Egg Donation: What We Have Learned From A Decade of Experience by Helane S. rosenberg, Ph.D. and Yakov M. Epstein, Ph.D.

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Egg Donation: What We Have Learned From A Decade Of Experience
by Helane S. Rosenberg, Ph.D and Yakov M. Epstein, Ph.D.

 

On February 3, 2003, Nathaniel and Allegra Epstein, our twins, born with the help of an egg donor, will celebrate their 10th birthday. From the moment they were able to understand human speech, we told them that a kind lady, an egg donor, helped to make their birth possible. As they have grown older and have come to understand a bit more ofwhat an egg donor is and what having an egg donor as part of their conception means, we have experienced first hand, a personal and unique perspective on egg donation. We know what it is like to parent children conceived this way. We also know, to the extent that they share with us, our children's perspective on their unique status. We will share these insights with you in this article.

During that same decade that we were parenting our kids, we were working professionally with women and men who were considering embarking on the path we took. We have talked with more than 800 couples and single women, about 75% of whom ultimately decided to do a recipient procedure at IVF New Jersey in Somerset New Jersey. Also, during that decade, we met with almost 3,000 women who expressed an interest in becoming egg donors. We'll also share some of what we've learned from that experience.

 

Why Egg Donation?

After having worked with potential recipients for several years, we observed recurring patterns in the life circumstances leading to this parenting option. We found it helpful to think of archetypes of egg recipients. Over the past decade, we have found at least a dozen instances (and usually considerably more instances) of each of these archetypes. We described many of these archetypes in our book, Getting Pregnant When You Thought You Couldn't. We began to ask couples to write their "stories" - the paths that led them to try egg donation as their parenting option. Here are some sample stories that exemplify these archetypes.

 

Secondary Infertility

The most frequent archetype we have met are couples experiencing secondary infertility. Both the woman and her partner are in their early 40's. They have a child but would like another. Here is one such couple's story:

"We are the proud parents of a happy and healthy 3 1/2 year old boy. Our love for our child and each other leaves us with a strong desire to have an additional child (or children). We have several reasons for wanting a larger family. The most important one is that we love being parents to our son so much that we want to experience the joy of parenthood again. Also, we feel siblings add to the richness of life, particularly as children grow older. We are fortunate enough to have the wherewithal to provide for our family and wish to share our blessings and love with another child, whom we very much desire. Unfortunately, we met as older adults, and our ability to have a 2nd child has been compromised by repeated (3) miscarriages. due to our advancing age, modern assisted fertility techniques have been unsuccessful. Therefore, we very much desire donated eggs as a generous gift to allow completion of our family. This would provide all three of us with the opportunity to add a cherished member to our loving family."

Members of the secondary archetype are generally not depressed because they are happy that they have a child. But as this couple stated, they would like to have a second child to enlarge their family and to provide a sibling for their child. People in this group have a difficult time deciding to do the procedure because they are concerned about the differences between the child who has a biological connection to both of them and a donor baby who will not be genetically linked to the mother. They worry about how that child might feel. Should they tell the child that they used a donor? If they do, will s/he feel like a second-class citizen? If they don't tell, they have to be very selective about a donor who will produce a child that looks as if it could have been the wife's own biological child. So members of this archetype often take a long time to decide upon their choice of donor. Indeed, it took this couple 442 days - much more than the average (median) time for all recipients which is about 120 days.

 

The Two Career Couple

The second most frequent archetype is the "two career couple." Like those experiencing secondary infertility, they too are usually in their early 40's. Listen to one of their stories.

"My husband and I only met a few years ago and married at 40. This was a first marriage for both of us. We began to try to conceive not long after we were married. Apparently, due to my age, I have been unable to produce eggs of sufficient quality to get pregnant. My husband and I have a very strong, very loving marriage. Because we married late (relatively speaking) in life, I think we were both more sure of the type of person with whom we could have a happy lifelong relationship. I think we were also more appreciative and grateful for having each other. While we both led relatively satisfying lives before we were married, and more so since we married, there is a definite void that grows more apparent every day. The desire to raise a child overcomes the emotional and logistical difficulties of using an egg donor. We both have careers which have been important to us. Having a satisfying career, for many years, however, I am now acutely aware of the satisfactions it does not bring. It cannot replace having a family. We are at a stage in our life when the priority of raising a child is above the demands of our careers.

