family building. Now that gestational and genetic motherhood can be separated, young women born without ovaries can carry, deliver and parent children conceived with another woman’s eggs. Women who survive cancer at the expense of their fertility are able to experience pregnancy and the joy of bringing new life into the world. Women can extend their fertility beyond their biological clocks. New families are being formed, together with new definitions of kinship.
Egg donation is still evolving, and, should you choose this path, you will be part of its early history. In this chapter we attempt to provide you with a context in which to view egg donation, past, present and future. From there we will move on to the “departure lounge of egg donation” so that you can meet your fellow travelers.
Historical perspective
So how did it all begin? There are published records from as early as the late 1800s of experiments conducted on women who lost their ovaries at a young age. However, it was not until the arrival of in vitro fertilization (IVF) in 1978 that physicians had a means for enabling a woman to become pregnant with another woman’s eggs. The first child conceived through egg donation was born in Australia in 1983.
In its early years egg donation, though possible, was not readily available. The first donors were either sisters or cousins of their recipients or they were infertile women who were undergoing IVF. Since cryopreservation of embryos was not available to all, some of these women had extra eggs for which they had only two options: discard or donate to other infertile women. Another group of early egg donors were women seeking tubal ligation who were invited to donate their eggs in exchange for the cost of their procedure. Either way, donated eggs were relatively few and far between and, for the most part, came from women whose donation was based more on practicality or expediency than on an affirmative decision to help an infertile couple. The scarcity of eggs made the experience challenging for would-be recipients who had little way of knowing if and when donated eggs would become available to them. One mother of a now 23-year-old through egg donation recalls taking medications over an extended period of time to ensure her uterus was ready for implantation should a donated egg come along. She was literally “on call” for news that an egg was available. When the call came, there was no asking about who the donor was or what her genetic history revealed. The recipient was instructed to go immediately to the fertility clinic where she underwent a full laparatomy (a surgical incision in the abdominal area) and a gamete intrafallopian transfer (GIFT procedure) in which the donor’s eggs were mixed with the recipient’s husband’s sperm and placed in her tubes.
Much has changed. Not only has IVF fully replaced GIFT as a vehicle for egg donation, but, beginning in the late 1980s, women were actively recruited for voluntary egg donation. This began in medical clinics, some of whom continue to recruit donors. However, in the United States, independent egg donor agencies rapidly replaced medical programs as the main source of donated eggs. By the late 1990s it was common to see advertisements like the following in college newspapers:
Make a dream come true. Help a childless couple become parents. If you are under 34, healthy, a non-smoker, please consider donating some of your eggs. You will be compensated for your time and effort.
The arrival of these programs transformed egg donation from something extremely difficult to arrange to something that, with financial/health insurance resources and access to medical treatment, can be launched with a few visits to internet websites. One need simply type in “egg donation” to be connected to agencies with names ranging from Precious Wonders to Tiny Treasures to An Angel’s Gift to Peas in a Pod and Our Fairy Godmother. At the time of writing, there are nearly 100 egg donor agencies listed on the website of the American Society for Reproductive Medicine (ASRM). Most have tantalizing websites that offer hope to infertile couples, many of whose journey to parenthood has so far been filled with only disappointment and loss. They also offer the promise of financial and emotional reward to young women who are invited to undergo ovarian stimulation and egg retrieval.
Just as there have been changes in the availability and accessibility of donors, so also have there been shifts in the way people think about egg donation. In the early years there was a real sense that the science was advancing far more rapidly than our understanding of what it means for a person to be physically born to three people. Instead of taking note of what a seismic shift this marked in human reproduction, physicians presented egg donation as a treatment for female infertility. In so doing, they missed the opportunity to examine, make sense of and ultimately celebrate what egg donation means for identity formation and our understanding of kinship. Sadly, egg donation was pushed into the shadows, spoken of in hushed tones and burdened by secrecy.
The experiences of parents through egg donation, their children and their donors changed significantly with the arrival of the Donor Sibling Registry (DSR) in 2000. This US-based worldwide registry was founded in 2000 by Wendy Kramer and her son, Ryan, who was conceived through sperm donation. The registry helps people connect with donor relations. In the 13 years since its founding, the DSR has helped connect more than 9200 individuals with their donor relations. Wendy Kramer reports there are on average two new matches every day. For egg donation families, this has meant that parents have connected with donors, donors with offspring and, as the name of the DSR suggests, offspring with other offspring. As word of the DSR has grown, and, with it, people’s appreciation of the significance of genetic connections, families have been turning to the DSR in new ways. Currently, there are several egg donor agencies in the US that include the DSR in their donor-recipient contracts, making it possible for people who want anonymity (or at least to start out with no identifying information) to remain in touch and share photos and updated medical and social information. The DSR’s global presence is growing steadily, with membership coming from around the world and in large numbers from Canada, Australia, Spain, Romania and Israel.
Where are we today?
Looking at egg donation today, we see a very different picture from what we saw even as recently as the original (2005) edition of Having Your Baby Through Egg Donation. In addition to the changes noted above, we see changes in the way egg donation (ED) parents feel about their path to parenthood. The secrecy that prevailed in the past has diminished significantly. True, there are some ED parents who still feel they have something to be secretive about, but increasing numbers are treating their child’s story as an open but private matter. They don’t go around saying “my egg donor baby,” but acknowledge donor conception when there is a reason to do so. In talking about it in a natural and appropriate way, most find that others are fully accepting of and comfortable with egg donation. Accompanying this more open approach to egg donation in general has been increased comfort with the donors. As one mother through egg donation put it:
When I first heard about egg donation, I did not want to meet my donor because I thought that I would see her face in my child and it would upset me. Now I feel the opposite. I have twins and one looks just like the donor. I love it because it is a constant reminder of the remarkable woman who helped make us a family.
With increased comfort and familiarity with egg donation has come increased use of this option. Or perhaps it is the reverse: as more people have become parents through egg donation, more of them have become comfortable speaking openly about it. Either way, the use of egg donation is on the rise. In 2010, the Society for Assisted Reproductive Technology (SART) reported there were 9321 transfers using donated eggs. Over 55 percent of these resulted in live births. This is the official SART number. Wendy Kramer of the DSR found, in surveying parents through egg donation, that 42 percent were never asked to inform their clinic whether they had a live birth. Some did so voluntarily and others did not. If we add in the pregnancies that resulted from cryopreserved embryo transfers, there were more than 8000 births in the US in 2010 alone from donated eggs.
A current trend in the United States is the promotion of “egg banks.” Until recently, it was difficult to freeze human eggs, and few documented pregnancies resulted from eggs that had been frozen. The development of vitrification, an effective means of freezing and thawing eggs, has made it possible
