Donor Information
Egg Donation Information (updated April 2011)
The following information is only provided to help you understand the potential procedures involved in the egg donation process. This information is not intended to be used as medical or legal advice. If after reading this information you are still interested in proceeding with egg donation, we ask that you contact our office by phone 619-464-1424 or you may e-mail darlene@aperfectmatch.com so we can send you the forms we require of all egg donor applicants.
A Perfect Match, Inc.
We are pleased that you have expressed an interest in helping infertile families through egg donation. A Perfect Match, Inc. (APM) works with individual families who have medical conditions leading to infertility, as well as same sex couples who can’t create their family without having the help of a kind and generous egg donor. Women find the donation process to be an incredible journey that is filled with ups and downs, but in the end there is the satisfaction of knowing that one person (you) really can make a difference in the lives of others.
The goal of the staff at A Perfect Match is to make our donor’s journey as enjoyable and fulfilling as possible. We know the time and effort it takes to be an egg donor and we treat all our donors with the care and the respect they deserve.
A Perfect Match is paid a fee by the intended parents once an egg donor and intended parent are matched and commence an egg donor cycle. Our fee covers the cost of recruitment of egg donors and we provide our donors with one egg donor coordinator who will follow her throughout the entire cycle to act as the liaison between the intended parents, the egg donor, the IVF center, the attorneys and any other professionals performing the procedures and screening during the cycle.
A Perfect Match, Inc. is providing the following information in order to help potential egg donors understand the “general” procedures a woman can anticipate throughout the egg donation process. Each IVF center has its own protocol; therefore, the processes, screenings, medications and retrieval procedures will vary depending on the IVF center.
Potential Egg Donor Recruitment Procedure
The State of CA requires all those persons or entities recruiting egg donors to provide very specific language to all prospective egg donors. It doesn’t matter if it is an individual agency or an IVF center with its own in-house egg donor program, ALL people recruiting must now adhere to CA Health and Safety Code #125325. As part of this code, this language is to be posted on all advertisements unless the advertiser has received a registration number from SART and is listed on ASRM’s website as having done so. APM is not registered with ASRM or SART; therefore, we now have to post this information on our CA advertisements, and we have to provide this information to all potential egg donors once they inquire about our program.
“Egg donation involves a screening process. Not all potential egg donors are selected. Not all selected egg donors receive the monetary amounts or compensation advertised. As with any medical procedure, there may be risks associated with human egg donation. Before an egg donor agrees to begin the egg donation process, and signs a legally binding contract, she is required to receive specific information on the known risks of egg donation. Consultation with your doctor prior to entering into an egg donor contract is advised.”
The first step in the egg donation process is APM’s recruitment of an egg donor who is between the ages of 19-29 and living a healthy lifestyle. Healthy lifestyle means you are a non-smoker, no more than a light, social drinker, you do not take illegal drugs, and that you protect yourself from pregnancy and sexually transmitted diseases.
As a potential egg donor applicant, you have received this document titled Egg Donation Information, an acknowledgment of receipt of language contained in CA Health and Safety Code Section 125325, Frequently Asked Questions (FAQ,) CDC Condom Effectiveness, Mini Profile, and Confidentiality Agreement. APM requires the signed Confidentiality Agreement and signed acknowledgment of receipt of these documents before we can proceed any further with the donation process.
Once we receive your Initial Questionnaire, we will determine if you meet the basic requirements of APM’s egg donor program. If you do meet our requirements, you will be asked to fill out a more detailed profile and to send photos. Please make sure to give all questions very careful thought...your online profile is your one chance to “shine” and show the intended parents (IP) who YOU are, what you’ve accomplished in your life, and what you care about.
APM will assign a number to your profile for identification purposes. Most egg donors are willing to have the potential IPs know her first name in addition to her egg donor number, so please notify our office in writing if you do not want your first name used. At no time will any further identifying information be given to any IP without your written permission.
APM also has potential egg donors fill out a genetic questionnaire which will include questions about your health history and your extended family’s health history. If we have further questions or concerns about your answers we may consult with a geneticist for clarification, but we will not give that geneticist any of your identifying information.
FDA Guidelines determine eligibility of all egg donors. As a part of your initial screening, you will be asked to answer a group of questions that are mandated by FDA. Most egg donors will qualify at the initial stage, but if you are matched with a family, the IVF center will require very specific tests to further qualify an egg donor under these guidelines.
