“Ivy League Egg Donor Wanted.”
Sound familiar? From the News to the New Haven Register, this and similar ads for egg donors have appeared in the pages of local newspapers, attempting to lure intelligent Yale women with sums ranging from $5,000 to $100,000.
One Web site, offering $35,000 is looking for a “Genius Asian donor,” and describes the ideal match: “You should have or be working on a university degree from a world-class university, you should have high standardized test scores, and preferably have some outstanding achievements and awards.”
Another, EliteDonors.com seeks a donor who is Caucasian, “very attractive,” “height 5’9” or taller” and “athletic.” The ad claims to offer $100,000 as minimum compensation.
But there are egg-donation programs that focus on finding donors who are more interested in helping infertile women than in monetary compensation.
Yale, for example, has its own anonymous egg donation program, called the Yale Oocyte Donation and Surrogacy Program, a subdivision of the Yale Fertility Center. The program compensates donors with $8,000, though administrators said donors are rarely motivated solely by money.
Despite the altruism that largely motivates egg donors, varying levels of compensation and the nature of the matching process — which allows recipients to select the type of donor they want — have raised concerns about how closely egg donation resembles genetic engineering.
Could fertility centers turn into factories for “perfect” children?
Better Than Blood, Easier Than a Kidney
The women who donate their eggs are primarily motivated by a desire to help others to conceive a child, Dorothy Greenfeld, the Yale program’s social worker, said, though the sum is often what first piques their interest when they see an ad in a newspaper or the Yale Calendar.
“They think it’s better than giving blood but easier than giving a kidney,” Greenfeld said.
Recent research from the American Society of Reproductive Medicine showed that almost 70 percent of egg donors across the country donated to help someone else have a family, while only 29 percent were motivated primarily by money.
This characterization was supported by an examination of the profiles of anonymous donors at the Yale program — identified only by numbers, as confidentiality constraints prevented the News from speaking directly with donors or knowing their identities.
Overwhelmingly, the donor profiles describe the women as active and outgoing, with at least some college education. There are social workers and MBA candidates; drama students and photographers. Some kayak for fun, while others enjoy cooking. They are Lithuanian and African-American, Italian and Asian.
Some donors have had abortions and are looking for a way to “give back,” and others have family members or friends affected by infertility.
Many even have young children and said they donated their eggs to give another woman the opportunity to experience motherhood.
“I love my children immensely and couldn’t imagine not having them,” said one donor during the screening process. “I want to give a couple the opportunities to share the love and joy that I experience daily.”
Others, like one social worker, said they were motivated by other aspects of their lives, like their jobs.
‘As a social worker, I have known many women that are unable to conceive,” she said. “This would be my way of contributing to them.”
“Why do you want to donate?” is just of the many questions possible donors are asked during the long process of egg donation, Greenfeld said. The entire program can take anywhere from five weeks to forever for women who are never matched with a recipient.
Interested women are first directed to Wendy Somers, the program coordinator, who does some prescreening to eliminate applicants who do not understand the procedure or who are not fully committed to donating their eggs. After the prescreening, prospective donors are mailed a screening form, in which they describe their family history and health history.
Healthy donors who are not obese and have at least a high-school education are then called into the office to meet with Dr. Greenfeld for a psychological interview.
“If a donor feels like she’s giving away a baby, we tell her not to,” Greenfeld said.
Women also meet with Dr. Emre Seli, director of the program, who determines their risk factors, testing for problems such as sexually transmitted diseases or genetic disorders.
If approved, donors must then wait to be “matched” with a recipient, which can take varying amounts of time.
She meets with the recipient to discuss what they think is important in a donor. Criteria range from personality to ethnicity to level of education. One of the most popular criteria is physical similarity. Many recipients — who range from single women to married couples to gay couples using a surrogate mother — want a donor who looks like them, Greenfeld said.
Seli said the most important criteria for recipients is that the donor has had a child or has caused a pregnancy with a past donation — both of which are evidence of their donor’s fertility.
How it Works
Once a donor and recipient — who never meet or receive identifying information about the other — are matched, the medical process begins. A trial hormonal cycle is administered first, and if both parties react favorably, the real cycle begins.
