0527 DonorBook 1009 DonorAssistPrple FORWEB V6 by lizzy2008


            By Cara Birrittieri
 Mary M. Fusillo, RN, BSN, MS
         Georgia Witkin, PhD
                        Table of Contents

                           A Word From the Authors


                                            The Basics

                                 Decisions, Decisions!

                                    The Professionals

                             Emotions and Concerns

            Telling and Talking About Egg Donation

                                   About the Authors

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A Word From the Authors

Cara Birrittieri                          smile broadly, give me a big hug,
Author, What Every Woman                  and whisper in my ear, “Thank you
Should Know About Fertility               so much for helping me become a
and Her Biological Clock
                                          mother. It is the very best thing
Egg donation has blessed me with          that ever happened to me!” It is
an amazing little girl who is the         only then I realize that helping
light of my life, and is the sparkle in   people achieve their own wonders
her big brother and daddy’s eyes.         of the universe, their very own
Against all odds, and following           children, is one of the best gifts I
years of disappointing agony with         have ever received.
failed attempts at conceiving on
our own or with treatment, we were        Georgia Witkin, PhD
able to have the child we dreamed         Reproductive Medicine Associates of NY
                                          Clinical Psychologist
of and made our family complete.
There is no parallel in medicine; no      Day after day, I help couples un-
procedure that can even compare           derstand the difference between a
to bringing a life into the world that    ‘genetic’ and ‘biological’ contribu-
would otherwise never be possible.        tion. Day after day, I explain that
When I look into her 2-year old twin-     a donor egg simply delivers some
kling eyes, hear her bubbly laugh,        genetic material to help them
and drink up her never ending smile,      conceive a child of their own. Day
I can’t help but feel thankful for all    after day, I help couples learn that
the people past and present, who          a new person, not someone else’s
made this precious gift possible. I       egg, is growing into their child. Day
only hope that my joy will help           after day, I reassure prospective
others realize their dreams as well.      ovum donation parents that they
                                          can have two or more feelings about
Mary M. Fusillo, RN, BSN, MS              ovum donation at the same time (for
Many times after an especially            example: both a sense of loss and a
challenging week at work or home          sense of excitement). Day after day,
with my family, I will notice a woman     I reassure them that bonding with
I think I know. Maybe in the grocery      the child and loving the child are as
store aisle, perhaps at a bookstore       natural as childbirth itself. Day after
or a children’s party and I will think    day, I watch tears of sadness turn
to myself “Hum, where do I know           into tears of joy.
her from?” and before I can even
figure it out, she will walk up to me,

You have in your hands a booklet that       issues are different. The concerns are
will help answer many of the questions      different. The emotions are different.
you are likely pondering about oocyte       Even the information and misinforma-
donation, or ovum donation, better          tion are different.
known as simply egg donation. This
                                            In fact, most published material
publication is long overdue according
                                            available for prospective egg donation
to many who work in this field since
                                            patients still uses the “adoption
there are thousands of children born
                                            model.” However, now there is a solid
to families every year via IVF with
                                            body of evidence and tremendous
donated eggs, and many of these
                                            clinical experience with egg donation,
new parents searched for information
                                            which can be used to counsel patients.
in various places and from various
                                            It is our goal to help prospective
sources to help them through the
                                            recipient parents understand that egg
challenges this option entails. Now
                                            donation is not a form of adoption. It
you won’t have to. Many experts have
                                            is a unique experience. It is a natural
seen a need to provide current, con-
                                            experience. It is an exciting process,
cise, and factually correct information
                                            which affords a mother a “biological
to their patients, but few have taken
                                            child” of her own. Within the pages of
the leap to publish a booklet. Here
                                            this guide, you will uncover many
three experts have come together to
                                            important facts and clarify several
provide a unique guide to help you
                                            issues pertaining to becoming the
understand this option.
                                            parent of a child created through IVF
What makes this book different is the       and egg donation. Some of them are:
perspective and recommendations are         dispelling the myths about the
based solely on egg donation clinical       donation; how to choose a donor;
research and experience — not               whether, what, how, and when to tell
extrapolations from counseling for          your child; how to talk with your
parents of foster children, adopted         doctor so they can hear you; and
children or children of surrogacy. The      why this is such a wonderful medical
advice appropriate for adoptive parents     advance for those dealing with certain
is not the same as advice appropriate       types of infertility.
for parents who use egg donation. The

The Basics
The Egg Donation Process                       the laboratory
                                           n The combined genetic material
Did you know that through egg
                                             (which is now 23 pairs of chromo-
donation you become the biological           somes with their own set of
mother of your child? This is perhaps        instructions for a new human
the most important “basic” fact of           being) duplicates itself and two
having a child through egg donation.         new cells are formed. They
                                             double and there are four new
This process enables you to become
                                             cells. This process continues
pregnant and bear a child even if            and the ball of new cells become
you cannot produce or use your own           an embryo (more about this later)
eggs. The egg may come from an
                                           n An embryologist monitors the
anonymous donor or from someone              growth of the embryos for
you know such as a family member or          2 – 5 days
friend. However, you do not receive
                                           n One or more of the resulting
her “egg” during the transfer, you           embryos are then transferred into
receive an embryo.                           your uterus
Here’s how it works:                       n One of the embryos must attach
                                             and implant in your uterus for you
n The donor undergoes a medical
                                             to become pregnant
  and psychological screening
                                           n You find out if you are pregnant
n If cleared for egg donation, she
                                             10 – 14 days after the transfer
  goes through a cycle of IVF (in vitro
  fertilization) medication so several
                                           The implanted embryo builds it’s body
  of her eggs will mature
                                           from it’s mother’s body, so she is the
n Meanwhile you (the recipient) take       baby’s biological mother and the child
  medication to grow your uterine
                                           her biological child. Her pregnancy is
  lining so it can sustain a pregnancy
                                           the same as every woman’s pregnancy
n After about 3 – 6 weeks the eggs         and the couple experiences the joy of
  are retrieved from the donor. Eggs,
                                           both the pregnancy and the birth of
  like sperm, carry genetic material
  (chromosomes and DNA)                    the mother’s biological child, and in
                                           many cases the father’s genetic son or
n The eggs are combined with
                                           daughter, and perhaps even a sibling’s
  sperm from either your husband
  or partner or a sperm donor in           brother or sister. No doubt about it,