Once you pass our initial screening, you will be asked to provide further documentation as proof of who you are as well as to verify some of the information on your profile. APM requires a scanned copy of your driver’s license, school ID and passport, plus transcripts and verification of SAT/ACT scores as applicable.
We may show your profile and photos to intended parents on an individual basis while we wait for all verifications and identification, but we generally show our egg donors to intended parents through an online database. Your online profile will not contain your name, address, phone number, etc. You will be given your own set of passwords so that you can view your profile and photos just as an intended parent would see. Once you give your approval of your online profile we will make you “live” for the intended parents to view and we will contact you when we have a family interested in working with you. All potential Intended Parents are required to fill out a confidentiality agreement before they can receive access to the database. We change our passwords on a monthly basis.
Please remember that no amount of money is worth risking a less than optimal outcome for you or for the resulting child created through your egg donation. You must be completely honest with all your answers on the profile and genetic questionnaire as people will be depending on your honesty when making their decision about working with you. The same applies to all questionnaires given to you by an IVF center...you must give full details about any physical or psychological issues that you have or are in your family. Your IVF physician will be making a determination as to which medication protocol they should use, as well as which tests they require for medical and genetic screening in order to ensure that you and the resulting child will be safe and healthy. Any information withheld from your profile through APM and/or from your IVF Physician may have a negative effect on you or the child that will be created through your genetics, so please do not put yourself or a child in harm’s way. The withholding of information may also constitute a breach of contract, so it is always best to be honest even if it may mean you won’t be chosen to be an egg donor!
Anonymous vs. Known Egg donor
In the past, ovum donation was a very secretive act and egg donors and IPs remained completely anonymous; however, we have seen a move toward a more open relationship between the parties. Once officially matched, many IPs and egg donors now welcome an opportunity to speak with each other, yet you can still protect your identity and contact information. IPs find it really is important to them to know they have chosen an egg donor who is kind and compatible with their family and the egg donors enjoy knowing the family they are helping will provide a loving home for the child created through the donation. If a conversation is desired by all parties, APM will arrange a phone conference though our office, so that your phone number will not appear on anyone’s caller ID. Other times, IPs and Egg donors want some sort of continued contact, but not necessarily a fully open relationship, so they create secondary email addresses through which they communicate. We can also arrange for personal meetings between the IP and egg donor if that is what all parties want. Again, you can still remain anonymous…you only give the information you want the family to know. If you and the intended parents prefer, APM is also supportive of a fully “known” donation. In this case, the egg donor and intended parents will generally share contact information so that either can be reached in the future without requiring agency participation.
Known or Directed Egg donor is also a term used when an egg donor does not meet all FDA requirements unless it is an open donation. (Please read FDA guidelines information on our website.) Donation through APM is geared toward each individual family and egg donor. You will never be asked to do something you are uncomfortable with, but we do also want you to know that there are many options available to you for getting to know your intended parents.
Medical, Psychological, and Genetic Screening
Once you are chosen by a family, you will be required to have medical, psychological, and genetic screening as required by the IVF center through which you are doing your egg donation cycle. As a part of the medical screening you will also be required to complete an infectious disease screening as mandated by FDA Guidelines. These tests will include testing for sexually transmitted diseases as well as other communicable diseases. If you test positive, then you may be deferred as an egg donor for a specific period of time (up to one year) or permanently deferred if you test positive for a disease that is not cured by antibiotics. All of the screening tests are paid for by the intended parents and there will be no cost to you.
Our egg donors and IPs are located throughout the country and each IVF center has its own protocol for egg donor screening; therefore, you may be required to travel to the location of the IVF clinic chosen by the IPs for all screenings. If you are required to travel outside of your home area, the IPs will pay for all expenses including flights, hotel, meals, shuttles, etc. Lost wages, however, are not covered during the screening or retrieval unless agreed upon in a contract.
If you are not required to travel to the IVF center for your screening, the primary IVF physician will allow some or all of the screening tests to be performed at a location that is convenient to your home instead of having you travel. The physician determines which tests are required and they will make arrangements (sometimes with APM’s assistance) to have an outside monitoring center complete the screening tests. The instructions are written by the IVF physician and will be faxed or emailed to the location where the screening will take place. All screening test results will be forwarded to the primary physician in charge of the cycle and retrieval.
