We are eager to view Alex Kuczynski’s “Her Body, My Baby” when it is posted online and comes out on Sunday.
The New York Times contacted the Northeast Assisted Fertility Group regarding our opinions on surrogacy law and procedure, but we did not participate in Kuczynski’s surrogacy. Preview the article on Jezebel.com.
(See our followup post to the Alex Kuczynski article.)
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Apart from egg donor compensation (at a limit of $10,000 for her time and effort, according to the ASRM), our egg donors are entitled to reimbursement for other expenses incurred by the process. For local donors, these can include gas, tolls, parking, and lost wages for the retrieval day (which requires a full day off from work). For out out-of- town egg donors, expenses include travel, hotel, per diem cash (NAFG’s egg donation program offers $75 per day), lost wages, as well as travel, hotel and per diem expenses for a companion. Although we appreciate the financial sacrifice that recipients make for fertility treatment, we discourage our clients from nickel and diming here: yes, your donor is getting paid for her efforts, but she is doing you a great service, and for that, she should be in a comfortable hotel, have money for food, and not be penalized for losing work. As an agency, we work hard to find reasonable rates for flights and hotels, but egg donor safety and comfort is our primary concern. An estimated expense budget is specified in the contract, so all agree on its amount and scope ahead of time.
According to our policy, the donor only receives her compensation if the retrieval takes place. If, for any reason, the egg donation cycle is not completed, the donor does not get paid. (Some agencies pay the fee in increments along various stages in the process, but we do not.) She cannot be held responsible for the recipients’ expenses for any of her travel or medical care (except in a hypothetical case of willful fraud on the donor’s part).
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This article is part two of a three part series. Click here to read Part One and Part Three.
“OK” reasons to consider surrogacy
“I am in the process of adopting internationally and surrogacy is my back-up plan in case it does not work out; Although I have children from a previous marriage I want more children with my new husband in order to bring us closer together; I have had endured many years of unsuccessful rounds of IVF and now I want to try with my own eggs and a surrogate.”
What is weak in these three scenarios is commitment to success. If you are working on an adoption at the same time, you are not fully committed, and risk abandoning the surrogate after a relationship has been established between you. The second two scenarios are risky because they typically involve women over forty who insist on using their own eggs, and will not consider donor eggs. The chances of a live birth resulting from an egg of a woman over forty is about 5-7%. The chances with an egg from a donor in her twenties is about 50% or higher. If you are only committed to a 7% chance of success, it is really not a full commitment. And keep in mind what the carrier has to endure. She wants her efforts to result in a live birth, too, and is disappointed when it does not work.
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This article is part one of a three-part series. Click here for Part Two and Part Three.
Reasons to Have a Child with a Surrogate: Bad, Not So Good, and Best
Surrogacy can be a risky endeavor, but not for the reasons most people think: the surrogate will get attached to the baby and keep it for herself, leaving the intended parents high and dry. This does not happen. Unfortunately, the sensational “Baby M” case in New Jersey twenty years ago still resonates. That surrogacy was a “traditional” one, in which the surrogate was inseminated with the intended father’s sperm, and the child resulting was indeed the surrogate’s biological daughter. Before the insemination, the surrogate signed a contract relinquishing her rights to the child in exchange for money. This contract was unlawful and the courts rightly determined it invalid. No parent can lawfully relinquish parental rights to an unborn child.
Now, however, the vast majority of surrogacies are not “traditional,” but “gestational.” Surrogates, or “carriers,” as we prefer to call them, do not become pregnant by insemination. An embryo is formed with sperm and egg from the intended parents (or donors) through in vitro fertilization (IVF), which is then transferred to the carrier’s uterus for gestation. So the carrier has no genetic relationship to the child, and contracts enforcing the rights of the intended parents are lawful (in states where surrogacies occur). The baby belongs to the intended parents from the start,
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Click here for Conceiving Through Egg Donation (9 of 10): Confidentiality and Anonymity.
Donor Reserving, Screening, and the Egg Donation Contract
Once you’ve made your choice, signed the contract with the egg donation agency, and paid your fee, your clinic can start the screening process. The agency will typically send an official “match sheet” (with the names of you and your egg donor), and the donor’s complete file to the egg donor coordinator at your clinic. The donor will have to fill out the clinic’s own application as well (obtained through the agency or directly from the clinic). One of the nurses will set up the egg donor’s screening appointments, which may occur all in one day, or broken up into about three separate appointments. Screening comprises a meeting with a social worker/psychologist (an MMPI test, a Minnesota Multiphasic Personality Inventory, is sometimes administered), a meeting with a genetic counselor, a doctor’s examination, and a series of blood tests for infectious and hereditary diseases. It takes about three to four weeks to get the results back.