an egg donation pregnancy and birth          pass on to a child.
is as natural as any other in the world.
                                             How much does egg
Many Women and Couples                       donation cost?
                                             Typically the fees involved in egg
Choose Egg Donation
                                             donation include the price for the
The latest statistics from the Centers       IVF procedure and related medical
for Disease Control (CDC) show nearly        procedures such as screening tests for
16,000 IVF cycles using donated eggs         the donor, and the cost of medications
took place in the U.S. during 2007.          for both the donor and the recipient.
Given that the success rate in 2007 was      Many clinics lump all of these costs
55% for transfers with fresh embryos         into a single fee, which may range any-
created with donated eggs, and 32%           where from $15,000 – $25,000 or higher.
with frozen embryos, thousands of            Other clinics separate costs of the IVF
couples became parents through this          procedure, the donor screening costs,
method of family building — and the          and the medication costs.
numbers continue to climb each year.
Clearly, egg donation has become an          If you choose an anonymous donor
appealing option to have a child. You        from an agency or clinic, she will
might consider egg donation for a            receive compensation. These fees
variety of reasons:                          vary, but are generally in the $3,000 to
                                             $10,000 dollar range. The American
n You have gone through several
                                             Society for Reproductive Medicine’s
  IVF cycles without success,
  especially if doctors determine            (ASRM) Ethics Committee advises
  a problem with egg quality                 that, “sums over $5,000 require
                                             justification and compensation of
n Your body has not responded
  well to fertility medication               more than $10,000 goes beyond what
                                             is appropriate.” This fee is in addition
n You are over 40 and fertility tests
  indicate success with IVF using            to the agency fee if you use an agency.
  your own eggs is unlikely                  Agency fees can run from $2,000 to
                                             $6,000 or more.
n You have had premature
  menopause or premature ovarian             There may also be separate attorney
  failure (defined as menopause
                                             fees. If you use an agency or find a
  before the age of 40)
                                             donor on your own, it is recommended
n	 You no longer have ovaries due            that a contract be written, negotiated
   to surgery or have lost the ability to
                                             and finalized. These fees can be
   produce eggs from chemotherapy
                                             arranged as a lump sum, or can be
In some cases, a woman who can               paid by the hour. You will also be
produce healthy eggs chooses egg             responsible for your donor’s attorney
donation — for example, if she carries a     fees. Plan to spend about $1,000 to
genetic trait that she does not want to      $2,000 if all goes smoothly.

Will my medical insurance pay?              genetic material from two different
Some health insurance plans in a few        gene pools. The combined genetic
states may pay for egg donation,            material instructs the developing
however, there are usually restrictions.    fetus to become a boy or a girl, tall
Some pay for the procedure only, not        or short, have curly hair or straight,
testing, or medications. It is extremely    blue eyes or brown.
unlikely that a health insurance compa-
                                            Myth number 1
ny will reimburse an egg donor agency,
                                            Fifty percent of the genetic material
the donor, or any attorney fees. Also,
                                            is delivered by a sperm cell. Most men
the older a woman is, the less likely in-
                                            think their sperm is carrying their own
surance will pay, even where infertility
                                            characteristics. This is the first myth.
coverage is mandated. In most states
                                            Actually their sperm is carrying genetic
and in most cases patients pay on their
                                            material from their entire gene pool
own. To find out what insurance might
                                            (parents, grandparents, aunts, uncles,
cover in your state go to:
                                            etc.). If the particular sperm that
                                            delivered the genetic material for your
Why would someone                           baby is carrying DNA for characteris-
donate eggs?                                tics expressed in the father or sperm
Research shows two primary incentives       donor, the baby may resemble him.
for donors. One is a desire to help a       If, however, that particular sperm is
couple become a family. Often donors        carrying certain characteristics from
have a family member or friend who          great uncle Harry for a little girl with
has suffered from infertility, and this     curly blonde hair and blue eyes, his
motivates them to help make another         daughter may look nothing like him
woman’s dream come true. The other          with his straight dark hair and brown
chief motivation is monetary compen-        eyes. It’s the luck of the draw. Each
sation. Payment to anonymous donors         sperm cell carries an entirely different
may be anywhere from $2,000 – $10,000       combination of genes from the man’s
per cycle.                                  ancestors.

Myths and Reality of the                    The same of course is true for eggs or
“Donation”                                  ova. Any given egg can contain genes
                                            from any group of ancestors — those
You probably learned the following          that resemble the woman donating the
in your high school biology class, but      eggs or those ancestors who look noth-
most of us need a review to dispel          ing like her. That means the genetic
many of the myths around baby mak-          material in a donor’s egg may give
ing and making a baby with a donated        instructions for a child to develop with
egg.                                        very different features than the egg
                                            donor herself. (This has important impli-
To create an embryo that will grow          cations when choosing an egg donor,
into a healthy child, you need

which is discussed later). Once the
two sets of genes combine, another
step determines which traits will
actually arise in the developing fetus
and child. When the genes come
together they all interact, some turn
on and some turn off, so in reality,
there is no telling which gene will do
the instructing, and who your child
will act like, look like, or sound like.

Think of a family that you know. If
each genetic contribution in a child
were an exact duplicate of their
parent’s genes, all the girls and all the
boys in the family would be clones of
one another. The fact is that each egg
and sperm contains a different com-
bination of genes, and each time they
unite a unique individual is created.
That is why within the same family there
might be some tall children, or short,
some brown hair, or blond, some look-
ing like one parent, or some who look
like neither. Indeed, the only excep-
tion to this rule is identical twins. Their
genes are identical because a single
embryo splits in two, duplicates and
develops as two people with the same
genetic makeup. Everyone else has
his or her own genetic combination or
code. This is also why genetic testing is
so accurate.
Myth number 2
Now here’s the part that may surprise
you. Although this medical procedure is
called “ovum donation,” the recipient
does not receive someone’s egg in
her uterus. This belief is another myth.
Once the genetic material from the
sperm and the egg has melded, the