" This couple is typical of members of this archetype. They have been highly successful in their careers and find the setbacks of infertility a sharp contrast to the success they have been used to in all other areas of their lives. This couple selected their donor and began their cycle rather quickly - 109 days.

 

Young But Feels Old

The next most frequent archetype is one we call "young but feels old." We selected that title because it characterizes the view that these women express in their conversations with us. In many ways, they are very similar to the women in the "two career" archetype except that they tend to be about 4 years younger. What this means is that they are in the age group where it is still possible for women to have a baby with their own eggs. Since they are in their late thirties, the idea that dominates their thinking is the rapidly ticking biological clock. Here is how one recipient described her situation:

"My husband and I married in our mid-thirties at a time when we felt fairly well established and settled and hoped to begin a family. We stopped using contraceptives and tried to conceive. After 6 months we had no success. We sought my doctor's advice and tried more constructively to conceive-again with no success. We then chose to seek out a local fertility expert. We then underwent several test procedures to evaluate a potential problem but nothing was found. We then tried several months with mild chemical stimulation but this did not prove successful either. 'Time' becomes a very precious thing to couples like ourselves. You look at the months passing and the years passing and you try and use your time most effectively. You really do not think in terms of "wasted time" but rather how much more constructively you could have used your time on a more positive note. You never lose hope, you just restore it as we are doing with IVF-NJ."

This couple highlights a critical issue for this archetype - the passage of time. They are acutely aware of their age. In this case, both the recipient and her partner were 39 years old. They were in the gray area where it is still possible to get pregnant with their own eggs but it is not happening for them. This makes them feel old. A large proportion of the members of this group decide not to do the procedure at this time - instead, trying one more time to get pregnant using their own eggs. This couple, on the other hand, did do the procedure, taking 174 days to choose their donor and get started.

 

Trendsetters

As we met more and more couples who were thinking about doing a recipient procedure we noticed an interesting phenomenon. Many of the couples had wives who were 4 or more years older than their husbands. In fact, when we compared the frequency of this age difference in our sample with the frequency with which it appeared in a sample surveyed by the U.S. census bureau, we found that our sample contained 3 times as many couples of this type as there are in the general United States population. One group for whom this was the case is an archetype we called "To Mother Again." That group consisted of a woman who had children from a previous marriage married to a man who never had children of his own. We'll describe that group in more detail later.

But we noticed a second cluster of couples - ones in which neither the husband nor the wife ever had children and in which the wife was at least 4 years older than her husband. We called this group the "Trendsetters" and they were the 4th most frequently seen archetype. Here is a statement typical of this group:

"My husband and I met each other a few years ago. Prior to that we had not been in what we considered a permanent relationship. At that time I was 43 and he was 29. Eight months after we met, we wanted to spend our lives together and wanted to have a family. Our attempts were not fruitful over a two year period, and we began to seek medical evaluations to see if there was a problem.

It was discovered that my husband had some male factor problems. After some improvement over a several month period, we still were not successful. I had two tube tests, the first showing a blockage and the second no problem. We proceeded with artificial insemination to improve the odds, including fertility drugs. We continued to be unsuccessful. We were told that my ovaries were not responding very well to the medications, and this seemed to indicate that it was actually an egg-production problem. Our doctor believes it is due to my age, and seems to feel our chances of having a child naturally are very minimal. We are loving, compassionate and sensible people with a lot to give a child, or more than one if we are blessed with more. We are conscientious about using appropriate child-rearing techniques to raise a child to have high self-esteem and to be successful at accomplishing what their dreams are in life, and equally important is to have a child have a happy, love-filled life."

This couple typifies the archetype of a couple in which the wife is considerably older than her partner. We have found that in many of these cases the woman is more eager to have the procedure begin than the man because she feels great time pressure. The husband, on the other hand, is relatively young and feels there is plenty of time. As a result, we frequently find that the couple has difficulty making the decision about which donor to use. In the case of this couple, it took them 282 days to make their selection and begin their cycle.