***Please do not get any Depo-Provera shots, hormone secreting IUDs, tattoos, or body piercings from the time you agree to donation or you could be disqualified from donation for an extended period of time. Women cannot donate for up to six months or perhaps longer if they take a Depo shot or use an IUD with hormones. They must be having regular periods before they will be able to be screened for egg donation. The State of California and the FDA require egg donors to wait six months after having any body piercing and six months to one year from the time they received a tattoo (depends on facility licensing) before she can donate. This is due to the increased risk of infectious diseases.***
Screening
The intended parents (IPs) choose all the medical professionals involved in the donation cycle. We encourage our egg donors to investigate the medical service provider chosen by the IPs and to satisfy themselves as to their professionalism and expertise. We will give you the contact information for that center so you may view their website and begin communication with the IVF nurse coordinator. If you are uncomfortable with that center for any reason, we ask that you notify us immediately.
APM egg donors are carefully screened and must pass a number of tests as required by our program and mandated by the FDA, the State of California or the State where the retrieval is to take place.
Genetic Screening is performed to identify individuals who are carriers of genetically transmitted diseases such as: Cystic Fibrosis, Fragile X, Spinal Muscular Atrophy, as well as other tests as deemed necessary based on egg donor and intended parent ethnicity, such as Sickle Cell Anemia or the Jewish Panel. Most genetic tests are standard within the industry and are ordered by the IVF physician; however, an egg donor may also be screened for additional genetic issues based on the findings of the initial tests, based on recommendation of a geneticist, or the desires of the IPs. Some of the genetic tests may take up to 30 days to get results and IVF centers will not begin medications for the egg donor until all test results are finalized.
Psychological Screening is required in order to screen the egg donor for any psychological issues as well as to make sure that a egg donor fully understands the long- term and emotional aspects involved with donation. A face to face meeting with the psychologist/social worker will be required and an MMPI or similar personality assessment will be administered during the screening. The person doing the screening will write a report and assessment stating whether or not the egg donor is cleared to do a donor cycle. This clearance letter and report will be submitted to the IVF center and APM. The psychological clearance is generally accepted for one year after which time the egg donor will need to be reevaluated if she will be doing any further egg donations.
Medical Screening is performed by either the Primary IVF center or a monitoring physician approved by the primary physician. This screening is to make sure the egg donor is physically capable of undergoing the ovum donation process. An egg donor will be tested for sexually transmitted or other transmissible diseases, which will include: HIV, HTLV-1 & 2, Hepatitis B & C, Chlamydia, Gonorrhea, Syphilis, etc. An ultrasound and vaginal cultures will also be required. *The sexual partner of the egg donor MUST be screened for sexually transmitted diseases.* An egg donor will also have a drug, tobacco and alcohol screening, and there is a possibility the IVF center will choose to use a hair follicle test for drugs, which will show if there has been usage over the last 3-6 months.
COMPENSATION
Some IVF centers follow the guidelines in regards to egg donor compensation, which states an egg donor should not receive more than $10,000 compensation. APM does not agree to abide by their guideline. Please follow this link to read further about egg donor compensation from ASRM:
A quick note about compensation: The compensation amount is never set by APM and you will be asked to give us a range of compensation that would be acceptable to you. APM will notify you of any offer from a family, even if the offered amount differs from your stated preferred range. You will then have the ability to accept, reject or negotiate any terms of the offer. You will never be penalized in our program if you do not want to negotiate your stated compensation. We believe this is your choice, and we are committed to allowing you to make all the final decisions when it comes to compensation. Though rare, there are some egg donors who choose to play an IP from APM against an IP from another agency just so she can get them bidding up her compensation. APM does not tolerate this action and it is cause for immediate removal from our program. Once a final compensation has been agreed upon, and you sign documents agreeing to a specific compensation, please do not attempt to request a higher compensation as this may mean the cycle will be cancelled.
Your legal egg donation contract will determine when any dollar amount will be paid; however, in most cases the agreed upon compensation is generally paid in two installments. The first installment is paid when an egg donor begins any injectable medication; the most commonly used first injectable medication is called Lupron. The medication start fee is $750.00 and will be paid to the egg donor by our office (through the mail) once we receive confirmation that the egg donor began the medication. An egg donor who is considered local (within driving distance to the IVF center) will also receive an additional $150-300 to cover travel, mileage, parking, tolls, etc. This may be paid at the same time you receive your medication start fee, but it also may not be paid until the balance of your compensation is paid. The second installment of compensation is paid on the day of retrieval as long as the procedure took place, and it is the balance of the agreed upon compensation. (For example: if you were receiving $10,000 total compensation, then $750.00 would be paid on the day you start Lupron, and the balance of $9,250.00 would be paid on day of the retrieval procedure.) If you are required to travel outside of your county or State in order to undergo the retrieval, your flights, hotel costs and shuttle services will be paid directly through APM, and the Lupron start fee is meant to cover your expenses for ground transportation, parking and meals until you are able to submit the receipts for reimbursement. All reimbursements are paid promptly upon our receipt of your requests and proof of paid expenses.