work of the sperm and the egg is done.           the materials and construction, from
The combined material duplicates                 the foundation right on up to the light
itself and two new cells are created.            fixtures. So, although her husband’s
The material duplicates again, and now           aunt Sara or the donor’s grandfather
you have four new cells. They double             may have genetically programmed
and there are eight. Soon there will be          the shape of a new baby’s earlobe,
a ball of new cells — the beginning of a         the earlobe itself is the pregnant
new human being (an embryo). When                woman’s “flesh and blood.” That
a women gets pregnant on her own,                means the earlobe, along with the
this duplication process begins in the           baby herself, grew from the recipient’s
fallopian tube. When a donor egg is              body. That is why she is the child’s
used, it happens in the IVF laboratory           biological mother. That is why this
and the embryo(s) are transferred to             child is her biological child.
the recipient’s uterus when it is about
                                                 Many recipients ask, “Is the baby
the same size it would be coming from
                                                 actually my flesh and blood?” Not
the fallopian tube. It is that ball of cells
                                                 literally. No baby is really its mother’s
(embryo), not someone else’s egg,
                                                 flesh and blood because the truth is
that hopefully implants into the
                                                 that every fetus builds its own flesh and
recipient’s uterine wall and begins
                                                 its own blood. Still you might wonder,
to grow into a fetus.
                                                 “If it was my own egg, wouldn’t the
Myth number 3                                    baby then have my blood?” No. The
Perhaps the greatest myth surrounds              baby might inherit your blood type,
pregnancy. Many believe the uterus               but would still be making it’s own
is simply an incubator. Nothing could            blood, just as it makes it’s own skin
be further from the truth. The most              and hair texture, and nails and teeth.
important aspect of all pregnancies —            Besides, with or without egg donation,
including egg donation pregnancies —             the baby might have inherited his or her
is that as the fetus grows, every cell in        blood type from the father’s gene pool.
the developing body is built out of the
                                                 Think of it this way: every baby is
pregnant mother’s body. Tissue from
                                                 a complete, self-contained, unique
her uterine lining will contribute to the
formation of the placenta, which will link       human being. You will meet this person
her and her new child. The fetus will use        when he or she is born. To try to sort
her body’s protein, then she will replace        out the genetic contributions at that
it. The fetus uses her sugars, calcium,          point is like trying to break a cake down
nitrates, and fluids, and she will replace       into flour, sugar, water, and yeast after
them. So, if you think of your dream             it has been baked. It is now a cake, no
child as your dream house, the genes             longer separate ingredients.
provide merely a basic blueprint, the
biological mother takes care of all

Decisions, Decisions!
Choosing a Clinic                           seminar if you have that opportunity.

There can be a host of factors to
                                            Pregnancy rates vs. live birth
consider when looking for a clinic.
                                            Every couple is interested in success
They include location, success rates,
                                            rates at their clinic, but what do these
and cost.
                                            statistics mean? Each clinic interprets
Which clinic is right for me?               its data a little bit differently, but in
Many patients, who have tried IVF           general the “pregnancy rate” is the
without success with their own eggs,        percentage of egg donor recipients
continue on to egg donation at the          who conceive and have a fetal heart-
same clinic. Others “shop around,”          beat at the first ultrasound, which
looking for the best match for their        usually takes place at 6 – 7 weeks. The
needs. They may want to compare             “live birth” or “take-home baby” rate
costs or evaluate the clinics’ donor        is the percentage of egg donor cycles
pools. Other factors to consider in         that end with the woman taking a baby
selecting a clinic include:                 home from the hospital. Pregnancy
n The clinic’s success rates for egg        rates are always the higher of the two
  donor procedures                          figures because some pregnancies end
                                            in miscarriage.
n The experience of the physicians
  with egg donation
                                            Choosing a Donor
n The options for screening and
                                            Searching for an egg donor can prove
  selecting a donor through the clinic
                                            one of the greatest challenges for re-
n Age restrictions that may                 cipient couples. Over the last decade,
  exclude you
                                            many options have become available,
n Your overall comfort with the staff       making the question of where to begin
                                            as perplexing as whom to choose. The
Most centers now employ full-time           following is intended to help you de-
egg donor coordinators for this             cide which route is best for you and
type of specialized care. Some              your circumstances, and then using a
centers also host seminars for              few fundamentals, guide you along the
prospective egg donor recipients.           way to select the right donor for you
It’s a good idea to attend such a           and your family.

                                        – 10 –
Four paths to consider                        travel costs for out-of-town donors.
Before beginning your donor search            The donors will then be screened at
you must decide on a path to take.            your clinic for infectious disease and
Currently in the U.S. your options are:       fertility potential and you will pay the
                                              clinic for these services.
n Your clinic may supply a donor
  or offer a pool of donors to                Searching on my own?
  choose from                                 Few choose this route due to the time
n Use an agency specializing in               involvement, and touchy nature of
  matching donors to recipients               the interview process. Those who find
                                              this option desirable tend to have
n Advertise in newspapers and on
  the internet and search for your            specific needs in a donor, for example,
  donor on your own                           a certain ethnicity or race background.
                                              In these cases, recipients will target
n Choose among willing friends
  or family members                           and advertise in specific publications,
                                              Internet websites, or community news-
Clinic or agency?                             papers that may offer a better chance
If you prefer an anonymous donor,             at finding the ethnicity they are looking
the two most popular choices are to           for.
choose a donor from an agency or
from the donor pool at your clinic, if        What about someone I know?
this is a service it offers. Those clinics,   If someone offers to donate eggs
which offer donors, typically recruit         for you, you must decide if you are
from the local area. These donors will        interested. If so, several things must
likely already be tested for infectious       happen. First, the woman has to pass
diseases and have undergone ultra-            the physical screening and fertility
sound exams and hormone tests to              testing much as any other donor at
determine their fertility potential.          a clinic or agency would, but the
Agencies may be able to offer a larger        psychological screening is even more
selection of donors from a broader            important with known donors. In fact
geographical area or even nationwide.         it is highly recommended that you
Some agencies also specialize in spe-         and your potential donor meet with a
cific “niche” matches based on ethnic-        mental health professional to define
ity or other recipient preferences.           your future relationship and roles. Each
                                              of you would retain separate attorneys
The cost will vary as well. Clinics           to draw up contracts and discuss
generally include the cost of donor           compensation and insurance needs
recruitment, health and psychological         for the donor’s time lost from work
screening, as well as testing and donor       or family. Many times the kind offer
insurance into their fees. Agencies           of donation is made in the spirit of
charge an agency fee in addition to           friendship and generosity without the
attorney fees, donor insurance and            potential donor understanding either

