OOCYTE DONATION By Cara Birrittieri Mary M. Fusillo, RN, BSN, MS Georgia Witkin, PhD

Table of Contents

A Word From the Authors 3

Introduction 4

The Basics 5

Decisions, Decisions! 10

The Professionals 14

Emotions and Concerns 17

Telling and Talking About Egg Donation 20

About the Authors 26

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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,

– 3 – 1 Introduction 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

– 4 – 2 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,

– 5 – 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? Choose Egg Donation Typically the fees involved in egg 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.

– 6 – 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 www.resolve.org 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

– 7 – 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

– 8 – 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

– 9 – 3 Decisions, Decisions!

Choosing a Clinic seminar if you have that opportunity.

There can be a host of factors to Pregnancy rates vs. live birth rates 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 becomes. 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 screened? 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 – 4 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 questions. 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 – 5 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 Multiples

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 this process is a will reject the mother when he or 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 – 6 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 dures have been com- eggs as early as 8 or 9 years old. It is 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 remind them that you was no big deal.” Or they might say, “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 “You, as their mother, be good for the sibling relationship 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

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