The above compensation payment scenario is based on the majority of cycles; however, at times IPs and egg donors become very creative in their negotiations for compensation by adding bonuses for certain events or at different times during the egg donor cycle. As long as all parties understand and agree to the terms, and they have received legal advice, then creativity and deviating from the norm is acceptable to APM.
If someone from our office cannot be present on the day of retrieval, the balance of your compensation will be paid through the attorney-client trust account and will be sent by either the law office or APM once we have confirmation from the medical facility that the retrieval occurred. Your compensation will be paid as long as the retrieval took place; it is not based on the number of eggs retrieved unless otherwise agreed upon in your contract with the IPs.
LEGAL CONTRACT
APM insists that every donor have legal counsel before she undergoes an egg retrieval. We believe having a donor enter into any type of agreement or signing IVF consent forms without the advice of legal counsel is unethical.
Once you are matched, APM creates an agreement called “Egg donor Travel Benefits” and this document sets forth the Egg donor’s compensation and travel benefits related to a local or traveling cycle. Once you sign this agreement, egg donors cannot change the agreed upon compensation, but it also means the IPs cannot come back and ask an egg donor to take any less than they agreed upon. The Egg donor Travel Benefits document is signed by both the IP and the Egg donor before any screening commences. Once the agreement has been signed by both parties, we will forward this agreement to the attorneys so that they can incorporate all these terms within your legal egg donation contract.
The egg donor and the IPs generally have separate counsel unless the donation is completely “open” with all parties providing full contact information to the other. All costs for your legal counsel are paid by the IPs. Egg donors enter into a legal contract with the IPs and this legally binding contract should not be entered into lightly. The contract will cover items such as compensation, legal obligations of the parties, egg donor’s conduct, who the eggs and resulting embryos belong to, etc. An egg donor is able to cancel the contract for any reason until the day she begins injectable medications, but an egg donor should never begin the cycle unless she is completely committed to the process. Once medications begin, however, the egg donor can only cancel for medical reasons substantiated by the primary physician, or she may be in breach of contract.
The IPs’ attorney is called the drafting attorney and the egg donor’s attorney is called the reviewing attorney. The drafting attorney (IPs) will send an initial contract to the IPs for their approval, and then they will send it to the reviewing attorney (Egg donor). The reviewing attorney is responsible for getting a copy of the contract to you. Once you have read the contract you will be asked to have a conference with your attorney, either in person or by phone, so you can discuss any changes you might want. Your attorney will also want to make sure you understand exactly what is expected of you and what would constitute a breach of contract. Your attorney then notifies the drafting attorney of any changes you are requesting. Once the terms of the contract are finalized all parties will be required to sign the contract and a legal clearance letter will be finalized. Medications will not begin until all parties have signed the contract and a legal clearance is sent to the IVF physician.
Here are a few things a legal consult should cover:
- What rights do you have to know the results of your donation including the right to know the amount of eggs retrieved, fertilized and whether or not there was a pregnancy? This is important for your own future family planning and you shouldn’t give away those rights without fully understanding how that may impact you and your own children in the future.
- What rights do you have to be informed of, or give consent to, the disposition of any unused embryos including the right to know if embryos were destroyed, donated to research or donated to another family? We believe every donor needs to understand what she is agreeing to before she signs any contract with the intended parents or IVF center because you should be of like mind when it comes to these embryos. If you have strong feelings against research, then you need to make sure that is not something the family intends to do. If you don’t want embryos destroyed, then you should say you want them donated to research or another family. If you want to allow the family to make all decisions then this is the time to say that.
- Will there be any future contact with the child created? For many couples and donors it is important to know that the needs of the child will be considered. In some cases there is an agreement that the donor may be contacted once the child reaches a specific age so that the child may meet the donor. If there is an agreement for future contact, how will everyone remain in touch? Through an attorney? Through an agency? Through the exchange of personal information? These are things that should be discussed with an attorney (and a psychologist) to make sure you really understand how these types of decisions can affect your future.
