What is the egg donor process, step by step?

How long does the whole process take?

The egg donor process usually takes about 2 to 3 months from match to retrieval. The time before match varies, because it depends on when intended parents choose a donor's profile. After retrieval, most donors are back to normal within a few days.

Here are the eight steps, with typical timing.

The busiest stretch is stimulation. Plan for early morning visits and keep the retrieval day and the day after free.

What happens at screening?

Screening happens after you match, at the intended parents' clinic. The intended parents pay for all of it. It has four parts.

• FDA infectious disease testing. Federal rules require blood and urine tests for infections such as HIV, hepatitis B and C, and syphilis, plus a standard questionnaire. Testing is done close to retrieval and repeated for every cycle.
• Genetic carrier screening. A blood or saliva test that shows which recessive conditions you carry. A genetic counselor compares your results with the sperm provider's.
• Psychological evaluation. An interview, and often a written test, with a licensed mental health professional. It checks that you understand the process and are choosing freely.
• Medical screening. An exam, bloodwork including AMH (a hormone that reflects how many eggs your ovaries hold), and a transvaginal ultrasound to count the small resting follicles in each ovary.

The ultrasound and AMH together help the clinic choose your medication doses. See the egg donor requirements for what screening looks for.

What is in the legal agreement?

Before you take any medication, you sign a donor agreement with the intended parents. You have your own attorney, and the intended parents pay for that attorney. Your attorney answers only to you.

A donor agreement usually covers:

• Parental rights. You relinquish any parental rights to the eggs and to any child born from them. The intended parents are the parents.
• Compensation. The amount, the payment schedule and how it is paid through independent escrow.
• Cancellation. What you receive if the cycle is cancelled after you start medications.
• Expenses. Medications, travel, medical care and insurance, all paid by the intended parents.
• Complication insurance. The policy that covers your treatment if you have a complication.
• Privacy and contact. Whether the donation is anonymous, known or identity-release, and what future contact, if any, is allowed.
• Use of the eggs and embryos. What the intended parents may do with them.

Read it with your attorney. If anything is unclear, ask before you sign.

How does stimulation work, and what are the injections?

In a normal month, your body brings one egg to maturity and the rest of that month's group of eggs is lost. Stimulation uses hormone medications to mature many of that month's eggs at once.

Before stimulation, your clinic often asks you to take birth control pills for a short time. This lines up your cycle with the clinic's schedule and the intended parents' plan.

Then the injections start. You give them yourself, usually in the evening, for about 10 to 14 days. There are two main types:

• Follicle-stimulating medications (gonadotropins). These are the same hormones your body makes to grow follicles, given at a higher dose so several follicles grow together.
• A medication that prevents early ovulation. Added partway through, it stops your body from releasing the eggs before the clinic can retrieve them.

Most injections are subcutaneous, with a small needle in the skin of your abdomen. Donors usually describe a pinch. The nurses teach you at your first visit, and many clinics give you a video to watch at home.

During stimulation you go to about 5 to 8 monitoring visits, usually early in the morning. Each visit has bloodwork to check your hormone levels and an ultrasound to measure your follicles. The clinic may change your dose after each visit. You can work or study during stimulation, but you need to avoid vigorous exercise in the later days, because enlarged ovaries are at risk of twisting.

What is the trigger shot?

The trigger shot is the final injection. It tells your eggs to complete their last stage of maturing so they can be retrieved.

When your follicles reach the right size, the clinic tells you exactly when to give the trigger, usually late in the evening. Retrieval is scheduled about 36 hours later. The timing matters. Too early and the eggs are not ready. Too late and they may be released before retrieval.

Many donor protocols now use a GnRH agonist trigger, such as Lupron, instead of hCG. It lowers the risk of ovarian hyperstimulation syndrome (OHSS) in donors. Your clinic decides which trigger suits your response. The egg donation risks and OHSS page explains why.

What happens on retrieval day?

You arrive at the clinic having fasted from the night before, with a companion to drive you home. A nurse places an IV, and an anesthesia provider gives you sedation through it. You are asleep or deeply relaxed and do not feel the procedure.

The physician uses a transvaginal ultrasound probe with a thin needle guide. The needle passes through the vaginal wall into each ovary, and the fluid from each follicle is gently drawn out. There is no incision. The procedure takes about 20 to 30 minutes.

The fluid goes straight to the embryology lab, where embryologists find the eggs under a microscope. In a donor cycle, 10 to 20 eggs are common, though it varies by donor and protocol. The lab fertilizes them with the intended parents' chosen sperm the same day. Learn more about the lab side in IVF for surrogacy.

You rest in a recovery area until the sedation wears off and then go home the same day.

What is recovery like, and when is compensation paid?

Most donors feel cramping, bloating and tiredness for a day or two. The day of retrieval and the day after are rest days. Most donors return to work or class within a day or two.

Some rules for the next couple of weeks:

• Avoid vigorous exercise until your next period. Your ovaries stay enlarged for a while, and that raises the risk of ovarian torsion.
• Use barrier contraception until your next period. You may still have eggs that were not retrieved, so you are very fertile.
• Watch for warning signs. Rapid weight gain, severe bloating, nausea or vomiting, shortness of breath or reduced urination can signal OHSS. Call the clinic the same day.

Compensation is released from independent escrow after retrieval, on the schedule in your donor agreement. It does not depend on how many eggs were retrieved. See egg donor compensation.

What does PLS do at each step?

• Application and match. PLS reviews your application, interviews you and builds your profile. Nancy Block, RN, runs matching.
• Screening. Mark Silverberg, DDS, MD, reads your medical records before a match. PLS schedules your screening and tells you what each test is for.
• Legal. PLS refers you to independent attorneys and does not employ lawyers. Your attorney answers to you.
• Escrow. The intended parents fund an independent licensed escrow account before you start medications. PLS never holds client money.
• Stimulation and retrieval. Your case manager keeps your schedule, arranges travel if needed, and checks in through the cycle. Natalie Gaudio-Fricano, a PLS case manager, was an egg donor three times herself.
• After retrieval. PLS checks on your recovery and confirms that your compensation has been released.

Sources

• American Society for Reproductive Medicine (ASRM), patient and practice committee guidance on ovarian stimulation and oocyte retrieval.
• US Food and Drug Administration (FDA), donor eligibility rules (21 CFR Part 1271).
• Society for Assisted Reproductive Technology (SART).