The menstrual cycles of the donor and recipient must be matched, so they both receive Lupron, a hormone suppressant, Seli said. When the donor is in a state of low hormones, she is given FSH, a hormone that stimulates ovarian follicles, while the recipient is given estrogen to stimulate the uterine lining to prepare itself for embryo implantation. The final medication, hCG, is administered when the donor’s follicle is considered mature, and thirty-six hours later, the 15 to 20 ripe eggs are retrieved using a needle and a vaginal ultrasound probe.
Seli said the eggs are placed in a Petri dish with the sperm provided by the couple and allowed to fertilize. The embryos are then observed under the microscope, he said, and after three to five days, about two are implanted in the recipient’s uterus.
There is a 60 percent chance of at least one of the implanted embryos resulting in a live birth, Seli said.
Seli said there are few health risks associated with egg donation. The chance of bleeding is slight and Ovarian Hyperstimulation Syndrome — which is induced by the hormone medications and causes bloating — has a risk of less than 5 percent.
Contrary to popular belief, egg donation does not affect the future fertility of donors, Hugh Taylor, Yale director of Reproductive Endocrinology, agreed.
“People ask if we’re depleting their eggs, or if they will have fertility problems down the road,” Taylor said. “But there are a certain number of eggs that grow every month, and if they’re not ovulated, they die off. We’re just stimulating those eggs to continue to develop.”
When hormones are administered to the donor, the only eggs that respond are the ones currently in development, Seli said. Dormant eggs are unresponsive to the medications, indicating that the treatments likely do not affect them, he said.
Engineering Perfect Children?
Greenfeld said she is uncomfortable with classifieds that raise questions about genetic engineering by advertising for specific, restrictive searches and large sums of money. And society at large, she said, often has similar concerns even about programs that are less choosy and offer less compensation.
The American Society for Reproductive Medicine recommends that egg-donation programs and agencies compensate donors — because, as Seli and Greenfeld said, women in countries that do not compensate donate less frequently. But ASRM guidelines recommend that programs not provide compensation of more than $10,000. The majority of official egg donation agencies offer compensation between $5,000 and $8,000.
“I have a real problem with the fact that Ivy League young women are really getting inundated with requests from these agencies,” Greenfeld said. “I don’t think it’s good for anybody. I don’t think it’s good for recipients to think that the most important characteristic an egg donor should have is that she’s an Ivy League student.”
Seli, though, said that while the Yale program adheres to ASRM guidelines, it does not bother him when other agencies do not. He said his philosophy is to do his job without a moral or judgmental attitude, and instead to simply follow what is considered ethical by societal standards.
Both Greenfeld and Seli say they have never received criticism about the egg donor matching process accusing it of genetic engineering, and they rarely work with patients who seem to be trying to engineer a child.
“Occasionally, though, we get a couple who requests a donor who looks nothing like the recipient,” Greenfeld said. “And that makes me a little uncomfortable. That to me feels a little more like engineering.
But Greenfeld said that while some patients come armed with laundry lists of ideal traits and others arrive unprepared, most fall somewhere in between, requesting only basic physical resemblance. Many, she said, even find the matching part of the process unnerving and feel that it seems too much like engineering a “perfect” child.
What Lies Ahead
The future of egg donation, both at Yale and around the world, may move in several directions, doctors said.
Egg-freezing technology is still in development, Seli said, and may eventually become so improved that egg banks — equivalent to sperm banks — could be established, eliminating the matching and synchronizing processes. Oocytes could be frozen in batches, he suggested, and then thawed whenever a recipient wants the type of donor who provided them.
Currently, Seli said, Yale offers the egg-freezing technology to women who want to freeze their own eggs to use in the future.
Taylor suggested that improved stem cell technology might even eliminate egg donors altogether. Scientists could induce a stem cell containing genetic material from a patient’s somatic cells and induce to become or produce an oocyte, he said.
But would this be a positive development?
Perhaps not, for the donors who found it an “honor” to donate their eggs and choose to return as many as six times — the maximum allowed by the program.
The Yale Oocyte Donation and Surrogacy Program is one of many anonymous egg donation programs in America, though many patients opt to use directed donors — donors they know or have chosen themselves — or agencies, which recruit donors and sometimes allow recipients and donors to meet.
The program was established in 1989 as part of the Yale Fertility Center, which already had an in vitro fertilization program.