APM asks specific questions on our profile about disposition of embryos, future contact, etc, and these answers are included in our attorney referral, but if you don’t have an attorney and contract with the intended parents, then as a donor you are probably giving up all rights to have information about results of her cycle, the disposition of unused eggs or embryos, and if/when there may be future contact.
It is the egg donor’s responsibility to notify APM immediately of any terms in the legal egg donation contract that deviate from the Egg donor Travel Benefit agreement. APM will then help in resolving any discrepancies by talking with the intended parents and attorneys.
Embryo Donation
Embryo donation is becoming more and more popular when people do not want to leave embryos in a frozen state for an indefinite period of time. Embryos may be donated to another person. Embryos may be donated for research. Embryos may be destroyed.
APM has learned (through numerous APM cases) that many parents are donating their embryos to others without the donor’s knowledge and they are also donating embryos to their IVF center for use in research or for their in-house embryo donation programs. This means the IVF center is giving them to other families and receiving a fee for the cycle...it is a means of income to the IVF center, which is fine as long as the donor gave permission for this to happen. Instead we find that many times this is all done without the donor’s knowledge or consent.
While this may not seem an abuse to many, we know that one of our donors purposely made a decision to only donate to one family so that she could limit the amount of children that would be born. The original family then donated the embryos without her permission to the IVF center, the IVF center in turn gave them to 2 additional families and three more children were born. We only learned of this when the 2nd family called asking for the donor’s photos and profile so they could give them to their children. We believe the only way to make sure your wishes are followed is if you have an attorney that sends the IVF center legal clearance that also notifies them about disposition of embryos.
If you have an attorney, the IVF center and intended parents are put on notice about your wishes and rights regarding disposition of embryos and they must follow this or they will be in breach of contract. As a donor, you should always insist that you are allowed to have a legal consult before you sign any agreements that give up your rights. This is not a guarantee that your wishes will be followed by the other parties, but it does put an IVF center on notice that they must get your consent before doing anything.
APM is very supportive of embryo donation, but ONLY if the donor is in agreement to the disposition of the embryos and if they are given to another family that the donor is informed of the donation and whether or not there was a resulting pregnancy. Again, this isn’t because we think a donor should “control” the decisions of an intended parent, but we do believe the donor and her own children should know if there are genetic half-siblings for purposes of their own future planning. Of course, it is also acceptable for a donor to agree to allow the intended parents to do anything they want...we just want to make sure every donor understands this very important “after” retrieval possibility and that she speak with an attorney to make sure her wishes are addressed in the process.
TRUST ACCOUNT
As a part of the legal agreement, the full amount of funds for the egg donor cycle, including cost of retrieval, medications, travel and egg donor’s compensation are to be placed in a trust account prior to the time the egg donor begins injectable medications for retrieval. The trust holder is generally Reproductive Law Center, and they will be responsible for paying your compensation and all cycle expenses submitted for payment by APM. APM will request your medication start fee and compensation and RLC will pay the invoice upon request by APM. You are required to submit to APM all receipts for any out of pocket expenses that the IPs have agreed to reimburse you for. If you do not have receipts, you will not receive reimbursement. The attorney-client trust is subject to State Bar of California regulations and we are happy to provide further information about the State of CA requirements if you are interested.
MEDICATION
THERE ARE POTENTIAL RISKS INHERENT WITH ALL ASPECTS OF THE EGG DONATION MEDICAL PROCESS AND PROCEDURES, INCLUDING TAKING ANY MEDICATION. IT IS THE SOLE RESPONSIBILITY OF THE EGG DONOR TO INVESTIGATE ALL SUCH RISKS AND TO DISCUSS ALL MEDICAL ISSUES WITH THE PRIMARY PHYSICIAN.
As with any medication, there are potential risks associated with taking the medication. There are also risks in having any type of medical procedure. APM is an egg donor agency, not a medical facility, so while we may be able to offer information based on our more than 10 years of experience in this field, we are not able to discuss the actual or potential side effects of medications or procedures as this may be deemed as “practicing medicine.” We do suggest a number of websites that will give you information about these medications and the two we most often recommend are non-profit organizations that are well-respected in the infertility field. They are: www.asrm.org and www.theafa.org. Please peruse their websites and search specifically for egg donor procedures and medications.