                                          – 11 –
medically or emotionally what is at         little details — like the size of her wrist,
stake. However, many family members         whether she prefers reading myster-
and friends have donated with very          ies or histories, or her favorite colors.
successful outcomes if the counseling       Look at the big picture, the gene pool
is sought and the proper legal              picture, and then just like any other
documents are put in place.                 parent-to-be wait to see who your child
Deciding on Your Donor
                                            However, there are some important
When you have decided on which
                                            points to consider. You want to try to
route to take, you are ready to move
                                            match your family’s gene pool to her
forward with the process. Here are the
                                            family’s gene pool. If the recipients
three most important things to think
                                            come from fair-eyed gene pools, the
about when choosing your donor —
                                            donor should also. If the recipients
gene pool, gene pool, gene pool!
                                            come from very tall, thin gene pools,
Consider the donor’s gene                   and want a tall, thin child, the donor
pool, not her genes                         should come from a tall, thin gene
Even if a donor is a fabulous dancer, a     pool, too. That way, if genetics are
terrific tennis player or loves horseback   passed on that were not expressed in
riding, that doesn’t mean she would         the donor (and therefore not similar
pass on those attributes to your child;     to the recipient either) the child will
she may in fact pass on her grandfa-        still look like “family.” Think about
ther’s talent for math puzzles instead.     whether the donor and members of
If she passes on some of her talents,       her family might blend into a photo
they won’t be in the finished form you      of your extended family.
know about, but rather in the form of
                                            How are potential donors
potential only — athleticism, or musical
ability. In other words, don’t confuse
                                            Most agencies and clinics begin by
nature and nurture. Furthermore,
                                            requiring potential donors to fill out
remember that no matter what traits
                                            a form to gauge their interest and
or abilities she may have the potential
                                            demographic fit for becoming a donor.
to pass on from her gene pool, your
                                            Those who meet the initial criteria
husband’s genetics might be dominant
                                            complete an in-depth medical and
in that area so her contribution might
                                            psychological profile, undergo an
not make any difference at all.
                                            ultrasound of their ovaries to evaluate
Of course you will look for a donor with    their potential to produce eggs, and
similar traits to yours, but you should     provide blood so their hormone levels
always try to find out all you can about    can be checked for any fertility prob-
the donor’s whole family. Ask about the     lems. Potential donors who pass these
donor’s parents, grandparents, broth-       tests may be evaluated by a mental
ers, and sisters. Avoid worrying about      health professional. The evaluation

                                       – 12 –
ensures that the donor fully under-          not duplicate health problems in your
stands the emotional risks and benefits      partner’s gene pool. For example, if
of egg donation.                             your husband’s family tends toward
                                             asthma, a donor with a gene pool
If the donor is chosen, she undergoes
                                             susceptible to asthma may double the
additional testing that is required by
                                             risk of a child developing asthma. Look
the Food and Drug Administration,
                                             for a donor gene pool that doesn’t
including screening for HIV and
                                             duplicate those very health risks. Think
hepatitis infection.
                                             of this as a wonderful opportunity for
How much information will                    you as a future parent to help ensure
the clinic or agency give me?                maximum health for your child.
Clinics and agencies provide varying
amounts of information about their           Also, be aware that some problems
donors. At a minimum, you should             that are considered “psychological”
have complete medical information            may have a genetic predisposition. Ask
going back at least three generations.       about depression, anxiety disorders,
Additionally, you should have enough         psychoses, alcoholism and any learning
personal information — such as hair and      disorders if there is a history of them
eye color, ethnic background, height,        in your partner’s family or extended
weight, body type, education, and            family. What you’re trying to avoid is
more — to have a sense of what she is        duplication of vulnerabilities. Keep
like. Your donor will be your genetic        in mind however, that no family gene
“stand-in,” so it is important that you      pool is perfect.
feel comfortable with her personal           And remember…
characteristics.                             Once your child is born, get to know
                                             your child and provide an inheritance
On the other hand, the donor’s
                                             from you. Children are all born with
personal characteristics are just that
                                             the capacity to learn from and see
— personal to her. Choosing a donor
                                             their parents’ world as their own. So
with a master’s degree in chemistry
                                             give them your sense of humor, your
will not guarantee that your child will
                                             patience, and common sense. Your
be interested in science, nor does
                                             child is an individual, not a simple sum
selecting a donor who is tall promise a
                                             of two gene pools, or a clone of your
future basketball player in your family.
                                             donor and partner. Your child is a new
The same holds true for eyes and hair.
                                             person. Unique… and yours.
You will not know what kinds of genes
will be expressed until you are holding
your child in your arms.

What about medical history?
Make sure that any health problems
in a potential donor’s gene pool will

                                         – 13 –
The Professionals
Your Doctor                                   typical eight minutes of discussion
                                              allotted by the doctor after an exam.
Did you know that medical statistics
                                              2. Bring a list of topics, symptoms, or
show an average doctor’s visit in this
                                              questions. This is highly recommended
country is less than 20 minutes long?
                                              by both patients’ and physicians’
That often means no extra time for
                                              groups. That way you won’t forget any-
topics that aren’t life or death, are em-
                                              thing you want to discuss. One study
barrassing or difficult to approach. So
                                              found doctors, on average, interrupt
how do you find the courage and time
                                              patients 18 seconds after they begin
to ask questions about egg donation?
                                              describing symptoms? If you have your
How to talk so doctors will                   list handy, you can quickly bring the
hear you                                      doctor back on track with your con-
The only way to get answers about             cerns. Also, put your main concerns
egg donation and medical options              at the top of your list just in case you
is to ask the questions. Doing so may         can’t get to ALL of them.
be easier said than done. Suppose
                                              3. Take notes. Follow up by taking
you are shy, or the doctor is busy, or
                                              some notes during the conversation.
you are not sure that the two of you
                                              Focus on your main concerns here too.
are really communicating. The doctor
                                              In fact, if the doctor doesn’t object,
may be unapproachable, very techni-
                                              you may want to record pertinent
cal, not a good listener or emotionally
                                              information. By the end of the
detached. Still you have to ask the
                                              meeting, you’ll probably have more
                                              information than you can possibly
Here are the 7 best ways to capture a         retain without notes!
doctor’s attention when you want to           4. Practice makes perfect. If you have
discuss egg donation:                         difficulty describing your problem or
1. Plan more time — if you know that          asking a question about your fertility
you are going to take longer than the         concerns, practice out loud at home.
usual appointment length — less than          Some patients give one-word answers
20 minutes — tell the receptionist that       to questions or are embarrassed to
you would like a longer appointment.          talk openly about their problems.
That way you will have more than the          Practicing what you want to say will

