On the off chance that you haven't been watching this season of Pretty Little Liars, let's just take a moment to recap a totally-normal-and-not-at-all-bizarre storyline: Last season, Emily decided to donate her eggs. After the procedure, her eggs were stolen by Ali's ex-husband. Then, Ali became pregnant via donor eggs without her knowledge. Finally, it was revealed this week that the donor eggs she received were actually Emily's stolen eggs. Like, what?! Let's all just take quick a moment to absorb this — and reassure ourselves that, luckily, all of this is pretty far from the way the actual process of giving and using donor eggs tends to go.
"This sounds like a desperate final-season plot line," laughs Jake Anderson-Bialis, co-founder of FertilityIQ, a startup that provides data about fertility clinics and doctors. The way it really goes down, he explains, is very emotional for many couples, even if it doesn't quite have that special PLL je ne sais quoi.
Using a donor egg for in vitro fertilization (IVF) is essentially the same process as traditional IVF, but the steps are split between three people: The source of the egg, the source of the sperm, and the person who will be carrying the pregnancy. Although there are definitely cases in which people are donating their eggs to a friend or family member, most of the time, donors are recruited. "The most sought after women have a good GPA at a prestigious university, are in good mental and physical health, and are physically attractive," Jake says. (Kind of makes sense that a lot of recruiting for donors goes on at college campuses.)
In the most straightforward scenario, the donor will end up going to the recruiting clinic for a discussion about what the process entails and how much they'll be compensated (which could be anywhere between a few thousand dollars and more than $40,000). At this point, the clinic will also perform a few tests to make sure the donor is in good health and will be up to the egg retrieval process both physically and emotionally.
The process itself involves stimulating the donor's ovaries (via injectable hormones, typically) in order to produce as many eggs as possible. That can take just a couple of weeks or a whole month, Jake explains. Then the egg retrieval process comes — and that's basically it. If you're a particularly "desirable" donor, you may be strongly encouraged to go through a few more cycles of this process so they can harvest more of your Grade A eggs. But, Jake explains, doctors are only allowed to put you through a maximum of five cycles.
However, it's a good idea to watch out for somewhat sketchy recruiters, says Deborah Anderson-Bialis, the other co-founder of FertilityIQ. In some cases, doctors may end up overstimulating your ovaries in an effort to get as many eggs as they possibly can. But this can cause serious side effects later in your life. Deborah suggests opting for egg donation clinics (where everything is done in-house) as opposed to agencies, which may send you elsewhere for the actual medical procedures.
When it comes to the patient on the other end, the one looking for a donor egg, they've probably already gone through some trial and error. "In general, the women we see using donor eggs are over 40 and have already gone through a round or two of IVF with their own eggs," Deborah says. "This is usually a pretty emotional hurdle," since many couples would prefer to have a baby using their own gametes. However, she says that any hangups couples have about using donor eggs tend to disappear once they're the other side of the process.
Unless the recipient knows the donor personally, they'll probably be looking through portfolios upon portfolios of donor profiles from various agencies and clinics. If they do find someone they like, they can choose to use the already-frozen eggs, which is a pretty straightforward process: The frozen eggs are thawed, fertilized with sperm, and the resulting embryo is transferred to the uterus.
For several times the money, however, the patient can choose to work with a donor and have that person's hormonal stimulation synced up with the recipient's. With this method, the eggs aren't frozen — they're considered "fresh" and are used to create embryos, which are then transferred to the recipient's uterus. Although some consider this method to give the patient slightly better chances at a successful pregnancy, Deborah points out that freezing and thawing techniques have improved significantly over the years. So today there may not be much of a significant difference in success between using frozen and fresh eggs.
Once the pregnancy is successful (IVF using donor eggs has about a 25% success rate overall, according to the CDC) and you've actually given birth, the next major hurdle will be when and how to tell that child about the donor egg. "Some people go in [to the process] thinking, I’m not going to tell this kid," Deborah says, "and that can lead to negative consequences down the road." In the age of 23andMe, it's surprisingly challenging to keep this sort of thing a secret. Jake explains that biting the bullet and having these difficult conversations tends to be the right move — and it's even better if you do so as early as possible.
Clearly, just because your personal fertility journey doesn't quite match the intensity of primetime TV doesn't mean it isn't a big deal.
Welcome to Mothership: Parenting stories you actually want to read, whether you're thinking about or passing on kids, from egg-freezing to taking home baby and beyond. Because motherhood is a big if — not when — and it's time we talked about it that way.