How Does Egg Donation Work in the USA?

Egg donation is a fertility treatment that allows many women make their dream of creating a family come true when they are unable to do so by their own means.

Within the US, you can choose between three types of egg donor: anonymous donor, semi-known donor, and known donor. In all three cases, every women wishing to become an egg donor should meet a series of requirements established by the American Society for Reproductive Medicine (ASRM).

The ASRM sets the limit of 25 donor-conceived children per donor within an area of around 800,000 inhabitants.

The different sections of this article have been assembled into the following table of contents.

Indications

The following are the main reasons why a women may need to use donor eggs in order to have offspring:

• Ovarian insufficiency or low ovarian reserve
• Carrier of any genetic disease
• Recurrent IVF failure
• Advanced maternal age

Ovarian insufficiency or ovarian failure is described as the loss of normal function of the ovary to produce eggs. Ovarian failure may be congenital in cases of early menopause, anovulation problems, absence of ovary, primary ovarian insufficiency, etc. It can also be acquired, for example in case a woman has had an ovary surgically removed as a result of an illness or after enduring a cancer treatment such as chemotherapy.

Ovarian insufficiency

When a woman is a carrier or suffers from a severe genetic disease likely to be inherited by her offspring, she can resort to egg donation to have healthy children, regardless of whether she suffers from any fertility problem or not.

Also in cases where the causes of infertility are unknown and no success is achieved after various IVF cycles, egg donation is the most common option. We are talking about cases of recurrent miscarriage or embryo implantation failure due to uterine conditions.

Finally, maternal age also plays an important role. As a woman ages, her ovarian reserve keeps on diminishing not only in terms of quantity but also in relation to egg quality. From age 40 onwards, chances for the embryos to develop genetic alterations become significantly higher.

The recipient

Given that surrogacy is allowed in the majority of US states, the recipient for the donor eggs may be either the mother-to-be or a woman that will be only responsible of carrying the pregnancy to term. Nevertheless, she won’t be considered to be the child’s mother but the surrogate.

Be it as it may, the egg recipient shall receive a mild medical treatment that will allow her uterus to be prepared for embryo reception and, therefore, for pregnancy. Such medication may vary slightly depending on whether the eggs are fresh or, conversely, they have undergone a freezing/thawing process.

Although there are no particular federal requirements in this field, recipients are recommended to be in good health. Besides, they have to successfully undergo a series of medical and psychological assessments to guarantee they are ready to become pregnant.

As for age, a particular age limit is neither established by law. However, recipients of age 45 and older are recommended to take a special medical evaluation, including cardiovascular screenings and an obstetric consultation to be informed of the risks of undergoing IVF with donor eggs.

Types of egg donor profiles

In case you decide not to pursue an anonymous donation, in which case a donor will be selected by the clinic, you should bear in mind a series of aspects when choosing your prospective donor. Thus, you can decide between either of the two following options:

• Totally known donation: a friend, relative or acquaintance will be the one chosen to donate her eggs.
• Egg donor database: the donor will be selected out of an egg donor database provided by the egg donor bank or agency.

In case you decide to pursue the former choice, that is, if we are the ones who choose the person that will donate her gametes for our fertility treatment, then guidelines given by the FDA (Food and Drug Administration) and the ASRM (American Society for Reproductive Medicine) should be taken into account. According to such recommendations, the person we choose to be our donor must undergo exactly the same screening testing as any anonymous donor. Only in case the prospective donor passes them, she will be allowed to donate her eggs.

Conversely, if you choose to select a donor from an egg donor database, the situation will vary according to how much information we wish to get about the donor. In this sense, it is possible to base our decision on two types of information. In the first case, you can focus on the donor physical characteristics (e.g. eye, skin or hair color), educational level, occupation, medical history, personality traits, etc. In the second one, the prospective donor is chosen after a personal interview that will allow you to find out more about the candidate.

All the above means that we can choose between selecting the egg donor after meeting her in person or by finding out which her features are basing our decision on paper-based lists. The latter case, in which pictures may be included, is known as “semi-known donation” across the US.

How are prospective egg donors selected?

Potential egg donors have to meet a series of requirements to make sure they qualify as donors. Thus, they must:

• Stay healthy.
• Pass all the psychological tests conducted by mental health professionals.
• Be of legal age, preferably between 21 and 34 years old. In case she is younger than 21, she will have to undergo a personalized evaluation. Conversely, if she is older than 34, the recipient must be informed through an informed consent.
• Complete a general and a sexual medical history to rule out any sign of HIV or any other sexually transmitted disease (STD).
• Be a mother, although this is an optional requirement.
• Undergo a series of genetic evaluations based on her family history. This is to confirm she is free from family history of hereditary diseases.
• Sign an informed consent to confirm she agrees to accept a shared egg donation, that is, her eggs will be used by more than a single recipient.

Becoming an egg donor

• Pass a specific medical screening: karyotype, serology, biochemical tests, genetic analysis, ultrasound scan…
• Agree with the fact that the staff at the fertility center (owner, laboratory director, technicians and any other staff member involved in the process) as well as any other staff member from the egg bank having any economic interest cannot act as donors whatsoever.

In addition to these requirements, the prospective donor must be aware of the fact that she won’t qualify as a donor in case she finds herself in at least one of the following situations:

• Drug abuse for non-medical reasons in the previous 5 years.
• Women with hemophilia or any other alteration in the blood clotting system.
• Having engaged into sexual intercourse with men who have had sex with men or have exchanged sex for money in the previous 5 years. Women who have engaged into sexual intercourse or have had contact with an AIDS or hepatitis B or C sufferer in the previous 12 months will be ruled out as well in case there’s a minimal chance of transmission.
• Women who have obtained a tattoo or body piercing in the previous 12 months without being certain that sterile procedures were used.

Although these are the main reasons why a prospective egg donor may not qualify as a donor, there are also other requirements that you will find down to the last detail in the American Society for Reproductive Medicine website as well as the particular medical tests that donors must undergo.