 

Young Infertiles

An archetype we have seen almost as frequently as the trendsetters is a group we have termed the "Young Infertiles." The statement below is typical of such couples.

"My husband and I have been married for 4 1/2 years and have been trying to become parents for 3 1/2 years. After various testing, it's been determined that I produce a poor quality and low quantity of eggs. This seems to be fairly unusual, as I'm only 33 years old. Because I have a very poor chance of getting pregnant with my own eggs, my doctors recommended that we attempt an egg donation program. It would be such a wonderful gift to have a chance to become pregnant this way.

Both my husband and I are very family oriented. Our social life revolves around our family and neighbors. We enjoy having our nieces sleep over and the children of our friends and family are a big part of our lives. There is much room on our home and hearts for children."

This couple had a clear need to do the procedure. She was very young as was her husband.

She knew her egg quality was poor and she was not going to get pregnant on her own. She was part of a social network of friends who were having babies and she wanted to be like them. For couples in her situation, the decision to do the procedure is clear. The difficulty they have is in deciding which donor is the right one to take the wife's place. Indeed, this group and the group that we call "Young But Feels Old" are the most depressed women of all the archetypes. In the end, this couple did the recipient procedure. But they took a relatively long time (perhaps because of their heightened depression) to decide on which donor to use: 291 days

 

To Mother Again

Women in the "To Mother Again" group have experienced mothering and would like to do it again. Like the Trendsetter archetype, many of them tend to be 4 or more years older than their husbands. Perhaps, one aspect of the attraction between husband and wife in this group was the motherly qualities of the woman. We can only speculate that perhaps the husband enjoyed being mothered by his wife and would also like to see her mother a child that they can create together. Here is the story of one such couple:

"I was in an abusive marriage where my now ex-husband saw abortion as a means of birth control. After two healthy children and two abortions, I saw tubal ligation as the only hope of ending the abuse. I was wrong. The abuse continued and eventually I was strong enough to leave the marriage. I am now remarried very happily. My husband and I would like to have a child together - one who grows up in a loving non-abusive home. However, my previous surgery prevents us from having a child normally. We have been through six tries at IVF and all have failed."

This woman loved having children but had an unhappy first marriage. Now, she would like to mother again but this time with a partner who can be the co-parent she always wanted. Like most members of this archetype, the couple decided to do an egg recipient procedure and made a quick decision about their donor which enabled them to start their procedure 97 days after their initial interview.

 

The Modern Classic

The next most common archetype is the one we know first-hand. It is the group we belong to. It consists of a woman, typically in her early 40's who was never before married who marries a man who has children from a previous marriage. Here is a typical story (not ours but not very different from ours).

"To have a family, that is to be married and have children, has been a quest for me since my mid-twenties. At that time, I began to feel I was old enough and mature enough to settle down with a husband and have kids. Although, I was working, enjoying and valuing my chosen profession, I felt deep inside me that the most important thing for me would be to become a wife and mother. My feelings and convictions stemmed from my upbringing. I thought it was a matter of time before I would get married.

As hard as I tried the right man didn't come along until I was 38. I met my husband, a loving, caring, and intelligent man, on a blind date. We fell in love, dated for a year and a half, and then got married. He had been married before and had two lovely boys, now grown adults, 26 and 22 years respectively. Judging from the way the boys both turned out, I can say he was a great father. He was deeply involved in their education, read to them, got them to participate in sports, encouraged them to make friends and be interested in the world and the people around them. Above all, he gave them affection.

We have been married for seven years. It is a good marriage, a solid partnership. We consider each other a blessing. We have felt we could share our bond with children. So we have been trying to get pregnant for five years. It's been difficult, discouraging, and at times heartbreaking."

For this couple the decision to do an egg donor procedure was also quite clear. The wife knew that she could not use her own eggs since she was 45 years old. She very much wanted to experience a pregnancy because she never had an opportunity to do so. Her husband already had children who had his genetic makeup. He was not stuck on which woman's genes would replace those of his wife and neither was she. The couple did the procedure and made their choice of donor fairly quickly (109 days).