Most egg donors pass their screenings. Any donor who does not will be informed by a doctor directly. If your donor does not pass, your clinic will inform you, and your agency should work hard to find you a replacement quickly. If some genetic findings are inconclusive, you will be counseled by your doctor about the possible risks, and may choose to find another egg donor.
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What happens to donor eggs after they are retrieved? Do I get to know the results? Do I meet the recipients or potential offspring?
After the donor egg retrieval, the eggs are fertilized and then observed for a few days. Not all will fertilize or develop. Between one and three embryos will be transferred to the recipient. If any viable embryos are left over, they will be frozen (embryos hold up better in the freezing process than eggs do). It takes about six weeks to find out if a pregnancy results.
The majority of egg donor cycles in the US at this time are mutually anonymous: the donor egg recipients and the egg donor may know general information about each other, but they do not know each other’s names and they never meet. If working in a mutually anonymous arrangement, you may be informed of the number of donor eggs retrieved, but not the number actually fertilized or whether a pregnancy or live birth resulted. If you are working non-anonymously, you may get more information, depending on the arrangement. Some donors meet their recipients with the supervision of a social worker, and leave the opportunity open to meet any potential offspring. Both parties agree to the anonymity level before the match is made.
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This article is part three of a three-part series. Click here for Part One and Part Two.
BEST reasons to consider surrogacy
I have a serious medical condition (premature ovarian failure, hysterectomy, a genetic issue) that prohibits me from conceiving and carrying a child; I am a single man or a gay man in a relationship and want a child.
In these cases, the need and the commitment, which often go hand in hand, are unequivocal. Our most successful surrogacies involve people who have yet to have any children of their own because of some physical disability. If the egg and/or uterus are not functioning properly or absent altogether, using someone else’s becomes the only way to go (aside from adoption, which is a great alternative but not right for everyone). Furthermore, these are the people who carriers are most eager to help.
Although some doctors will not perform surrogacies for gay male intended parents because they do not consider them legitimate medical cases, there are many who will. NAFG supports gay families and are always happy to help them.
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Read information about our surrogacy program, both for surrogate mothers and intended parents.
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Click here for Conceiving Through Egg Donation (8 of 10): Repeat Egg Donors.
Anonymity and Openness in the Egg Donor/Recipient Relationship
When working with a private egg donation agency, as long as there is mutual consent between egg donor and recipient, the relationship can be as closed or as open as both parties desire. The idea that the donor and potential offspring would knowingly meet one day instills anxiety in some donors and recipients, and comfort in others. It is a completely personal attitude.
Egg donation has not had the chance to evolve the way adoption has regarding openness and public acceptance. In the past adoption was shrouded in secrecy and anonymity, but now it is commonplace for domestic adopting parents to meet birth parents (typically before the birth), and adoption is celebrated for what it is. There still may be, for some, a stigma attached to egg donation, which creates the desire to keep it private or even secret. After all, you chose an egg donor who resembles you so your child could “pass” as your own. You don’t want your child and other family members to feel he or she is only “related” to the paternal side. On the other hand, secretiveness is unfair to the child and creates an unhealthful atmosphere. Egg donation will never lose its stigma until it is pushed out in the open by brave parents. Not everyone is willing to be a hero,
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Will egg donation affect my future fertility?
No relationship between egg donation and future fertility has been clearly established, although research is continuing.
Egg donation does not deplete your ovarian reserve. Each month you release a number of eggs, but only one comes to maturity, generally. The hormones administered in the egg donation process stimulate more than one to reach maturity. Women in their 20s have hundreds of thousands of viable eggs, although the number diminishes over time.
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Click here for Conceiving Through Egg Donation (7 of 10): Out-of-Town Egg Donors.
Does Using a Repeat Egg Donor Offer Any Advantage?
The ASRM guidelines allow any one donor to go through up to six egg donation cycles. Any candidates who have donated eggs before should be clearly marked as such on their profiles, for the obvious advantages she offers.
First of all, she knows exactly what she is getting into, and is less likely to have second thoughts about the process of donating eggs. Although she will have to be screened again for her next cycle, you can be assured she has already passed at least one screening, and has no major genetic or psychological issues. Secondly, you will know the results of her previous donations, which need to be good enough to qualify her for another cycle. These results will include the number of donor eggs retrieved, the number fertilized, and if enough time has passed, whether a pregnancy and live birth resulted.
If you choose a repeat donor, her egg donation records will be forwarded to your doctor for review as part of the donor’s screening. If you have any questions about the results, ask the clinic to send redacted records directly to your doctor to get an informed opinion. Don’t jump to any conclusions about the number of donor eggs retrieved or pregnancy results. Keep in mind that factors beyond egg quality determine pregnancy and live birth.
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