                                          – 14 –
make you feel more comfortable when          In addition to your egg donor, your
you meet with the doctor.                    physician, and the donor coordinator,
5. Bring someone with you. Taking            you may also find yourself consulting
your partner with you means four ears        a lawyer, an agency coordinator, or a
instead of two. Someone else might           psychological counselor.
ask questions that you won’t think           The donor coordinator
of and may react more rationally to          The donor coordinator, typically
information. Also, some people ask a         a Registered Nurse (R.N.), is your
lot of questions, and then forget the        new best friend during your egg
answers. Some of us want to know             donation cycle. The coordinator will
every detail now. Others want news           schedule your donor for her testing,
delivered a bit at a time. Some don’t        communicate between the physician
want to know much at all. Having             and your donor during her work-up
a companion with you will ensure             and coordinate the testing of you
that whatever your listening style is,       and your partner in preparation for
someone else will be there to write          your cycle. Many times the donor
it down or commit it to memory.              coordinator is a very experienced
6. Honesty is the best policy — even         infertility nurse who also helps recruit
if it’s difficult for the doctor to deal     and select donors for in-house pools.
with, be honest about your feelings
                                             Her job during your cycle will be to
with your doctor. If the topic is too
                                             manage the donors schedule, make
overwhelming, let the doctor know
                                             sure she has her daily results from her
you are tuning out and need time to
                                             cycle monitoring and coordinate your
absorb everything. If you need another
                                             schedule and medications too. She
appointment to talk, schedule it. If you
                                             is also someone to ask questions of
don’t feel comfortable with the infor-
                                             and her goal is to partner with you
mation or options you’ve been given,
                                             to make the cycle a success. Her
always get a second (or third) opinion.
                                             knowledge about the ins and outs
7. Make doctors avoid “Doctorspeak.”         of egg donation will make your cycle
Insist the doctor speak in your              smoother and less stressful.
language, not medical jargon. If you
don’t understand, keep asking, “What         Do I need a lawyer?
is that? What does that mean? What           You may find it helpful to have legal
are the consequences of that?” “Can          assistance to understand state-specific
                                             laws regarding donor parenting. Some
you explain that in simpler terms?”
                                             states, such as Texas and Arkansas,
Other Professionals                          have laws that address the legal status
Who Can Help                                 of a baby born from the eggs of a
                                             donor or through a surrogate. Califor-
Many people are working to help              nia requires the prospective parents
you and your partner make this baby.         and the egg donor to each have an

                                         – 15 –
attorney, to protect the rights of both       when to disclose to the child his or her
parties.                                      genetic origins.

Some experts in the field of egg dona-        Mental health professionals who
tion recommend that both parties be           practice in infertility are also familiar
legally represented even if the donor is      with the feelings of loss, anxiety, and
“known,” such as a family member or           grief that are part of the egg donation
friend. Some clinics may have refer-          experience. Their job is to assist you in
rals to attorneys that are familiar with      learning ways to make the journey less
third party parenting, and contracts          fearful and easier to navigate. A good
between donors and recipients. Local          mental health professional will help
support groups such as RESOLVE and            you learn to deal with these anxieties
American Fertility Association may            or other feelings you may have so you
have a list of professionals that they        can proceed with creating your family.
may be able to recommend. A family
                                              Selecting a mental health
lawyer would also be helpful in finding       professional
the right attorney to represent you. It       This is a personal decision, just like
is important to find an attorney who is       your choice of a clinic, a physician,
familiar with third party reproduction,       and an egg donor. In this case it
especially egg donation.                      would be extremely helpful to select
Mental health professionals                   a professional who has experience
Often your clinic will require you to         working with infertile couples.
meet with a mental health professional.       Mental health professionals who
However, one of the biggest miscon-           work in infertility may be Ph.D.’s,
ceptions about seeking the guidance           M.A.’s, or licensed social workers.
of a psychological professional before        The degree is less important than
an egg donation procedure is that the         the experience and commitment to
counselor can keep you from becom-            helping infertile couples as a large
ing a parent. This myth keeps many            part of their professional practice.
couples from benefiting from the guid-
                                              Many large clinics have an in-house
ance and information that a counselor
                                              mental health professional that you
can bring to this lifelong decision.
                                              may choose to consult. Other clinics
For most mental health professionals,         have referral lists to professionals that
the appointment is a way to open up           they have worked with in the past and
a discussion about important psycho-          who have experience with infertility
logical matters that you should address       and third party parenting issues. Other
before you embark on the egg dona-            resources for finding a mental health
tion process. A mental heath profes-          professional include the patient sup-
sional can help you explore such issues       port groups, RESOLVE, and American
as what to tell family and friends and        Fertility Association.

                                          – 16 –
Emotions and Concerns
Mixed Emotions                                the decision to pursue parenthood via
                                              donor eggs is not a one-step process.
It is completely normal for women             It is a journey toward the family you
and their partners to have mixed              have always dreamed of. Along the
emotions over starting the egg                way, you may encounter a variety of
donation process. Many couples have           feelings — grief, anxiety, and the thrill
gone through years of unsuccessful            of actually being pregnant with your
fertility treatment before making             child! Knowing that these feelings are
the decision to try egg donation.             normal and developing ways to cope
Others who have had children                  with them will do a lot to ease the
previously, either with or without            sense of loss and let you fully enjoy
treatment, also feel mixed about the          the excitement of becoming a parent.
idea of using someone else’s eggs
to have a child. However, once the            Fear of Failure
decision is made, many people feel a
                                              After everything you’ve been through,
sense of excitement because at last           it makes sense to fear it may not work.
they are about to embark on a fertility       This may cause intense anxiety. Unfor-
treatment that has the highest success        tunately, no one can predict who will
rates in the field. For the first time cou-   succeed, and often there is no clear
ples will feel they have a real chance        reason why some donor cycles don’t
of having their longed-for baby. Still,       result in a healthy pregnancy. One way
these feelings will likely ebb and flow       to help alleviate some of your anxiety
with a sense of loss since you likely         over this “what if” is to decide what
had planned to use your own eggs.             your next step will be if it doesn’t work.
                                              For example, you might have back-
These emotions are normal, and you
                                              up plans for another cycle, a frozen
may go back and forth between them            embryo transfer, adoption, or child
for an extended period of time. But,          free living. Being able to discuss the
experts in the field say the sense of         process with a professional infertility
loss will subside as time passes, par-        counselor, a friend or family member
ticularly if you make an effort to grieve     who understands the process, and
the loss of the child you expected to         your partner can help you deal with
have. Professionals and infertility sup-      stress or disappointment.
port groups can help with this. Making

                                          – 17 –
Anxiety Over
A high percentage of egg
donation pregnancies result in
more than one baby. In 2005,
about one-third of all donor
egg pregnancies resulted in
multiple births, usually twins.

