guidance should not be painful because sufficient pain killing drugs are given under the direct supervision of an anesthetist. It is uncommon to experience any pain after the operation is over. There may be a little bloodstained discharge from the vagina for a day afterwards. This is quite common and should not cause concern.
Complications are rare but need to be recognized. Any surgical operation involves risks from surgical damage including excessive bleeding or infection, or anaesthetic complications.
Risks to the Recipient:
The hormonal treatment to prepare the uterus for the transferred embryos involves negligible risk. The hormones used and the associated risks are similar to those in oral contraceptive pills, although they are natural hormones and are prescribed in a different pattern.
Risks of infection from the donor with the eggs are remote, and are minimized by the specific testing required to check that donors are free of serious infections. The risk of transmitting genetic abnormalities in the eggs from the donor is also minimized by appropriate screening checks, as previously described. The transfer of multiple embryos involves a risk of multiple pregnancy. About 1 in 4 pregnancies is multiple, mostly twins but about 1 in 25 is triplet. The usual risks from pregnancy are multiplied accordingly, but the main risk is to the babies due to premature birth. The greater the number of babies, the earlier they are likely to be born, therefore the greater the risk of dying from prematurely, of needing prolonged intensive care, and of suffering permanent damage if they survive.
Once pregnancy occurs, it continues in the natural way. It is subject to the usual risks but they are unrelated to the original treatment. The risk of miscarriage appears to be no higher than usual, after allowing for the pregnancies that fail at a much earlier stage than would usually be recognized. Nor is there any increased risk of developmental abnormality of the fetus related to your age when the eggs have been donated, though there is an increased risk due to sperm from men over the age of 55.
As a lesbian donating your eggs, you will have the opportunity to contribute to the Gay agenda by preserving the gay gene for future generations. Many lesbians feel that egg donation is a way that they can make reproduction possible for couples who desperately want children, while simultaneously securing a stable environment for their own genetic offspring. Others need money and find the financial compensation for the donation process well worth it. Before deciding to donate eggs, it is important to examine the risks and benefits carefully.
Egg donation raises questions regarding all four of the basic principles of medical ethics: autonomy, justice, beneficence, and non-maleficent. Infertility specialists, donors, donor recruitment agencies, medical ethicists, patients, and health insurers must consider these conflicts of interest when formulating and evaluating policies regarding egg donation.
Medical ethicists often question the quality of consent involved in the egg donation process. For donors who receive payment for their participation, high financial incentives may provide pressure or coercion, which hampers ability to make clear, informed decisions. While most egg donors in the US receive around $4,000 as compensation, current advertisements offer up to $100,000 for young, healthy donors with "desirable" characteristics. Studies show that women who donate for financial reasons suffer more emotional harm from the procedure and are more likely to regret their decision than women with altruistic motivations. Also, with the highly technical nature of ARTs, donors may be incapable of fully understanding all the potential risks and treatment options without substantial background in biology and medicine. Clearly, potential exists for coercion and uninformed consent with regards to egg donation.
Because of the current shortage of qualified egg donors, infertility treatments are subject to distributive injustice. Approximately 1,000 women conceive each year with the use of donor eggs, while many more must postpone treatment until an acceptable donor becomes available. Women who can afford higher payments for advertising, compensation, and agency fees are more likely to receive treatment than women from lower socioeconomic levels. This fact may potentially lead to ethical conflicts.
Injustice may also occur in the management of needs, rights, and obligations involved in egg donation. Infertility specialists are required by the principle of justice to provide appropriate treatment to their patients, which implies they will do all they can to ensure a successful pregnancy for an infertile woman. With a shortage of egg donors, doctors may be unable to provide optimal treatment to their infertile patients, making donor recruitment necessary. A conflict of interest emerges then, in the doctor's need to serve her patients by encouraging donation by young women and her responsibility for protecting the health of these donors who would otherwise not be involved in the medical risks of the procedure.
Beneficence and Non-Maleficence:
These last two principles require that egg donation procedures be performed for the purpose of improving the health of the patient and preventing harm. However, there is an inherent aspect of maleficence in respect to donors, who undergo the risks of an invasive surgical procedure without clinical benefit. Doctors and legislative bodies must decide whether placing a young, fertile donor at risk for harm is justifiable for the benefit of an older, infertile patient.
