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Egg donation has been around for decades, but it's still controversial.
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The INSIDER Summary:

  • Young, healthy women can make thousands by donating their eggs to infertile couples.
  • Some doctors say the process is generally safe.
  • Critics, however, worry there may be undiscovered health risks.
  • Similarly, some former donors say the experience is positive and meaningful, while others regret it.
  • INSIDER spoke with doctors and real women who've gone through the process to learn what it's really like — and understand all sides of the debate.

Online ads recruiting egg donors make the process seem like the pinnacle of win-win situations. You give the gift of life to a couple that desperately wants a child. They compensate you with thousands of dollars. Everyone walks away feeling fulfilled.

"Egg donation is a gift that lasts a lifetime," one ad reads.

"Help a recipient's dream come true today and take your dream vacation or pay off some bills tomorrow!" says another.

But things don't seem as rosy if you stumble across one of the many sources claiming egg donation is dangerous and unethical.

A few minutes of Googling reveals pages and pages of personal essays, news stories, and even a 45-minute documentary detailing the alleged risks of donation and regrets of former donors.

Messages about egg donation can vary dramatically depending on source. And that's a problem, because egg donation has steadily grown in popularity over the past decade, according to data from the Centers for Disease Control and Prevention (CDC). Potential donors deserve to know whether the process is a safe and altruistic gesture, a high-stakes medical risk, or something in between.

INSIDER interviewed doctors, women who've donated their own eggs, and one vocal critic of the egg donation industry to get the full (and very complicated) story. Here's a closer look at what the process is really like, and what you need to know if you're considering donation.

The first step in being a donor is getting picked.

Donors usually go through thorough medical screening.
Flickr/Andrew Malone

Not everyone can be an egg donor.

One of the most important factors is age: The American Society of Reproductive Medicine (ASRM) — a major organization in fertility industry — recommends that donors be between ages 21 and 34, since female fertility starts to decline rapidly around age 35.

By FDA law, potential egg donors must get screened for HIV, hepatitis, syphilis, chlamydia, and gonorrhea before donating. But most clinics go a lot further than the minimum legal requirement. Genetic, psychological, and even personality tests might be included in screening.

The ASRM has a very long list of guidelines for selecting and testing potential donors. But they're only guidelines, not rules or laws. Some clinics may follow them to the letter and others might be more or less intensive.

"I took a long personality test and was required to meet with a counselor to discuss a variety of topics," three-time egg donor Rhiannon Schwisow, 26, told INSIDER. "This included my motivation for donating, my family relationships and support system, my job and education level, my hobbies, what I did in my spare time, and if I was generally happy and satisfied with my life."

Once a donor has been screened and selected by recipients, everyone involved will usually sign a legal contract that outlines the specific terms of the donation. Some donors opt to hire lawyers to help them fully understand (and potentially negotiate) this contract.

The donation process begins with hormones.

Donors inject themselves with hormones at home.
Shutterstock

Normally, in each menstrual cycle, the ovaries produce one egg.

Egg donors, however, are prescribed hormone injections that stimulate the ovaries to create a lot of eggs. These hormones are the same kind taken by women who are freezing their own eggs or undergoing in vitro fertilization (IVF) to try and get pregnant themselves.

The daily, at-home injections last about a week or two. During that period, you'll see the doctor every one to three days for blood work and ultrasounds.

"The medications themselves are actually not associated with a lot of side effects and discomfort," Dr. Cynthia Austin, a fertility expert at the Cleveland Clinic, told INSIDER.

Then a doctor extracts the eggs vaginally, using a needle guided by ultrasound. It's a quick procedure done under anesthesia and most women go back to normal activities the next day.

Of course, the experience can very from person to person — even from cycle to cycle.

"My first donation was easy. I didn't have any physical discomfort at all," two-time egg donor Deaven Williams, 27, told INSIDER. "My second time was more rough. After retrieval I physically felt terrible. Like really bad period cramps. I could barely stand up straight after the procedure on retrieval day and if I laughed it gave me terrible pain. It took a few days for me to not have any pain left."

Schwisow's donations were less painful overall.

"During my donation cycle, I would get bloated for the last few days, but there weren't a lot of side effects other than that for me," she said. "My donation cycle was really easy on my body [...] I would say some of my birth control [has been] harder on my body than egg donation cycles."

Getting the eggs out of your body is a bit more complicated — but it's low-risk.

A woman undergoes an egg retrieval surgery.
Shutterstock

The retrieval procedure has just a 1% risk of bleeding or infection, Dr. Brooke Hodes-Wertz, assistant professor of obstetrics and gynecology and reproductive specialist at NYU Langone's Fertility Center, explained to INSIDER.