Also, while it is important that you do your own research, your best source of information will be the IVF physician in charge of your egg donor cycle. Please discuss with the primary physician exactly which procedures they will do, and the medications he/she will be prescribing for the egg donor cycle. The IVF center should provide written information about the medications and procedure as well as the possible side effects and risks associated with each medication and procedure. If they don’t provide this information please contact your APM coordinator and we will make sure you receive the information you need from the center.
Most egg donors will be placed on some type of birth control in order to regulate their cycle; this will allow the physician to coordinate your cycle with that of the intended mother or surrogate. If you are already taking birth control, the primary physician will decide if it is an acceptable brand or if you need to switch to another brand. Birth control is not an injectable medication; therefore, the egg donor will not receive any compensation for starting or taking this medication. Some centers, but not all, may require an egg donor to be off of birth control for one month prior to their physical screening. Please discuss this with your coordinator at APM once you are matched and we will let you know the IVF center’s protocol.
An egg donor may begin the first of her injectable medications on day 21 of her cycle. The most commonly used medication is called Lupron and is a daily subcutaneous injection. (It sounds worse than it is!) This needle is usually a tiny, 1/2 inch insulin type needle. A professional will teach you how to administer this to yourself. *Lupron is not approved by the FDA as a fertility medication, but is used by physicians in order to keep the ovaries from ovulating. A different form of Lupron is used by some IVF centers and is given as a onetime injection called Depo-Lupron, and a number of IVF centers are switching to a protocol in which Lupron is not used; rather a medication called Antigon, Ganarelix, or Cetritide is used.
THERE ARE POTENTIAL RISKS INHERENT WITH ALL ASPECTS OF THE EGG DONATION MEDICAL PROCESS AND PROCEDURES, INCLUDING TAKING ANY MEDICATION. IT IS THE SOLE RESPONSIBILITY OF THE EGG DONOR TO INVESTIGATE ALL SUCH RISKS AND TO DISCUSS ALL MEDICAL ISSUES WITH THE PRIMARY PHYSICIAN.
While most egg donation cycles are free of complications, it is important that you understand it is your responsibility to immediately notify the primary physician of any side effects you may be having as a result of taking any medications prescribed by the IVF physician. Your well-being is the most important thing and you should never underestimate any symptoms you may have. Failure to notify the IVF center could result in severe complications. If you have any problem getting through to the IVF center, you should tell the answering service it is an emergency, but if you feel it is life-threatening you should always call 9-1-1 first or get to the nearest emergency room. You will also have your APM coordinator’s cell phone number, and if you can’t reach your IVF coordinator or physician, we may have their back office number or cell phone number, so please call us as well, but again, if it is an emergency then treat it as such and always call 9-1-1first. If you do go to an emergency room then you need to have a list of all medications, let them know you are doing an egg donation cycle and give them the name of your primary IVF physician. You should keep this information in your wallet or on your phone so that it is easily accessible should you need it.
The first installment of the compensation is paid at this point; the amount paid is generally $750.00. You should begin your flow within a week to ten days after starting Lupron. An ultrasound will be performed to make sure the ovaries are quiet and that you have no cysts. Once the egg donor and IPs both have their flows the next medication will be administered.
Follicle stimulating hormone (FSH) is a medication causes the eggs to grow and mature. This medication is administered for approximately 8-10 days. There are many brand names, but the most common are Gonal-F, Follistim and Menopur. These medications are given daily, by subcutaneous injections, generally with the small 2 inch needle. There are other medications that the primary physician may use that may also require intramuscular administration. Please discuss the administration of these medications, and all potential side effects and risks of each medication with the primary physician. Again, it is your responsibility to monitor how you are feeling and contact the primary physician if you are having any complications or questions.
SEXUAL ACTIVITY
Egg donors must refrain from sexual activity once injectable medications begin unless you are informed otherwise by the primary physician. This is not limited to intercourse...it means ALL sexual activity because you can get an STD from any bodily fluid. You will also be extremely fertile during this time and for your own protection you will need to either abstain from sexual relations completely, or use a combination of effective barriers prior to starting any of the medications. If you become pregnant or you contract a STD during the medication stage, the cycle will have to be cancelled and you will be in breach of contract subject to reimbursement of all costs to the IPs for your screening, medications, travel, etc. You will be able to return to normal sexual activity once you have your flow approximately 7-10 days after retrieval.
You will most likely be asked to curtail any heavy exercise during the stimulation stage as this may affect the quantity and quality of your eggs. You are not allowed to take any medications during the cycle unless they have been prescribed or approved by the primary physician, so if you need to take medication for a cold, headache, etc. you need to make sure it is approved by the physician.