While many women are thrilled
to have an “instant family,”
the complications for both the
women and their babies can be
serious. The risks of pre-term labor
and premature birth are real, and
you need to discuss these with your
doctor before you even undergo the
embryo transfer. In the past, women
typically received multiple embryos
in a single transfer, because the odds
were that only a fraction of them
would successfully develop into a
baby. Now, after many advances in
IVF and tremendous rise in successful
births from donor eggs, many clin-
ics routinely transfer only one or two
embryos to reduce the chances of a
multiple pregnancy.

It is best to be prepared in advance
for your instant family. If you become
pregnant with more than one baby,
you should seek out support during
the pregnancy through a group such as
the National Organization of Mothers
of Twins Clubs (NOMOTC). You should
also research the sorts of physical help
you’ll need during the later stages of
pregnancy and when you bring the
babies home. Many women give birth
to their multiples early, and the babies

                                         – 18 –
spend time in intensive care. If this        Common Fears
happens, you will need both emotional        and Anxieties About
and physical support during this time.       Your Future Child
Feeling Alone and                            Many who explore the donor egg
Needing Support                              process fear the child will not look like
                                             the mother, and people will notice
An egg donation cycle is a highly
                                             and comment on it. The best way to
emotional and stressful time in your
                                             address this fear is to realize that even
life. This is probably not the time to
                                             a genetic child might not look like the
“go it alone.” Since few women tend
                                             mother either. Often children exhibit
to talk about their egg donation pro-
                                             the father’s physical characteristics,
cess, you may not know whom to talk
                                             or even a distant maternal ancestor
with about this stressful and exciting
                                             who the mother may not know, or
time in your life. So, joining a support
                                             look anything like. If this becomes an
group of other women engaged in egg
                                             overwhelming issue, go back and read
donation, consulting a counselor on a
                                             the “Basics” section again, and try to
regular basis, or taking part in an
                                             remember that any child that is born
                                             to you through this process is a unique
    “... any child that is                   individual and truly yours.

    born to you through                      People also worry that their child
                                             will reject the mother when he or
    this process is a
                                             she is told about the egg donor.
    unique individual                        However, with egg donation, the
    and truly yours.”                        child has always had only two parents,
                                             the biological mother, and the genetic
                                             father. Hence, the bond between
Internet group devoted to egg dona-          mother and child is so strong that
tion issues are all effective ways to gain   these fears usually fade as the child
the support you need. If you have            begins expressing his love in the
family and friends who understand the        toddler years, and then moves into
difficulties related to infertility, you     preschool, elementary school and
might also consider asking for their         beyond.
support along the journey. Of course,
you can share your feelings with your
spouse or significant other, but re-
member your partner is in this adven-
ture too, and may also need support.

                                        – 19 –
Telling and Talking About Egg Donation
Should We Tell Our Child?                    These parents point out that with the
                                             widening use of genetic screening, the
Perhaps more than any other aspect           chances of keeping egg donation a
of ovum donation, recipients say they        secret for a lifetime are slim, and they
are concerned about telling the child.       would rather tell a child than to risk
Many ask if the child really needs to        him or her finding out at a vulnerable
be told at all. Others plan to tell the      time.
child but are unsure about when and
whether they should tell others before       This can happen due to medical
the child. Still, many wait to decide,       reasons. It is possible that during a
but want to know how to provide              health crisis the information will be
the most information with the least          important. One couple found they
confusion and least emotional upset          had to tell their teenager about their
to the child.                                egg donation because the teen was
                                             trying to donate tissue to his mother
The decision to tell or not to tell          and a DNA test revealed that he was
the child about the egg donation is          not a match. Another couple shared
completely personal. However, more           the information with their daughter
often than not parents are telling their     because she was so concerned that
children, and now most mental health         she would inherit her mother’s family’s
professionals say it may be better to        breast cancer vulnerability.
tell than risk the child finding out at a
later, sometimes difficult time.             Indeed, if these children are never
                                             told about the egg donation, they will
The reasons parents decide to tell vary.     be unaware that their mother’s family’s
Many say it’s because the egg dona-          medical history is irrelevant to their
tion is part of their child’s inheritance,   own. That means when they are older
part of his or her life story, and because   and a physician asks, “Is there cancer,
children have the right to know their        heart disease, diabetes, depression,
genetic origins; many tell because           or blood pressure problems in your
it is part of their own “journey” to         genetic pool?” Your grown child may
parenthood; others say they would            be answering “Yes,” when the happy
never want the child to find out from        truth is that the real answer is “No.” It
any source other than themselves.            is for this reason, that many parents tell

                                        – 20 –
their child about egg donation when          have little information about the sperm
the child is old enough and ready to         donor.
understand eggs and sperm and their
                                             Because donor egg procedures have
genetic implications.
                                             been commonly used only since the
However, perhaps the most compel-            late 1980’s, there’s little information so
ling evidence to support telling comes       far on the responses of these children
from the adoption model, which has           as they grow up. It appears those who
shown over the past four decades that        know about their conception and
children who know about their origin         understand it, have not shown undue
— and know from an early age — tend          anxiety or fear, much less rejected their
to be much more accepting than chil-         mother or parents. The pendulum has
dren who find out accidentally. These        swung to favor disclosure in almost all
findings are now supported by more           cases of donor eggs or sperm.
recent data from the children of sperm
donors. This research has shown that
                                             When to Tell
early disclosure to children conceived       There is no one right time. Many
via a sperm donor seemed to reduce           mothers talk to their infants about egg
concerns, since it was “always” a part       donation as “practice,” so that the
of their identity.                           explanation becomes easy for them.
                                             Most children will understand the con-
                                             cept of a “helper” at around 5 years
  “... donor egg proce-                      old, and the concrete idea of donated
                                             eggs as early as 8 or 9 years old. It is
  dures have been com-
                                             probably best to avoid delaying the in-
  monly used only since                      formation until adolescence, since this
  the late 1980’s...”                        is a time of great emotional upheaval
                                             and uncertainty, and not a good time
                                             to add egg donation to the mix.