There's also a small risk that the hormone injections will lead to ovarian hyperstimulation syndrome. That's when the ovaries become swollen, causing abdominal pain, weight gain, bloating, and nausea, vomiting, or diarrhea. Severe cases can be life threatening, but these only happen 1 to 2% of the time. Most go away on their own.

Dr. Hodes-Wertz also said that there's a very slight risk of an ovary becoming twisted during the hormone treatment. In some cases, the ovary's blood flow can be cut off and it may need to be surgically removed.

"It takes a fair amount of energy, both physical and emotional," Dr. Austin said. "It's not like a sperm donation. It's a more invasive process."

After the retrieval — and potentially some follow-up appointments — the process is over. The egg donor returns to life as usual.

You can make serious cash by donating.

It's illegal to sell eggs or other body parts in the US. Instead, when donors get paid, they're being compensated for their time, for undergoing risk, and for inconveniencing themselves.

The ASRM notes that various interviews, tests, appointments, and the retrieval procedure can add up to more than 50 hours spent in a medical setting. For all that time and effort, donors are offered sums as high as $10,000 or $15,000, according to some online ads.

Have you ever thought of becoming an Egg Donor? https://t.co/rwkq2ZzRQL #donorlife #eggdonorpic.twitter.com/nNHhaCbDJk

—Genesis Fertility (@GENESIS_NYC) August 13, 2017 ' data-e2e-name="embed-container">

"We are one of the few countries in the world that actually allow for paid ovarian stimulation," Dr. Mary Jane Minkin, clinical professor of obstetrics, gynecology and reproductive sciences Yale School of Medicine, told INSIDER.

The amount that donors are paid can vary from place to place and clinic to clinic, as there's no official or legal standard. Schwisow said she received $4,000 for each of her first two donations and $5,000 for her third. Williams received $5,500 for each of her two donations, and was also reimbursed for her travel to and from the doctor's office.

And it's fairly likely that your eggs will result in a live birth.

Odds are around 50% that a donation results in a baby.
Tim Bish/Unsplash

For some donors, the primary motivator isn't money — it's altruism. In 2010, researchers surveyed a group of 80 former donors and found that a third of of them donated purely out of the desire to help others. (40% of respondents said money and altruism were equally important.)

"My initial motivation was my manager at my college retail job," Schwisow said. "They used IVF with donor eggs to conceive and I realized how incredibly loved and wanted IVF children were."

On the other hand, potential donors might feel weird about creating biological children they'll never meet. Either way, it's good to know the odds of a donation actually resulting in a baby.

The answer mostly depends on the fertility clinic where you donate. Clinics across the country publicly share their success rates online, and some are higher than others.

In general, Dr. Austin said, there's about a 50% chance a donation cycle will lead to a live birth. But that's not a 50% chance per egg : Not every egg you donate will last through fertilization and develop into a healthy, normal embryo.

"At every step [of the process], there's a little drop-off," Dr. Hodes-Wertz said. "You can go from 20 eggs to three."

That 50% estimate is in line with the real-life data, too. Every year, more than 90% of American fertility clinics report their success rates to the Society for Assisted Reproductive Technology (SART). In 2014, the most recent year for which stats are available, 53.4% of women who received donated eggs ended up having a baby.

Your donation might be anonymous, but that's not the case for everyone.

Sometimes family members will donate eggs to one another — for example, a woman might donate to her sister.

But both Schwisow and Williams made anonymous donations, as mandated by the clinics where they donated. That means the donors don't know the identities of their recipients, and the recipients don't know the identity of the donor.

"If I had an option, I would have chosen anonymous [anyway]," Williams said. "My donations were in 2012 and 2014 so I was only 22 and then 24. I had no idea what my future would look like, who'd I be with, if I'd have a family one day. I didn't want to have that knowledge looming over me. Part of me is curious if the donations were at least successful, but I'm also completely fine not knowing at all."

Interested in becoming an egg donor? Learn more...https://t.co/CJIp9hZ4Agpic.twitter.com/2SLw0RPsQS

—RMSCVA (@RMSCVirginia) October 11, 2017 ' data-e2e-name="embed-container">

Schwisow was informed by her clinic that her donations had led to three live births. But she said she doesn't exactly think of those children as hers.

"I am not at all uncomfortable knowing my donations resulted in live births. I'm elated they did," she said. "The woman who received my eggs still grew that baby inside of her body. It was she who had morning sickness, swollen feet, and leaky boobs. It was her partner that touched her belly to feel the baby kick, and it was she who brought the baby into the world, not me."