You must refrain from alcohol once you begin medications. Alcohol may have an impact on the effectiveness of the medications, but alcohol may also affect the quality of your eggs and resulting embryos. If you take drugs or drink alcohol during the medication stage you would be in breach of the contract. These requirements are not a judgment about your lifestyle, rather drugs and alcohol may adversely affect the quality and quantity of eggs retrieved and everyone wants to provide the best possible outcome for the intended parents.
Please make sure you have a clear understanding of the requirements of the primary physician regarding sexual activity, physical exercise, drugs and alcohol and that you are willing to commit to these requirements prior to starting any medication.
PROCEDURE
Many women do not understand how the number of eggs to be retrieved is determined. We are not able to give medical advice, but if you do an internet search about the number of female eggs, the following is the information you will generally find:
Females are born with a finite number of eggs (approximately 1 million +/-) and by the time a young girl begins puberty the number has already decreased significantly (approximately 400, 000 +/-). The number of eggs produced during any particular monthly cycle varies from female to female; however, the average number is 10-20. Some women produce more per month and others less. Every month the ovaries tap the “reserves” and will produce a varying number of potential eggs for fertilization, but every month the body also generally selects only one of those eggs to become the "lead follicle". This egg is selected by the body to be the one that will be used for ovulation that month. The other eggs stop growing and are absorbed or discarded by the body. After ovulation, if the lead egg is not fertilized, it will also just be absorbed or expelled by the body. An egg donor cycle only utilizes the eggs your body would have produced for that particular month. The hormone medications used during a cycle are used to grow as many of those monthly available eggs as possible. So, donation is a great way of putting to use a number of eggs that would have been flushed out and destroyed by the body!
Until an IVF center is chosen by the family, we will not know which medication protocol you will be asked to follow, but you will be informed as quickly as possible. The following describes a typical procedure, but it is possible that your cycle will vary from this.
After all screening results are back, and you’ve been accepted as a donor through the IVF center, you will receive a calendar from the IVF center telling you exactly when to start and stop all medications. The IVF center will make sure to go over all instructions with you so that fully understand all the instructions. APM will also receive a copy of this calendar and will keep in touch with you to receive updates about your appointments and receipt of medications. If we have any concerns or belief that you don’t understand the instructions, then we will ask you to contact the IVF center and go over all the instructions again until you have a complete understanding of all that is required.
You will be instructed to begin some type of birth control medication as a means of synchronizing your cycle to that of the intended mother or surrogate. You will remain on birth control until instructed by the IVF center to stop.
Generally, egg donors begin Lupron on day 21 of their cycle, and then start their period within 7-10 days. An ultrasound will be required on day 2 of that cycle to make sure the ovaries are quiet and that you have no cysts before beginning the stimulation medications.
During the 10-12 days stimulation phase you will most likely be required to have a blood test on day 3, an ultrasound and blood test on day 5, and then possibly either every day or every other day you will be required to have a blood test and ultrasound until the IVF center determines that the eggs are mature and ready for retrieval. If you are traveling for the retrieval, the IVF center may require the egg donor to have her day 5 ultrasound at their center only; however, some centers allow the egg donor to remain in her home area until day 6, 7 or 8.
The blood tests and ultrasounds help the physician determine the number, size, and quality of the eggs. These tests are generally done between 7-9 am and results are given same day. Once the eggs are mature, the egg donor will be given a medication called HCG. This medication is given approximately 35 hours prior to the retrieval. The timing and administration of this medication is crucial. This medication will be given intramuscularly in the posterior, lateral hip. You will need help in the administration of this medication. Some IVF centers are now using a different protocol in which a donor uses Lupron as her “trigger” for ovulation. Again, until we know the protocol of the IVF center, this is just general information to help you understand the procedure.
The procedure for harvesting eggs is usually performed 35 hours following the receipt of the “trigger” shot, but almost always takes place first thing in the morning. You will be required to be at the IVF center an hour or so prior to the procedure, the procedure generally takes 20-30 minutes, and then you will be in recovery for approximately one-two hours during which time they will monitor all your vital signs, make sure you are able to drink fluids and have no significant bleeding or other symptoms.