Parents may also have a variety of           That said, it is still important to
reasons for not disclosing. These            make sure your child or children
include concern that family members          can understand the concept that you
might reject the child if they found out;    are trying to get across. Anything that
that the child might reject the mother;      is unknown or confusing to a child is
or that others would not approve of          stressful. Also, this doesn’t have to be
a non-genetic child. Some studies of         one lengthy, in-depth conversation.
children conceived with donor sperm          It can be a series of age appropriate
have found that the resulting offspring      talks beginning in infancy for practice,
are often conflicted over the role of the    then following through the pre-school,
donor in their lives, this is particularly   elementary, and middle school years.
true when offspring find out later, and

                                        – 21 –
For a full explanation, it’s best to wait       positive approach as “We were so
until your child has studied “eggs,”            thrilled that you had blonde curly hair,
“sperm” and “human reproduction”                since Daddy has black hair and I have
in school, or until you have discussed          brown. I always wanted a curly headed
these concepts at home. Until then,             baby. The donor gave you that great
simple statements such as, “Doctors             head of hair.”
and other people can help Mommies
                                                By keeping the donor as a positive the
and Daddies have babies,” are easily
                                                child will begin to see this as “good
absorbed by children of any age.
                                                news” first and foremost.
How Do We Tell?                                 Keep it medical
When you decide to tell your child,             You would like to think the first que-
here are some suggestions that have             stion would be, “Mommy, why did you
helped parents that we have worked              need a donated egg?” But it rarely
with in the past. Each suggestion               is. Instead, be prepared for “Who
is aimed at giving the child a view             donated?” If your donor was an anon-
of egg donation that is accurate,               ymous donor, the simplest answer
understandable, and psychologically             might be, “There were many donors
easy-to-digest. The goal is to give             to choose from and I picked one that
them new information–not a                      was the most like me — you lucky kid!
new identity!                                   That’s why you’re so smart and cute.
                                                Blame your glasses (or your braces) on
Here are three golden rules when                your father’s side of the family.” This
talking with your child:                        reminds children you are their mother,
n Keep it positive                              and there is no other. Conjuring a fan-
                                                tasy figure donor will not only confuse
n Keep it medical                               your child, but will probably also make
                                                him or her more curious about the
n Keep it about you, not them
                                                donor as a person. As more questions
Keep it positive and age                        come later on, there will be time to
appropriate                                     provide more information.
It’s important to remember what a
wonderful way this is to create a child.        Keep it about you
So, when talking with the child, pres-          In the case of anonymous donation,
ent egg donation as “good news.” To             presenting the child with the above
most kids, good news is a “surprise.”           information will underscore that you
So for a child of about 9 or 10, begin          had egg donation, not them. That is,
by asking them if they’ve heard of egg          thanks to egg donation and their
donation (try to be sure the answer is          father, you became pregnant and
yes), then tell him or her that you have        carried the child and gave birth to the
“good news.” Continue with such a               child. It’s very important to remind

                                            – 22 –
them that you went through nine               At any age, make the explanation real
months of pregnancy, that you were in         for children by showing them pictures
labor and you delivered them.                 of you while you were pregnant. This
                                              also helps to remind them that every
Making it clear that you were the egg
                                              cell in their body comes from your
recipient, not the child is even more
                                              body. This makes their origins clear.
important if the donor is not an anony-
                                              This normalizes their story. Pictures
mous donor. If the donor is a family
                                              show them your pregnancy was
member, friend, or other known-donor
                                              just like every other on earth. It will
who is comfortable being identified
                                              reinforce the reality that you had the
to the child, keep it clear that the
                                              procedure, you are their biological
donation was to you and not the child.
                                              mother, through you they have re-
And if the child and donor want to talk
                                              ceived the genetics from the donor’s
directly, make sure the donor is clear
                                              gene pool. You, as their mother, are
on that point, too.
                                              their source of life.
When Do Children                              Often professionals receive calls from
Really Understand?                            parents eight or nine years after their
In general, children hear more than           egg donation because they are ready
we think and understand less than we          to talk to their child about the proce-
think when it comes to egg donation.          dure; their first question generally is,
But by the time they study conception,        “What did you tell me then?” After the
                                              review, and talk with their child, the
                                              parents usually call back and say, “Why
 “It’s very important to                      did I worry about that for so long? It
                                              was no big deal.” Or they might say,
 remind them that you
                                              “We presented it matter-of-factly and
 went through nine                            in an upbeat way and my child took it
 months of pregnancy...”                      matter-of-factly and in an upbeat way.”
                                              Bottom line… don’t worry if you can’t
                                              remember the words to the song. As
sperm and eggs in school, children            long as you hum the right melody, your
get it. Much to their parents’ surprise       child will hear the tune.
they have strong opinions about it!
                                              Where Can I Find Age-
Some recipient parents say that by
                                              appropriate Dialogues?
8 or 9 years of age, their children
have heard of egg donation and have           Search online or at your library for the
learned about human reproduction.             increasing number of books devoted
Others say their children weren’t             to this topic. Many of these books are
ready for a full explanation until they       appropriate for children under 5 years
were 11, 12 or 13 years old.                  old, with dialogue stressing the love