 

Long Marriage Trying For A Very Long Time

A less common archetype consists of a couple who have been married for a very long time and trying unsuccessfully, for most of the time they've been married, to have children. The story below is typical.

"We have been married for 14 years and have always wanted a family. We started trying to have a baby about 10 years ago. It took several years before we sought help, as it was difficult to admit we had a problem. Although the doctors never really were able to diagnose with certainty the cause of our infertility, they basically concluded that it was an ovarian dysfunction, which seems to be confirmed several years ago by the onset of premature menopause. I underwent exploratory surgery, surgery to remove a fibroid tumor and more than several years of treatment with all types of infertility drugs, including IVF; we never achieved a pregnancy.

Although we are happily married, we both feel our lives would be more meaningful and fulfilled by raising a child or children. We are both close to our families and feel we would offer a wonderful home and upbringing to our children. We have considered adoption, but have many reservations about it, and now it would be very difficult at our ages to be approved for adoption. Although neither of us feel our ages to be a negative we both hoped to have a family much sooner."

This couple is typical of those in this archetype. They have tried to get pregnant for a very long time and have not succeeded. They have also considered adoption but not pursued it. They display a certain hesitancy to take action - either through egg donation or adoption - to have a baby. In some sense, even though they may not be aware of it, they may have become resigned to living without children. This couple ultimately did not do a recipient procedure. Moreover, others who we also characterized as fitting this archetype were one of the least likely groups to do a recipient procedure. As a group, members of this archetype are some of the most depressed women we have met.

 

Long Marriage Trying For A Brief Time

Another archetype bears some striking similarities to the previous group. Like the previous group, this group has also been married for a long time. In contrast, however, they have only recently begun trying to get pregnant. So they do not have the long history of failure that members of the previous group experienced. Consequently, they are less depressed and more likely to do a recipient procedure. Here is a statement of a couple that we classified as a member of this archetype.

"Sometimes you find the 'right' person a little later in life. I was in my mid thirties, my husband was just turning forty. We wanted a family but we weren't ready right away. Then my best friend had a little girl. We became very attached to this child and she spent a great deal of time with us. It was then that we realized how much we wanted our own child, and we were secure in our feelings that both individually and together we'd make great parents! We wanted to nurture a child emotionally, spiritually and physically. We wanted to protect its happiness and innocence and to love and guide it to adulthood."

This couple is typical of this archetype. The woman is 46 and her husband is 48. They had been married for 8 years but only started trying to get pregnant two years earlier when the woman was 44. Like most people in this group they tend to be low risk takers who want everything to be right before they make a decision. They ultimately did do a procedure but took 282 days to decide on a donor.

 

Single Women

At IVF New Jersey we have seen quite a few single women. Some have been married previously, then divorced, and now, as single women, have decided to have a child without a partner. Other women have never married, have no partner, and want to be a parent. Finally, we have also met with a handful of lesbian couples who have done recipient procedures. Here are two stories.

"I have always wanted children but I waited too long. I felt I had to be married first. I was married for 5 years and I did get pregnant during that time. I was 28 years old. But the baby was stillborn. Soon afterwards I separated from my husband, as he really did not want children. To this day, he has no children and does not intend to have any. Frankly, after my baby was born dead, I was afraid to get pregnant again and so the years passed. Also, I was still unmarried. My father was old-fashioned and I loved him so much that I could not even contemplate having a child our of wedlock. When he died I was 43 years old and alone. That was when I decided to try to get pregnant but with no success."