The UnIted States has been characterized by a significant lack of legally enforceable regulation regarding reproductive technology. Because most infertility research is not federally funded, the fertility Industry has had a high level of autonomy in dictating procedural requirements and guidelines. Due to homophobic guidelines promulgated by the AATB and FDA; both sperm and egg donation facilities systematically reject Gay applicants on the sole basis of their homosexuality. Although these guidelines directly exclude gay men, they have been unofficially used to exclude gay women as well.
As with many of the pioneering reproductive technologies, the law continues to struggle to keep pace in defining each partys ultimate role. Egg donation involves the removal of one or more eggs from a donor, fertilization of the egg by the Intended Father's sperm, and the transfer of those embryos to the Intended-Recipient Mother. To date, there are no judicial decisions or statutes that sets forth the rights and obligations of the participants in these agreements. Under the Uniform Parentage Act, maternity and parental rights may be established by genetic testing, completed adoption process or by giving birth to the child. Thus, in a standard egg donor/egg recipient case, where the egg recipient contracts to receive the egg and deliver the child, her name and her husbands name have traditionally appeared on the original birth certificate.
One of the most critical elements of an Egg Donor Contract is the specific relinquishment of parental rights such that the child born under the agreement is considered the legal child of the Intended Parents and to establish that the Intended Parents "consent" to the reproductive treatment. Voluntary and informed consent must be obtained from an egg donor prior to the aspiration, which would include a thorough medical and psychological screening, genetic testing and social disease testing (including HIV). The psychological screening process plays an important role in obtaining free and voluntary consent for the aspiration of an egg.
There are other legal issues to consider when deciding whether to donate eggs. As a donor, a woman essentially signs away her rights to her eggs. Once they have been fertilized, unused embryos are frozen. In an anonymous donation situation, the donor has no say in when and for whom the eggs are used. These procedures are new and there is very little legislation governing donors' rights. Arguably, the single most important legal document ever to be executed by a couple or individual who desires to have children is the Egg Donor and Surrogacy Contract. A properly drafted Egg Donation Contract will prominently and exhaustively address the relinquishment of parental rights by the egg donor and her spouse and/or the surrogate and her spouse. It bears noting that those rare court decisions, in which issues of third party reproduction have been addressed, have yet to enforce the terms of the contract. Rather, the courts have turned to the reproductive contract to determine the intent of the parties.
While Constitutional principles have yet to dominate the legal landscape relative to assisted reproduction, compelling equal protection arguments nevertheless exist, which could compel judges to treat egg donors similar to sperm donors. Anything short of this would arguably violate a woman's right of equal protection under the law. A carefully drafted Egg Donor Agreement will specify the Egg Donor's intent not to establish any form of a parent-child relationship with a child born pursuant to the Agreement, as well as release the Egg Donor from any and all responsibilities regarding the rearing and caring for the child. Any other result, as the court pointed out in Johnson v. Calvert, would unduly "burden her with responsibilities that she never contemplated and is directly contrary to her expectations." Thus, the contract should specifically address the relinquishment and/or waiver of parental rights by the egg donor.
All parties to an Egg Donor Agreement should be counseled by medical professionals regarding the risks associated with medical procedures and drug therapy. In addition to the usual risks of pregnancy and childbirth, an Egg Donor may have to undergo hormonal stimulation, medical intervention for egg retrieval and embryo insertion. Diagnostic tests, such as ultrasound examinations, are also required for the timely retrieval of the eggs. The parties must be informed of potential complications and side effects of all medical procedures prior to initiating treatment. In order to obtain proper consent, the parties to an Egg Donor Agreement are required to complete a detailed medical history questionnaire and undergo a physical examination by a physician. A complete medical screening for sexually transmitted diseases (including HIV) lowers the risk of infection, and genetic screening minimizes the transmission of known genetic disorders. The Intended Parents generally bear complete financial responsibility for all monetary aspects of the infertility procedure, as well as any resulting complications.