                                          – 23 –
the parents have for each other and         If the age difference is less than ten
their desire to have a baby to share        years, it’s not unusual for older siblings
that love. Several other books are          to spill the beans — even accidentally
available for children ages 5 – 9. These    — and their frame of reference is not
add the explanation that mom was            sufficient to explain it properly. One
missing a part and needed the help of       child was told by a brother, “You come
an egg donor.                               from the egg nation,” because he
                                            didn’t understand what egg donation
Talking to Siblings                         really meant. Another was told by a
Not Conceived This Way                      cousin, “You come from a chicken,”
Many couples that have already              because she had overhead her parents
parented a child or children, either        talking about the number of eggs that
naturally or through IVF and are unsure     were transferred.
whether they should tell any older
                                            Another issue is that the older sibling
siblings. If you plan to tell the child,
                                            may tell someone else, intentionally
the siblings eventually ought to know.
                                            or not, before you and the donor-egg
However, parents who already had
                                            child are ready for that information to
one or more children before using
                                            be passed elsewhere. The sibling may
egg donation often advise against
                                            also feel anxiety over letting the info-
telling an older sibling about the egg
                                            rmation slip out accidentally.
donation, at least during the younger
one’s early childhood. Until the egg        If, however, your ovum donation pro-
donation child is old enough to decide      cedure is open information within your
with whom he or she wants to share it,
there are many reasons why it may not
be good for the sibling relationship
                                                “You, as their mother,
for the older child or children to know         are their source of life.”
something about the younger child
that the younger child still doesn’t
know.                                       family, your ovum donation child’s
                                            siblings will probably know long before
The fact is, it may be some time before
                                            your donor-egg child is old enough
your donor-egg child is old enough to
                                            to understand. And that is how many
understand the details of his or her ge-
                                            families want it. On the other hand, if
netic origins. If the older sibling knows
                                            you decide not to tell an older sibling,
this information first, it can create
                                            it is important to realize you are not
problems in the children’s relationship.
                                            simply keeping a secret; rather, you are
The older sibling may even tell the
                                            respecting the younger child’s privacy.
younger one before he or she is ready
                                            When the donor-egg child is old enough
to grasp the concept, or may do so in
                                            to talk about this very personal infor-
a way that creates anxiety or insecurity.
                                            mation by choice, he or she can decide

                                       – 24 –
whether to share it with any older siblings.     certain situations not to tell, since they
                                                 don’t want to give the impression that
Think of it as protecting your child’s
                                                 women can have genetic children at
privacy as he or she grows up. If you
                                                 any age.
have one child who is 5, for example,
when the other is a newborn, they                Still, even if you know that you want to
will soon be ten and fifteen years old           tell your child about egg donation, and
respectively. Is it really fair for a fifteen-   tell them early, you may want to keep
year-old brother to know something               your procedure somewhat private.
about his ten-year-old sister that she           Most egg donation couples choose to
doesn’t understand yet? Is it worth the          wait before telling their closest family
risk that he will tell his younger sibling       and friends because they don’t want to
before either of them is ready to grasp          hear any uninformed comments, or be
the concept? It is quite possible that           questioned about their progress. Then
the younger sibling would prefer to              once the pregnancy is well on its way,
digest the information and decide                they share the news. Other couples
whom he or she wants to share it with.           never share the information because
                                                 they want the child to know first, be
Telling Others                                   able to understand the concept, and
The decision to tell or not to tell family       control when and how they tell.
and friends about your egg donation
                                                 If you decide to tell others, it’s im-
is as personal as the decision to tell or
                                                 portant to be aware that even if you
not to tell your child. Again, there is no
                                                 swear someone to secrecy, they often
right or wrong rule. There is, however,
                                                 tell others and swear them to secrecy,
advice from those couples that came
                                                 and so on. Soon many people could
before you: You can always tell later,
                                                 know something about your child that
but you can’t “un-tell” later.
                                                 your child doesn’t know or understand
Think like parents. What is best for             yet. So if you decide to tell someone,
your child? If you want time to think            you can be certain that others will
about telling, it’s probably better to           likely find out. If that matters to you,
keep it all private now. However, some           it’s probably not the right time to talk
couples are so thrilled with the success         about it.
of the procedure they want to share
their excitement; others feel so blessed
once the baby is born, that being so
cautious about their child’s conception
is unnecessary. Many experts say that
the less mysterious, or secret the whole
topic is, the better the child will feel
about it. Also, some older donor egg
recipients feel it would be unethical in

                                             – 25 –
About the Authors
CArA BIrrITTIerI                           speaks to groups nationwide about
Cara Birrittieri is an award-winning       current trends in donor care, ranging
television reporter                        from recruitment and retention to the
who covered                                psychosocial aspects of third-party
health and medi-                           parenting. Recently Mary’s research
cine in Boston,                            abstract was accepted for oral presen-
throughout New                             tation at the 2007 ASRM.
England for nation-
                                           GeOrGIA WITKIN, PhD
al & international audiences and has
                                           Dr. Georgia Witkin is a clinical psychol-
reported extensively on reproduction
                                           ogist and expert on infertility, ovum
issues. Her awards include: an Emmy
                                           donation, and therapy for couples at
Nomination, the Health & Science
                                           Reproductive Medicine Associates of
Journalist’s Award from the American
                                           New York. She is an Assistant Professor
Heart Association, two Sword of Hope
                                           in the Depart-
Awards from the American Cancer
                                           ment of Ob/Gyn
Society, the Award of Excellence from
                                           and Reproductive
the American Medical writer’s Associa-
                                           Science as well
tion, and an AAA Science Journalism
                                           as in the Depart-
Award. Recently she has joined the
                                           ment of Psychiatry
board of directors at the Massachu-
                                           at Mount Sinai
setts chapter of RESOLVE The National
                                           Medical Center. She is also
Infertility Association. Since undergo-
                                           Director of the Stress Program at the
ing her own battle with her biological
                                           Mount Sinai School of Medicine. She
clock, she speaks publicly about her
                                           has recently received awards from
struggle and the topics in What Every
                                           RESOLVE and from the American
Woman Should Know About Fertil-
                                           Fertility Association.
ity and Her Biological Clock in order
to help others avoid facing a similar      Dr. Witkin can be seen on the Fox
ordeal.                                    News Channel as a news analyst and
                                           a weekly guest expert on “Fox &
MArY FUSILLO, rN, BSN, MS                  Friends”. In addition, she has
One of the nation’s leading experts        authored 11 books on stress and a
on third-party reproduction is Mary Fu-    variety of men and women’s health
                     sillo, RN, BSN, MS.   issues, and is a frequent contributor to
                     Mary, a session       magazines such as Newsweek, Time,
                     chair at the 2006     Parade, and Self.
                     and 2007 Interna-
                     tional Conference
                     on Egg Donation,

                                      – 26 –
         We understand the complex needs

         of patients undergoing third party

         reproduction. At Freedom Fertility

        Pharmacy, a dedicated donor team

          will provide donor and recipient

             patients with a high level of

            service helping to deliver an

          exceptional fertility experience.

Tel: 800-591-4413 I Fax: 800-354-4337 I www.donorassist.com

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