This single woman is one who is presently single but had been married previously. Other single women have never been married. Here is an example:

"I have wanted children for many years, but waited until I could provide a good life for a child before I started trying to get pregnant. Being single, I had to save for many years to be able to buy a house. I took in roommates to bring in extra money to have a "baby fund". Finally, when I was 39, I began trying. Perhaps because I am missing a Fallopian tube, it was 8 months until I conceived. I was overjoyed and greatly relieved that I hadn't waited too long after all. At 5 weeks, the baby appeared fine, and had a heartbeat. But at six weeks I miscarried, and felt an enormous loss. I became depressed, but resumed trying after two months. After six more cycles on fertility drugs and IUI's, I tried a GIFT procedure. After four Clomid cycles failed, I lost hope that my own eggs would ever fertilize. I am 41 now. My periods have gotten very light, and I don't respond well to Pergonal anymore. I am remorseful that I didn't start trying sooner, but I didn't know it would be so difficult, or take so long. I want to be a parent because I am a nurturer. I feel the most relaxed and content when caring for someone. I always took care of the younger children in my neighborhood, and dreamed for years of the games I would play with my own children and how I would raise them. I dreamed of the things we would do together, and the things I would teach them. I am not able to put these dreams aside."

The decision to use an egg donor is somewhat easier for women in this group than for women in some other groups since they are already using a sperm donor. Some medical practices do not want to work with this population - viewing the procedure which we term "double donor" as an instance of embryo creation (bringing together two donors neither of whom has an connection to the parents of the baby that will result.). The first single woman (who had once been married) eventually decided to do the procedure and took 174 days to make her decision. The second single woman also decided to do the procedure and decided fairly quickly - taking only 105 days to do the procedure.

 

Adopted Kids

We have also met more than a dozen couple who have an adopted child and would like to have a second child. Although they adopted their first child, they would like to try to use an egg donor to have a second child. To understand their motive, consider the following story.

"We have been trying to have a baby for 8 1/2 years. After 3 surgeries and numerous IVF and IUI cycles, my ovaries do not respond to the medications. I have endometriosis and one blocked tube which has made it difficult to conceive on my own. We have one son whom we adopted and he would have a little brother or sister. We would love to have our own biological child and I would love to know how it feels to be pregnant and bring a life into the world."

As this woman noted, a strong motive to do an egg donation procedure rather than a second adoption procedure is the desire to experience "how it feels to be pregnant and bring a life into the world." Unlike members of the secondary infertility archetype who also have a child, members of the adoption archetype have an easier decision about using a donor. They already have a child that is not biologically connected to them. This couple took 156 days to decide on a donor and begin their cycle.

 

Medically Infertile

The final archetype that we have constructed is one consisting of medically infertile women. There are many reasons why a medical problem may lead to the decision to do an egg donation procedure. Consider the following story.

"When I was going into 10th grade, I was diagnosed with an ovarian dermoid cyst. Apparently it had been growing for over one year. My symptoms were minor, but after surgery we realized the extent of the damage. I lost 1 ½ ovaries and one of my fallopian tubes. Fortunately, the doctor felt that pregnancy could still be achieved so we decided not to worry. After all, I was only 15! Several years later and after 4 ½ years of marriage, my husband and I decided to try to have a child. We were devastated to find that upon examination and without symptoms I had another ovarian tumor. After this one was removed I was told that I had ½ of an ovary and a tube that was damaged beyond repair due to the scar tissue. Subsequently fertility specialists and tests have determined that the donor program is our only chance to conceive and carry a child."

Like other members of this archetype, this potential recipient is clear that she cannot use her own eggs. For her the choice is between doing a donor egg procedure or adopting if she wants to have a child. This couple weighed these two choices carefully:

"Since our diagnosis, we have concentrated on exploring both the donor option and adoption.

We know other couples who are experiencing trouble with infertility who are also experiencing martial problems because of it. We have worked hard to be supportive of each other through this very difficult time and feel that our marriage has been strengthened through the crisis, not weakened. After seven years of marriage, we are very fortunate to still feel like we did when we were newly weds but with a more mature outlook on life." Because they spent a great deal of time trying to choose between adoption and egg donation, it took them 383 days to begin an egg donor procedure."

Other medically infertile women have needed to use an egg donor for reasons such as being born without ovaries, having radiation treatment that destroyed their ovaries, or being carriers of a genetic disease that they did not want to pass on to their baby.