But egg donation is controversial for a lot of reasons.

Some critics bemoan the lack of governmental regulation when it comes to egg donation and other assisted reproductive methods. (The US is sometimes called the "wild west" of the fertility industry.) Some people have religious objections to the concept itself. Some argue that the potential medical risks of donation haven't been adequately studied.

Others have even gone as far as to say that egg donation is exploitative— that donors are treated more like profitable egg factories than human beings.

To understand the current state of affairs, it's helpful to know how we got here.

Egg donation used to be very different than it is today.

The first successful pregnancies via egg donation were reported in 1983, according to a 2014 paper in the journal Nursing for Women's Health.

In those early days, egg donation was intended to serve a specific population: Women younger than 40 who had premature ovarian failure. (Or "women whose ovaries pooped out at a very young age," as Dr. Minkin put it.)

Initially, experts thought that egg donors would fall into one of three camps:

  1. Women who agreed to donate excess eggs harvested during their own IVF treatment.
  2. Women who agreed to donate eggs while having a totally unrelated surgery.
  3. Women who volunteered to donate out of the blue.

Then a couple of things happened.

First, scientists discovered that egg donation didn't just work for young women with ovarian failure. It could also help women have babies in their 40s and 50s. This new development led to a surge in demand: One paper noted that it spurred a 10-fold increase in the number of egg donation cycles.

An egg cell getting fertilized by sperm in vitro.
Flickr/ZEISS Microscopy

Then it turned out that the women who were envisioned as donors didn't actually want to donate, according to the ASRM.

As egg freezing technology became more advanced, most women undergoing IVF for themselves opted to freeze their extra eggs, rather than giving them up. And women getting unrelated surgeries often couldn't donate eggs due to medical reasons.

That left only one group — young, healthy, volunteer donors. In order to meet the demand for donor eggs, a solution emerged: Offer young, potential donors some money to sweeten the deal.

Paying donors got more and more popular — which raised some sticky ethical questions.

A 1993 survey found that 60% of US fertility centers offered payment to egg donors, the ASRM reports. By 2004, 94% of programs were offering money. Today, it's still the status quo.

In its official position statement on paying egg donors, the ASRM rules that the practice is justified because donating takes a lot of time and involves some risks — and because offering payment increases the number of donors, thereby helping more infertile couples have kids.

It's strong, clear-cut position borne from a tangled mess of ethical quandaries.

Make someone's dream come true! Become an Egg Donor today! pic.twitter.com/peZdxi2ryp

—LasVegas EggDonation (@LVEggDonation) September 29, 2017 " data-e2e-name="embed-container">

For instance: What if the amount of money offered is so high that women donate out of financial desperation, ignoring the risks? What if donors lie about their medical history in order to get accepted?

What if some couples offer wildly high sums in order to get donors with specific physical characteristics or talents? Isn't that a lot like eugenics? And couldn't you argue that it's fundamentally wrong to treat a part of the human body like an item with a price tag?

But then, wouldn't it be wrong to not pay donors for everything they go through? Besides, sperm donors are compensated for donating their reproductive cells to couples in need. Even back in 2000, they could net an average of $60 to $75 per donation, according to the ASRM. Who's to say we shouldn't pay female donors when male sperm donors have long been donating for cash? It's a lot to mull over.

In the past, the ASRM said that payments more than $10,000 were "not appropriate," but some donors were still offered sums up to $50,000. (Remember, those ASRM guidelines are still just guidelines).

But in 2015, a group of former egg donors sued the ASRM, accusing the organization of illegal price-fixing. The suit was settled and now the ASRM no longer recommends a specific cap on payments. It only warns, vaguely, that they shouldn't be too high.

Schwisow, for one, thought her payment was both justified and appropriate.

"There is a stigma of greed surrounding egg donation, like someone's desire to help other people couldn't possibly outweigh their desire to sell their bodies for money," she said. "Considering the effort I put into making time for my appointments, injecting myself accurately each day, and the minimal risks associated with the retrieval surgery, I think that my compensation was very fair."

Williams emphasized that donation is a lot more than just a financial transaction.

"I've heard it referred to as 'selling babies,' which I think is pretty insensitive and diminishing what you're actually doing for these families," she said. "I can't imagine getting news that I couldn't have a child of my own if I wanted one. The fact that I was able to change that for two families is honestly priceless."

When it comes to long-term risks, there's still a big question mark.

There's no research on the long-term health of egg donors specifically.
Shutterstock

Jennifer Schneider is a doctor specializing in addiction and pain management — not fertility treatments or egg donation. But 16 years ago, a personal tragedy changed everything.