There are a variety of psychological risks faced by individuals who participate in egg donation agreements. During the course of the egg donor screening process, egg donors are routinely required to fill out a complete psychological history, including requests for specific information regarding past and current drug and alcohol intake, and the use of antidepressants. Couples should be aware that there is no specific remedy for patients or couples injured by their reliance on medical history forms.
Considerations That Your Contract Should Cover:
1. Establish financial responsibility on the part of the Recipient Couple for all expenses incurred pursuant to the contract.
2. Declare that the Recipient Couple is financially and legally responsible for the child no matter what. Additionally, the Recipient Couple shall have full custodial and parental rights to the Child.
3. All parties must have legal and medical informed consent.
4. All parties must complete disease testing (including AIDS). Additionally, the Egg Donor must be medically examined and declared medically appropriate for the program.
5. With recent breakthroughs in cryopreservation, or the freezing of eggs, for later use in infertility treatment, it is important that couples consider the use, storage and disposal of excess embryos not used for the initial medical treatment.
6. Establish specific responsibilities of each party so as to minimize subsequent misunderstandings.
7. ED, Inc., should keep records on all parties in the event information is later needed for legal or medical reasons.
8. Detail legal and psychological framework so all aspects of this process are thought out, considered and pondered by everyone prior to entering into the agreement.
9. Outline confidentiality concerns and provide for privacy for all parties.
10. Stipulate that the laws of the State will govern this contract.
Type of ART Procedures:
90% in vitro fertilization (IVF)
8% gamete intrafallopian transfer (GIFT)
2% zygote intrafallopian transfer (ZIFT)
11% of ART procedures involved intracytoplasmic sperm injection to fertilize eggs (ICSI). 1995 ART Report from the Center for Disease Control.
Infertility by Race:
7% of Hispanic women are infertile
6.4% of white women are infertile
10.5% of black women are infertile
13.6% of other groups are infertile
"Fertility, Family Planning, and Women's Health: New Data From the 1995 National Survey of Family Growth," U.S. Dept. of Health and Human Services.
Infertility Among Married Women, by Education Level:
8.5% of women without high school or equivalent
8.1% of women with just high school or the equivalent
6.6% of those who have some college, but no bachelor's
5.6% of women with bachelor's or higher
"Fertility, Family Planning, and Women's Health: New Data From the 1995 National Survey of Family Growth," U.S. Dept. of Health and Human Services.
First Births for Women 35 and Older:
Ages 35-39 jumped from 11, 704 in 1970 to 44, 427 in 1986.
Ages 40-44 went from 2,442 in 1970 to 4,419 in 1986.
Women over 35 made up 3.2% of first births in 1986.
"Trends and Variations in First Births to Older Women, 1970-1986," National Center for Health Statistics.
7.1% or about 2.1 million of married couples were infertile in 1995.
2.3 million were infertile in 1988 and 2.4 in 1982."Fertility, Family Planning, and Women's Health: New Data From the 1995 National Survey of Family Growth," U.S. Dept. of Health and Human Services.
6.1 million or 10% of married couples in 1995 had impaired fecundity (either infertile or had problems conceiving or carrying a child to term.) "Fertility, Family Planning, and Women's Health: New Data From the 1995 National Survey of Family Growth," U.S. Dept. of Health and Human Services.
In 1995, the peak childbearing years were still in the twenties for American women. "Report of Final Natality Statistics, 1995." Birthrates for women in their 30s have increased. The birthrate for women aged 40-44 increased 20% from 1990-1995. That's 74% since 1981."Report of Final Natality Statistics, 1995."
The National Institutes of Health found that from 1938 to 1996, sperm counts in the United States have fallen annually about 1.5%. European countries have fallen at twice that rate. "Environmental Health Perspectives," November 1997.
One cycle of IVF costs an average of $7,800. (Includes everything from consultation to transfer) "American Society for Reproductive Medicine," 1995.
Factors Causing Infertility:
Tubal factor: 31%
Uterine Factor: 1%
Male Factor: 18%
Other factors: 18%
1995 ART Report from the Center for Disease Control.
CYCLES Using Fresh Embryos from Non-Donor Eggs:
Live births per stimulation: 19.6%
Live births per retrieval: 22.8%
Live births per transfer: 25.1%
Multiple births per transfer: 9.1%
1995 ART Success Rates.
CYCLES Using Frozen Embryos from Non-Donor Eggs:
Live births per transfer: 15.1% CYCLES using donor eggs:
Live births per transfer: 5.5%
1995 ART Report from the Center for Disease Control.
Singletons vs. Multiple Births in ART
4.5% triplets or higher
1995 ART Report from the Center for Disease Control.
Q. Hi. I'm considering being an egg donor for a couple unable to have a child. I'm young and quite healthy and I seem to fit their qualifications. My question is: I'm certain I'm very healthy and have no diseases, but what if they discover down the road that I am a lesbian, and have passed the gay gene to the child? What's the likelihood of that happening, and can I be held legally and/or financially responsible for the child? Also, I'm wondering about compensation. I've seen ads offering egg donor anywhere from 2 to 6 thousand dollars. What's an appropriate reimbursement?
A. When you are screened for being an egg donor, your family history is scrutinized by both the agency and the Intended Parents. Some of the blood work will also reveal certain ethnic disorders that could be genetically passed down as well. But as far as them finding out that you are a lesbian in the future, it is important to remember that there is currently no biological test to determine homosexuality, and so there is no way to prove that gay DNA can be passed on. You can not be held responsible. In your egg donation contract, you absolve any and all parental rights to the possible babies. There is no way you could be held accountable to the health and well being of a child created through the donation of your eggs, as the recipient parents are the legal parents, thus assuming all the responsibility that comes with it. In terms of payment, the common reimbursement for a cycle of donated eggs through a clinic is between $2,500 and $5,000. However, there have been many cases of Ivy League collage students receiving sums upwards of 35,000.00 through private arrangements.
Q. I am scheduled to start the process of donation with a local agency this month, but I was recently chosen by a couple through a seperate egg donor program. How long would I have to wait after this donation to donate to the other couple? What is the maximum amount of donations a woman can do without causing harm or lowering the quality of her eggs?
A. The minimum time you should give your body to rest in between donations is one complete drug-free cycle. This would give you about 3 months between retrievals. I don't think there are any statistics yet as to the maximum number of donations that are safe and the maximum number of retrievals for a donor varies from clinic to clinic. Personally, I would not want to do more than 4-5 egg donations since the long-term effects of the egg stimulation drugs are still mostly unknown.
Q. What should I be concerned about physically when it comes to egg donation?
A. In rare cases something called Hyperstimulation of the ovaries can occur. Most of the time this does not even happen, but on the off chance that it does, you would be hospitalized until the ovaries returned to normal. In extreme cases, the ovaries can rupture resulting in permanent infertility for the egg donor, and even death. I must stress that this is very rare, but it is best to be informed of all risks before entering into any process dealing with medicines and minor surgery. The Dr (Re) who will over see your egg donation should go over all of this with you. If you have specific questions I would advise you to call your local infertility clinic and they may be able to answer your specific questions and go over them in detail with you.
Q. I am getting ready to be an egg donor for a couple. What kinds of drugs and treatments do I have to go though? How long do I have to wait before I donate eggs again?
A. Although all Dr.s have a different protocol here is the basics on what you will take for your egg donation. The Dr (RE) may decide to put you on either Lupron or birth control pills (sometimes even both), to suppress your cycle and to match your cycle to that of the recipient. You will then begin the egg building drugs called Pergonal, Metrodin, Fertinex, Humegon, or Gonal-F. These drugs are given by injection directly into the back of your upper hip or thigh (except Fertinex which is a tiny needle). You usually start these on day 3 or 5 of your menstrual cycle and it use the meds for between 7-11 days depending on your protocal and the size your follicles grow too. During this time you will have blood draws before 9am as often as every day to every other day, to check your hormone levels, as well as interior ultrasounds to check the follicle development. 36 hours before egg aspiration or retrieval you will be given a shot of HCG (profasi) which must be taken at the precise time the Dr. tells you. This is given so that the eggs will be ready for pick up at the scheduled retrieval, and not release on their own. Good luck with your egg donation.