 

None Of The Above

Over the years, many infertile couples heard about our various archetypes. We received letters and emails from numerous people telling us that although they found our descriptions interesting, when they tried to see where they fit in, none of these descriptions were characteristic of their situation. And they are correct. When we looked at the more than 800 couples and single women that we met over the past decade, we found that some of them, less than 10% of the sample, could not be classified as fitting in to any of these archetypes. Some had features of one particular archetype but were different in one or more important ways. As an example, we met several couples who were similar to our "Modern Classic" archetype. The woman was around 40, had a successful career, never had any children, and was married to a man who was previously married and had children. But the woman in this instance had been married previously and had tried unsuccessfully to have children in her first marriage. We could not classify this woman as a "Modern Classic" because her "story" was not that of a woman who had put off having children until she established a successful career.

 

So Why Do We Care About The Concept Of Archetypes?

So, is the classification that we did just an interesting academic exercise or is it important for recipients, physicians, and mental health professionals to consider this concept?

 

We believe that the archetype concept is important. All recipients are not alike and the struggles that they have deciding whether to do an egg donor procedure and whether to choose a particular donor are likewise different. So while a "To Mother Again" couple has an easy time deciding on a donor, a "Young Infertile" or a "Young But Feels Old" couple has a much harder time. All of these women need a donor to conceive. But the "Mother Again" woman has had a child or children, has passed on her genes to a child, knows what it is like to be pregnant, and has the support of her husband to do an egg donor procedure. In contrast, the "Young Infertile" or the "Young But Feels Old" woman has not passed on her genes, and is not completely convinced that she doesn't still have an opportunity to do so. After all, other women her age are still having babies using their own eggs.

Mental health professionals can use this information to help their clients understand the issues surrounding their response to the procedure. If they are also helping couples select a donor, mental health professionals can point out to these couples why they are experiencing such turmoil about the procedure. As IVF New Jersey Donor Coordinator, Helane often shares information (anonymously) about other of the same archetype coped with their concerns about the matching process.

Physicians sometimes wonder why a recipient keeps passing up wonderful donor candidates who are presented to her. Knowing about the archetypes can help the physician understand why it is difficult for a particular woman to select a donor when other women can do so easily. The same is true for the recipients themselves. They may participate in face-to-face or internet support group and hear other women discuss their ability to select a donor easily and be thrilled with their decision. They may wonder why the other person had an easy time and they find themselves struggling. We believe that thinking about these archetypes can help them make better sense of their own situation.

 

And What About The Donors?

In the past decade we've also learned a great deal about egg donors. At IVF New Jersey, recipients can choose from the anonymous pool of donors that we have met, oriented, and interviewed, or they can choose to select a donor they have obtained by working with a "donor broker." In practice, more than 98% of the recipients at IVF New Jersey have worked with IVF New Jersey's own donors. Since none of the recipients we have worked with have done "split cycles" (sharing the eggs of one donor with two different recipients), we have had to meet with many potential egg donors in order to have a sufficiently large pool of donors for all the women who want to be recipients.

So how does IVF New Jersey find donors? It's not easy! The donors come from two different populations: young mothers and college students. All of IVF New Jersey's donors are between the ages of 21 and 30. They all attend an informational seminar designed to familiarize them with important aspects of egg donation. The seminars are conducted jointly by one of the IVF

New Jersey physicians and by Helane Rosenberg, the IVF New Jersey egg donor coordinator. At the seminar the potential candidates learn about the medical and logistical aspects of egg donation. They are apprised of the risks involved and encouraged not to do a procedure if they feel uncomfortable with these risks or if doing a procedure would cause them conflicts with significant others (spouse, boyfriend, or parent). Further, they are encouraged to consult their own physician to get a second opinion about the medical advisability of doing an egg donor procedure. They receive an informational packet that contains literature about research on the relation between infertility medical procedures and the risks of ovarian cancer. At the seminar, they ask questions and fill out forms with demographic and contact information. They are told that they will be contacted after the seminar to discuss their interest further and to be interviewed in depth if they would like to continue to consider being a donor. Finally, they are told that if they go home and think about whether they are comfortable deciding to donate and if they are not, to please tell the person calling that they do not want to donate. Many candidates indeed decide they are not willing to donate and are thanked for coming to find out about the procedure. No candidate is ever pressured to reconsider.

Interested candidates have a skilled clinical interview about their comfort and motivation to become a donor. Any candidate who shows evidence of psychological instability or any of the other features that the ASRM task force on egg donation has indicated as risk factors that should disqualify a candidate is eliminated from the pool of potential candidates. In contrast to other practices that administer the MMPI (Minnesota Multiphasic Psychological Inventory), we do not use this instrument as a screening device. The decision to do so is one of the things we learned over the decade of working with donors. When we began working with donors we did use the MMPI. But we did not find it useful in discriminating between good and poor donor candidates. Rather, we found that a skillful clinical interview was the best way to choose appropriate candidates.

We conducted a follow-up study of our donors and found that none of them had suffered any adverse effects from their decision to donate. The one instance of a negative reaction was one of the first donors we worked with who had previously had an abortion and, while in a "twilight sleep" from the IV sedation, had flashbacks of the abortion and felt badly about that.

Subsequently that donor felt Okay but we learned a lesson that we incorporated in our subsequent donor screenings. Almost all of the women who we interviewed subsequent to their donation felt proud of what they did and considered it one of the most important acts they had ever done. What concern the women had were not about their connection to a baby or any ambivalence about their genetic material being "out there." Rather, the few concerns that we heard were about the possible effects of the medications. Even though they had heard about risks ahead of time and had concluded that they were not concerned, a few women, after having donated, began to worry about long term negative effects that had not emerged as of now.

Not all women are suitable to become donors. Of the nearly 3,000 women that we interviewed, only about 450 actually donated. A little more than half of these women donated more than one time. Of all the cycles that were initiated, very few had to be cancelled because of donor problems. IVF New Jersey carefully screens donors for drug use. A few cycles had to be cancelled because donors were found to exhibit traces of marijuana in their drug screenings. (Such drug use is quite rampant on college campuses and it is not surprising to find a handful of women who succumbed to this temptation despite their promise to refrain from doing so.)

 

So What's Involved In Doing An Egg Donor Procedure?

Once you have decided that you are comfortable with the idea of having a baby using someone else' eggs, your chances of giving birth to a healthy baby are quite good. Over the decade that we have been involved with egg donation, the success rate for this procedure has climbed dramatically. When we got pregnant with our twins, we were members of the subset of successful recipient couples that constituted only about 30% of those trying to get pregnant with this procedure. Today, the national averages for live births from egg donation are nearly double what they were when we used this procedure. At IVF New Jersey, nearly 70% of the recipients are giving birth to healthy babies.

The biggest obstacle is the cost. Adding up all the components of an egg donation procedure can yield a cost approaching $30,000. In some states, for example, in or own state of New Jersey, medical insurance can cover a large fraction of these costs. But some costs will never be covered by any insurance. These include the fee paid to a donor and the costs for the non-medical management of the donor-recipient cycle.

The other major obstacle to doing a procedure is the wait for a donor. Some clinics have long waiting lists of a year or more to do a procedure. Fortunately, at IVF New Jersey we have been able to keep the wait to a reasonable period of time. In fact, if we compare the wait for a donor at IVF New Jersey during the first 5 years they did this procedure with the last 5 years, we find that the average time between coming to the practice for the initial interview and the date on which the donor selected began taking her medications to begin her cycle decreased from about 7 months to about 4 months.

The good news then is that it is now possible to do an egg donation procedure without having to wait very long at a reasonable cost with high odds of taking home a baby. The only remaining question is: "will I be happy parenting a baby born through egg donation?"

 

What Are The Experiences Of Parents Of Egg Donor Babies?

Here we have less data to use to provide answers. Certainly we have our own experience to discuss and that has been extremely positive. We also have talked informally with many of the recipients who we worked with at IVF New Jersey. Their reports to us have likewise been uniformly positive. Indeed, many of the recipients have returned to try to achieve a second pregnancy with egg donation. Some have asked us to try to locate their original donor for a second procedure. Sometimes we advised against doing this because now, several years after doing the first procedure, the age of their original donor was too old to offer them the best odds of success. But often, the donor was still of an age where she could be a good donor candidate.

The only problem was locating her after all the time that elapsed. We have had some success tracking down former donors and a number of them have agreed to donate again so that these recipients could have a baby with the same gene pool as their first baby.

But we would love to have more systematic information to offer potential recipients. With the help of INCIID we are planning to conduct a survey of recipients about their experiences parenting children born using this procedure. If you are a parent of a baby born through egg donation, you can contact us at yepstein@rci.rutgers.edu to find out how you can participate in an interview about your experiences. We will collate all the information we obtain and publish a follow-up to this article discussing parenting experiences and anecdotes in detail.

 

And Finally, The Voices Of The Children

We could not write an article about being an egg recipient without sharing the experiences of our children. We believe that it is very important to tell our children that they were conceived via egg donation. First, we believe that it is their right to know. Second, we don't like to keep secrets. We believe that keeping this matter a secret would change the atmosphere in our family in a way that we find unacceptable. For us, there was an additional reason to disclose. We want to inform people who are contemplating this procedure about our experiences so that they can act in a more informed way. If we tell others, we of course need to tell our children.

We had no trailblazers preceding us to let us know about their experiences. We had to act based on our hunches. We decided that it was best to start talking about egg donation from the time our children were very young. We starting including this term in our discussions even before our children were able to understand what it meant. We just wanted them to hear the words "egg donation" and "egg donor." At first, they had no idea what we were talking about. As they grew older they began to understand a little more. Now that they are about to turn ten years old, they understand that mommy needed a third party to help her become pregnant.

They do not understand the genetic implications of this yet, but will understand it when they get older.

In preparing this article we talked to them. We said that people reading this article might want to hear their thoughts about being an "egg donor child." Nathaniel said: "tell them I like Yugio and I love my family." We asked him "Do you ever talk to other kids about being a donor baby?" He said "No, why should I?"

We also asked Allegra what she had to say. She said, "It's a special thing." We said "what's life like for you?" She said:, "Life is pretty much like it is for anyone else." We said, "Do you talk to your friends about being an egg donor baby?" She said, "Sometimes." We said, "And what do they say" She said, "They don't understand what I'm talking about." Then we asked, "So what do you say?" She said: "I tell them someone had to help my mom get me born."

But sometimes there are painful moments. Last summer Nathaniel was playing with our dog, Yankee, and being a bit too rough. Helane told him to stop and he got angry. He said, "You can't tell me what to do, you're not even related to me." Helane told him that what he said made her feel really bad. She said, "Would you like it if I said you (Nathaniel) were not related to me?"

He thought for a minute and said, "No." Helane said, "Would you like it if I said to you that you're not really my son?" He said, "No." Helane said, "You can be angry with me, but you cannot say mean things to me because you hurt my feelings." Nathaniel apologized.

 

Allegra said a similar thing to Helane once when she wanted to stay up late and Helane would not allow her to do so. We have learned to expect that some time the kids may say things like this and we can deal with it. Sometimes they are saying it because they are angry. Sometimes they say it as a way to manipulate us. They know they can upset us and that gives them some power.

Allegra has also expressed an interest in meeting the donor to see what she looks like. She is primarily interested in looking at the donor's hair because Allegra has such unusually beautiful blonde hair, a characteristic that people mention when meeting her. Although Helane has dark hair, Yakov has blonde hair this. Interestingly, Allegra compares herself with her mother, Helane, not her father. Allegra also ponders whether the donor has had children. We believe that her interest at this time is in knowing if those children look like her. We have explained that Allegra's meeting the donor is not possible because of the agreement we made with her. We explain that we must honor our agreement. In fact, in our daily lives, both of us (Yakov and Helane) try to model a life in which we honor our commitments as a way to show that we will indeed honor our agreement not to look for the donor.

Our children are open to communicating with potential recipients if they have questions for them. If you email Allegra, she will respond to your questions (just be aware that she is only 10 years old and is not a fast typist.)

 

We hope this article has been helpful to you. Please contact us with your feedback and any questions you may have.

 

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