Dr. Schneider's daughter Jessica donated eggs three times. Then she was diagnosed with stage 4 colon cancer at age 29. She died two years later.

Dr. Schneider wondered whether the hormone injections used during the donation process might have had something to do with the cancer, so she decided to research the possible long-term health risks for donors. She came up empty-handed.

"The fact is that there is an incredible blindness about the risks of this procedure," Dr. Schneider told INSIDER.

Dr. Minkin confirmed that — to best of her knowledge — there has not been any official long-term study of women who have been egg donors.

Dr. Schneider has since writtenpapers urging the medical world to conduct more research into egg donor health.

Some fertility doctors are still optimistic.

There are still no long-term studies of egg donors, but there are long-term studies of women who have used IVF to get pregnant themselves. And, as mentioned before, the hormone injections are the same in both processes.

Some experts say that we can take the results from studies of IVF patients and apply them to egg donors. Overall, these studies are pretty encouraging: Though earlier research suggested a possible connection between IVF and certain hormone-related cancers, newer data does not support this link, according to the American Cancer Society.

"It's been pretty clearly shown that these types of cycles don't raise the risk for ovarian or breast cancer," Dr. Hodes-Wertz said. "We feel pretty confident that we're not harming women's reproductive future."

Could you donate your eggs to help another woman with her dream of having her own baby? Find out about #eggdonationhttps://t.co/T6jL3oK8gxpic.twitter.com/0MOd4qhtVW

—H&E Fertility Centre (@FertilityUnit) September 5, 2017 ' data-e2e-name="embed-container">

And though what happened to Dr. Schneider's daughter is tragic, stories like hers are still only anecdotal evidence. They don't indicate that everyone will experience health complications after donating.

But the problem, Dr. Schneider and other critics say, is that we still don't know for sure. They maintain that egg donors need to be studied on their own.

"You can't really use that just substitute information [from IVF patients] and say we don't have to study egg donors," she said. "I'm saying, as a scientist, that's not very medically sound."

Dr. Austin acknowledged the lack of data but seemed optimistic.

"We don't really have data to prove that it causes a problem," she said. "Do I think it does? No. [But] you have to caution patients that it's an unknown."

That's an important point, since not all women may get that information before they sign up to donate. A 2010 study found that a majority of advertisements soliciting egg donors violated ASRM guidelines by neglecting to mention either known or unknown risks of the process.

There may never be one tell-all study on possible long-term risks of donation.

Large groups of egg donors could be tracked by researchers and asked to report back on their health problems over time, but such a study wouldn't be able to determine cause and effect, Minkin explained. The development of cancer can be influenced by so many variables— obesity, smoking, chronic inflammation, viruses, exposure to certain chemicals or radiation. Hormone-related cancers in particular can be influenced by birth control and pregnancy, too.

If an egg donor gets ovarian cancer, say, 20 years after her donation, it's extremely difficult to prove that donation alone was at fault.

One piece of good news is that most women don't seem to regret donating.

A few small studies indicate that donors are mostly satisfied with their experience.
Eli DeFaria/Unsplash.com

At least, that's according to the small amount of available data. Two small surveys of American donors from 2004 and 2010 indicated that a majority of donors were satisfied with their experience. Several studies of donors in other countries also report high levels of satisfaction, but since donation laws and protocols differ, we can't necessarily apply those results to American donors.

And even though it's only anecdotal evidence, both Williams and Schwisow were very satisfied with their decision, too.

"I had a wonderful and positive experience at [my clinic]. I felt cared for, appreciated, and like they were helping me do good in the world," Schwisow said. "I donated three times because [my clinic] made me feel so comfortable, and because they gave me great feedback about the results of my donations."

Williams expressed similar sentiments.

"It's honestly one of the most meaningful things I feel I've done in my life," she said.

Then again, egg donation is still dogged by unanswered questions. Tragic things have still happened to women who donated in the past.

"It's a tough one," Dr. Minkin said. "We don't have a lot of great data to say do this or don't do this. I do think it does come down to a personal decision."

That might be the best bottom line we can draw. It doesn't seem like medical experts will ever universally celebrate or condemn egg donation. The decision to donate ultimately lies with each woman examining the benefits and the potential risks, then weighing them against her current situation.

It's not a satisfying conclusion, but — for now — it's the one we have.

Correction: A previous version of this post said that there is a 5% chance of ovarian torsion for patients undergoing hormone treatment prior to egg donation. The risk was misstated and is actually much lower.

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