Prior to the retrieval, a small IV may be placed into the arm vein to administer fluids and general anesthesia; some centers choose to use a sedative only. Please discuss which protocol your IVF physician will use for the retrieval. The majority of IVF centers have their own operating facility on location, but some use facilities at local hospitals. The physician will use an ultrasound guidance machine and a needle will be placed through the back of the vagina and the eggs will be removed from the ovaries and the eggs will be taken to the laboratory to be mixed with the IP or egg donor sperm. You will remain in recovery for an additional hour or so until the physician feels you are recovered enough to leave. You will still be required to rest for that day and you will receive instructions from the IVF center about your intake of fluids and signs to watch for that may require some further medical attention by your IVF center.
In order to protect and care for donors after the retrieval, all egg donors are required to have a companion with them on day of retrieval. If a donor does not have a companion, a visiting nurse will be hired to accompany the donor and to stay with her for a few hours after leaving the IVF center.
The majority of egg donors are able to go home within two hours after donation; however, if you had to fly to your IVF center for the procedure, you will be required to stay through the day of retrieval and then as long as you have no symptoms or complications you will be allowed to fly home the following morning. If you have a traveling companion some centers may agree to let you fly home late the same day, but that is rare. Please make sure you have a complete understanding of the IVF center requirements regarding when you will be able to travel to your home.
We find most donors go through the retrieval process without any serious side effects and only have (tolerable) cramping post retrieval, and feel good the next day, but there are occasions when donors may have more severe reactions to medications and the procedure. Donors must understand egg donation is a medical procedure and there are risks with the procedure as well as risks from taking medications. Donors must discuss all risks and side effects with the IVF Physician so they understand the potential of serious reactions and conditions.
Hyperstimulation is a rare, but the most common post-retrieval medical condition we see with our donors. It is a potentially dangerous condition that occurs after retrieval and is a usually a result of having a large number of eggs retrieved and/or high hormone levels during the stimulation stage. Your IVF center will notify you if they are concerned that you may hyperstimulate and they will give you instructions on what symptoms to look for and what you should do if you notice any of the symptoms. If there is concern of the potential that a donor may hyperstimulate, most IVF centers will continue donors on medications to prevent it, but sometimes this condition will still result in the need of having fluid removed from the abdomen and this may be done at the IVF center, at an IVF center near your home or an emergency room.
It is the lack of treatment that can cause this to be dangerous, so every donor must follow the instructions of the IVF center and every donor must take all post-retrieval symptoms seriously.
You can expect to begin your normal cycle again within 7-14 days after retrieval and you will also be required to have a follow up ultrasound approximately 2 weeks after the retrieval in order to ascertain that your ovaries are back to normal. Congratulations...you did it! Now what?
RESULTS
After retrieval, you will be able to receive the cycle information regarding the number of eggs retrieved, but fertilization and pregnancy results are only shared at the discretion of the IPs. Most IPs are willing to share results with the egg donor because they want the egg donor to be able to do her own family planning, but this is not automatic, so each donor should make sure to have the ability to get this information if she wants and should make sure it is in the legal agreement.. Please notify APM of your desire to know or not know if there was a resulting pregnancy so we can make sure the attorneys add the correct language to your egg donation contract.
Also, if there is an agreement to inform the egg donor of the results, an egg donor needs to understand that a negative result after a “fresh cycle” does not mean that the IPs would not be able to still attain a pregnancy through the use of frozen embryos. There may be many factors involved which might lead to a negative result on the fresh or even the frozen cycle, including sperm issues or uterine lining issues. We want every egg donor to know that her efforts are appreciated regardless of the results.
Lastly, we will always notify an egg donor if there is any miscarriage or birth defect that is a result of a genetic issue passed through the egg donor’s eggs, but it is your responsibility to keep APM updated with your contact information if you want to make sure we can inform you of any issues. We also ask that you notify APM if you discover any genetic issues after your donation so that we can inform the family.
COMMITMENT
As you can see, an ovum donation cycle requires a strong commitment on your part and everyone will be counting on you to comply with each step by doing your best to do everything that is required by the physician. Egg donation may be financially beneficial for an egg donor, but our egg donors say their greatest reward comes from knowing they made a difference in someone’s life by giving of themselves in such a personal way. The gift you are offering is beyond measure and for our part we commit to doing everything in our power to make this a positive experience for you and your IPs. We value each and every one of our egg donors and are thankful to have the opportunity to work with such outstanding women.
We hope you will want to continue with the process and ask that you please contact our office to let us know if you are interested in continuing with the process.
For More Information
1-800-264-8828
Websites with further information on ovum donation and potential risks:
