SART Fertility Experts - Egg Donor Screening

Welcome everyone, my name is Dr. Cristin Slater. I'm a reproductive endocrinologist and the medical director at the Idaho Center for Reproductive Medicine. This is an episode of the SART Fertility Experts.

SART is an acronym for the Society of Assisted Reproductive Technology. We're going to discuss egg donor screening. I've been in the fertility world for 23 years and I've seen the egg donor family building process exponentially rise and it's such a wonderful happy way for people to build families and it's quite striking.

I mean, I've looked back at the numbers and in 2019 alone by the SART statistics, approximately 20,000 transfers were done with egg donor cycles. And by the way, if you go to www.sart.org, it's a wonderful resource where you can look at the numbers of cycles that have been done with IVF and certain technologies and look at the success rate. So it's a great, great resource.

Today, I'm very happy and excited to have Courtney Dalton assist us. She is an authority and just has a passion for egg donor screening. She has been an egg donor coordinator for six and a half years at the Idaho Center for Reproductive Medicine.

So she has a really good perspective on all sides of the egg donor process, you know, the front end for meeting the egg donors and screening the egg donors. And in fact, we tell the patients, you know, Courtney is like their mother or their mother-in-law, she knows them. And then it's also wonderful on the other side, seeing the intended parents and how happy they are.

So I think it's very, very good information for people that are going through this process to see both sides of the process. Today, we're going to answer questions. I know people that have gone through this process, they're very happy.

They have so much love and joy in their life. But initially, when they start the process, there's many questions. They're wondering like, who is my donor? Why would they donate? What is this process like? And Courtney will give us information firsthand of what, you know, what happens.

So first of all, welcome, Courtney. And thank you so much for doing this. I think this is exciting information.

I know a lot of people want to know this. And this is something we know and we feel so comfortable, so excited about. So we should share this with our listeners.

Absolutely. I'm happy to help and to talk about, you know, donor screening. I think that there is, you know, a lot of misconceptions, you know, for those who aren't in the fertility world, or have the exposure to it that we do every day, there's a lot of misconceptions, you know, about the donor process and, you know, who becomes a donor and why and, you know, what it's like, and even, you know, the misconceptions that donors can have about being a donor and what their families know about it, or if they tell anybody they're donating the responses they get.

So it's really interesting. And I've learned a lot in this field, and I owe it all to you. And, you know, the education I've got here, it's just incredible.

And I love what I do. Yeah, I think you couldn't ask for a better field to be in, honestly, to help build families. Yeah, that's a great segue.

So I know a lot of people are going through this, and at the end of the day, they've got a beautiful family and babies in their arms. So when they start, they're going to ask you, like, who are these egg donors? And why? Why would they want to donate? And who are these people? You meet them, you talk to them, who are they? And why do they want to donate? Yeah, so we have, you know, we're really lucky here in the area that I live in that we have a really good population. There's a local university.

So a lot of it is, you know, these one, these young college kids, who a lot of it is that they have a friend who donated or, you know, a big one is that they maybe had a family member who suffered from infertility. And so they wanted to be able to help because they saw that family member, that friend struggle, and they realized, like, you know, oh, my gosh, I'm young and healthy, and I could help people. And so they will want to help.

And it really is coming from that altruistic perspective that they know that they have something that others don't. And so they just want to be able to help others. Yeah, I agree with that.

Because I'm always amazed after I do the procedure on the egg donors, and they're sitting in the recovery room. And they'll ask me, how many eggs I make? Is this enough? You know, I hope that this is going to make, you know, the intended parents happy. So to me, it's, it's just like, resonating.

And it just makes me feel so good about the process. Like, these are people that are going into this for the right reason. They really do care.

And so I know a lot of times, intended parents will ask questions at the initial consult. Should I have an egg donor from an in-house donor bank? You know, if I'm lucky to go to a clinic that has this, or should I go with frozen eggs from an egg donor bank? And I know, there's pros and cons to both. And so maybe you could talk about the difference between the both and the pros and cons of both options, because there's options, which is great.

For sure. So you know, one thing that really has gained in popularity in the last couple of years is the idea of frozen eggs. You know, it used to be just the fresh eggs that, you know, you had to find a clinic that had a donor database like we do.

And now with the perfecting of the freezing process, you know, or really narrowing that scope down, they've been able to, to really hone in on that and help by establishing these donor egg banks where you can get, you know, a really big population of donors that are going to vary a lot based on ethnicities and hair color and eye color and, you know, education levels and height, you know. So if you have somebody that wants that really specific donor, it's great. So, you know, the egg banks are really amazing at being able to help in those areas where there isn't that donor pool that we have, or, you know, if you want that donor who is of, you know, South Korean, you know, that is ethnically her, she's Asian or South Korean, or maybe even Jewish, you know, that, that it can help you find that donor that is exactly like you.

The eggs from the egg banks, you know, where it's awesome that then there's that immediate availability typically that they have, you know, six to eight eggs that you're going to get. They have that immediate availability, but you're going to get that six to eight eggs and you're going to get at least one embryo plus one to freeze is the typical guarantee, I believe, from that lot of eggs. And those are great numbers, but on the other side, when you have these egg donor pools, you know, within a clinic that has an in-house donor database, you know, you're looking at being able to, rather than getting six to eight eggs, you're going to get maybe the average of 15 eggs or maybe even up to 25 eggs.

And so you're looking at getting four to seven embryos typically. So it can just vary depending on what your family wants in terms of your family building. If you just want one child or like I said, that very specific population that you're looking to capture, or if you are wanting to be able to have multiple embryos or to be able to have the ability to have a sibling journey in a few years, or maybe multiple siblings in the future, you know, it can help sway you on if you want to go for those frozen eggs or if you want a fresh bank where typically those donors are going to be really well known because the clinic has screened them, you know, we know each of our donors personally where I'm at, and it's just kind of based on the field that each one wants, you know, you know the statistics better than I do, Dr. Slater, as far as success rates on fresh versus frozen eggs in terms of what you would see pregnancy-wise.

Yeah, and when I talk to patients, whenever I say, okay, if you get 10 eggs, that doesn't mean 10 babies, and a good rule of thumb is like how many mature eggs to embryos you get, and I usually say, okay, it's a three to one ratio from egg to blastocyst, which is an embryo you can transfer. So, if you get 10 eggs, I'm expecting around three blastocysts. Now, if you do genetic testing on embryos to see are they chromosomally competent, typically I'll say with the law of averages, you know, five to one ratio.

So, if you have 10 eggs, you're expecting two PGT genetically tested normal embryos, and each PGT genetically tested embryo typically is 60-65 percent baby. So, I guess, I mean, this is a little bit of sidetracking, but 10 eggs or eight eggs doesn't mean eight babies. So, it, you know, sometimes that is a part of the equation.

Are you going to go with a fresh egg donor whose yield is usually 15 to 25 eggs, or do you really, really want this specific ethnicity or qualifications in egg donor that you can't find other than going, you know, to the egg bank? So, there's pros and cons to both, and luckily there's options, but either way, if an egg donor goes through for an egg bank or for a fresh cycle, there's rigorous screening. I mean, a lot of patients will say, geez, you know, who are these egg donors, and what's their screening? I mean, it's not like just saying I'm going to go to the clinic, and I'm going to stick my arm out and do a venipuncture and get some blood. It's not that.

These egg donors are committed, and, you know, there is a process for screening them, and I think that it'd be nice for you to tell, you know, our audience what they go through because, you know, it's a commitment. For sure. You know, I think that a lot really do think that it is just the money that drives the donors, and what I always say to that is those who are trying to do this just for money thinking they're going to make a quick buck, they kind of weed themselves out, so to speak, because once they get into this, they realize like, oh my gosh, this was more than I thought.

You know, I'm, I know it's not worth it to me. You know, there's, there are risks. There is a lot that goes into this, so where I'm at, what we do is first they start with about a 10-question screening process that will basically give like an approval to go forward or a denial based on, you know, BMI, age, and a few other things, and then if they pass that one, then it allows them onto our profile, so they can start completing the profile, so our profiles are about 50 pages blank before they even start filling anything out, and so it's really extensive, and so it goes through everything from their entire like physical characteristics from height, weight, what is their shoe size, their dress size, their, are they right-handed or left-handed, what's the texture of their hair, what was their hair color now versus when they were a child, and then it goes through that, and then it'll start to go into education, you know, do they have a degree, what was their focus, do they have any aspirations for future education, what are they doing in their life now in terms of, you know, work, and then it'll start into all of the, I would say health-wise as far as the donor goes, like their medical history, and then it goes into the family history and genetics of it, and so especially, you know, what I always tell the donors when they come in for screening is you're the real MVP for finishing this profile, because if we print it out, it's 50 pages, but they do a really good job of, you know, you don't realize how long it is until you're all the way through it, and then at the end of that process, after they've done, you know, all of the screening or going through that as far as the medical history of themselves and family, it culminates in some essay questions to try to really get to know them, and then photos of themselves, and so both childhood and adult photos so that we can try to get a sense of them.

Once they complete that profile, they turn it into us electronically, and so then we go through it with a fine-tooth comb and say, okay, you put your uncle has diabetes, well, is it type 1 or is it type 2, and how old were they when they were diagnosed to try to get more information on that diagnosis and make sure that we've got all the information and that everything looks good, and from there, if they pass that screening, you know, the profile looks good, then we'll bring them in for medical screening, and the medical screening process, so we're going to do a transvaginal ultrasound to look at their natural follicle count. We want to see, you know, how many follicles that we see at rest within the ovaries. We'll do lots of blood work, so we're going to do AMH ovarian reserve testing.

We're going to do genetic testing, nicotine and drug screen, blood type, CBC, and then we're going to send them after that. You know, those results will take one to three weeks, and then from there, we'll send them for psych screening. You know, the purpose of that is to look for signs of sociopathology, psychopathology, and to really make sure they understand their decision, that this isn't just like a decision for today.

It's a decision for the future, and that there is going to be life that's potentially created from this, and you know, how do they feel about that, that quote-unquote, there is, you know, their DNA that's out walking around, you know, that there's a child, and so it helps them to really, I guess, it will resonate more then, so that it's not just this easy process where you just come in for the screening, and then, oh, yep, yep, we're just going to take those eggs today, and that's it, you know, that it's, this is a big deal, and then once they've passed psych, then that's when we're looking at potential matches for cycles. Right, so it's not easy to be an egg donor. It sounds like you've got to have some sort of altruistic commitment to this, and you have to have a pretty clean medical history, family history, psychological screening, and I know that there's actually genetic carrier screening, so, yeah, it's not just a pretty face, and most of the clinics that have egg donor banks will also, you know, make sure that you have a good egg reserve, because you can be someone who's very, very healthy, got a great family history, and psychologically very sound, but you may not have the highest egg reserve, and with our technology, like we were talking about, you know, the ratio of 10 eggs to three blastocysts, you know, that you want to have the ability to be a high egg maker, just, you know, just for a statistics perspective, and so when, with egg donors and the egg reserve screening, you know, typically it's the two things.

It's the anti-mullerian hormone, the AMH, and the antral follicle count, and so, you know, that's part of the screening process, typically, so when you're looking for a donor, you know, that's something you can ask your clinic and your agency about, but I think it just really opens our eyes that it's not easy to be an egg donor. I mean, would, as far as like how many donors apply to be on your egg donor list, what would be the ratio from the, from someone first calls you and says, I'm interested in being an egg donor to actually when they are on the egg donor database list? I mean, they may not get picked, they may get picked, but what would you say the percentage is from people that want to be an egg donor that actually get on that list? From the time they start the profile until they come in for screening, it's probably, and are screened okay, probably 10% maybe because, you know, a lot of them, they may get through that profile, even we could weed them out of that process once they get the profile done, or even, like you said, their ovarian reserve testing, or it could just be that once they get that profile done and we say, okay, it's time to come in for screening, a lot of them weed themselves out there, just because they, they, I don't want to say chicken out, but they kind of get cold feet. And so they kind of will panic at that point and don't come in for screening.

So a lot of it is just self weed out even. And so I would say probably 10% hit the list. And then, you know, like you mentioned, it's the matter of getting a match, because we have some donors that may sit on the list forever and never have one match, or we have some that will get matched immediately, some might wait a month or two.

Right, and most intended parents can go and get profiles, whether it's on paper or electronic, and look and get a sense of their egg donor, they get to see their ethnicity, their height, their hair color, eye color, their family history, their medical history, they answer essay questions, am I mathematically oriented? Am I musically oriented? I mean, you really get a true sense of these egg donors. And then how many times can an egg donor donate? So ASRM guidelines are six donations in a lifetime. Frequently, what I would say to donors is that usually the first cycle is the hardest one for them to get because sometimes intended parents are nervous or scared to take a chance on an unproven donor.

So frequently, what we may see is that the first cycle might take a little longer to be matched for even though we've done all that testing, you know, that we've looked at them, it's not a shot in the dark, it's not somebody that's just filled out this profile and poof, they're an egg donor now, you know, we've done rigorous testing to make sure they can get to this point. So a lot of parents may wait until they may love this donor, but they want to wait until somebody else chooses her first. And then they will say, I want the cycle after them, because they almost see it as, I would say, like not an insurance policy, but like more reassurance, I guess, that somebody else has used her.

And so typically, it's six donations in a lifetime, usually our donors would do maybe three a year. But you know, that would just depend on the situation too, you know, sometimes it might be one a year that they do. So there is a limit.

And I know there's always the question, like, will I know my egg donor before the retrieval, after the retrieval? I mean, what's the typical scenario? And what are the different options? If it's a kind of anonymous or non-disclosure egg donor, and you're just picking a donor based on a profile versus do you get to meet the donor like before or after? That's definitely something that's become more of a conversation in the last couple years. You know, when I first began in this, it was very anonymous. It was almost like an iron curtain.

And anymore, there is a lot more curiosity around it. So as we know, the term anonymity is dead, is what we say. So, we really refer to it as a non-disclosure donation.

You know, when donor cycles first came about, what they never saw coming. And this is part of the education that we give the donors that, you know, you're non-disclosure on our list, that the intended parents won't know your identity beforehand. And so that's part of what our protocol is with our donors.

And so non-disclosure just means that there's nothing identifying shared before the cycle happens. But then on the other side, there are known donations. And so a known donation means that they would know each other before the cycle begins.

And known could be anything from an acquaintance donating to somebody they know, to a sister donating to her sister, or a cousin, or a niece, or a family situation, or a best friend. You know, I've had cases like that, where it's somebody that you know, that's within your life, and you know, a name. And so with a known donation, there's a little bit more that goes into that process.

But you know, they're kind of at the opposite end of the spectrum versus the non-disclosures where, you know, the identity has yet to be revealed, but could be revealed. And that's where, you know, we kind of talk about that idea of like, contact in the future and donor sibling registry. Right.

And I've been really impressed in most of the donor recipient cases I've seen are anonymous or non-disclosure, where, you know, they're not friends, they don't know each other. But what a beautiful bond that they have. And in the things that go on, and you can probably describe it more just by, you know, at the clinic that you work at, like, if you have the egg donor, send a note anonymously in the recipient.

And I just would like you to say that just because I think it's such a beautiful, you know, just makes this whole process so beautiful and feel good and worthwhile. Yeah, for sure. So when I first started, it was very anonymous.

The donors never knew anything about their couples. And they never knew anything about their donor after that process. And I am a curiosity killed the cat kind of person.

And I'm very curious. And so it made me question myself, like, what would I want if I were looking for a donor? And would I ever want to meet my donor? And if what would I want if I were a donor, and I knew I would want to know that it was successful and who I helped. It's just that's my nature.

And so I kind of started asking the donors, do you want to know more about your couples? And the resounding answer was, Oh, my God, yes. What can I know? Oh, my gosh, I helped two dads that are in Spain. Oh, my gosh, really? And and so then it became really that they kind of were the driving force on that.

And so from there, a lot of parents started writing, it was almost like they were mini pen pals between me that they would pass messages. And then it would really culminate in a letter that the intended parents would write for the donor to open on the day of retrieval. And that really is the most for a lot of the donors, they'll say like their most life changing moment, because up until that point, they know that they're helping somebody, they might know that it's somebody that lives in the States, they might know that it's somebody that lives in Spain, they might know that it's, you know, a same sex couple, or that it's a straight couple or a single parent, they know little, just that, you know, they don't know anything identifying just a little something.

But then here's this letter saying, you know, we're the person on the other side of this and and our dreams are coming true right now because of you. And I've had several donors that have said, you know, that their first cycle that they thought, Oh, this bloating and I just I don't want to do this again. I don't like feeling this bloated and stuff and giving myself shots.

And then they get a letter and their whole world flips around. And they're like, it's their purpose. Like, I need to keep helping.

I need to keep helping these couples like I need to keep going. And then when I went on my first trip to Israel, I took some letters from donors, where they I had some of the donors write letters to those they'd helped and just said, you know, like wishing you well, and I've heard, you know, you're building your family now or you're pregnant, and I'm so happy for you. And it'll make me emotional just thinking about it.

Because nothing has ever, as I say, punched me in the face so hard as watching one partner sob into their partner's chest clutching this letter saying you don't even understand this is the most important thing that I own. Because it was like, they got that reflection back that it wasn't just this profile. This was a person and this was 50% of their child's genetic makeup.

That's a humanistic aspect to this whole process. I mean, what percentage of donors donate again? So if someone donates one time, I mean, what percentage would want to donate again? I guess that's a better way of framing that question. I would say it's more often than not that donors want to donate again that by the time they finish their first cycle, they're asking when their next cycle is pretty rare for us, at least that donors say like, I don't want to do this again.

You know, they usually really, they go into it not knowing what to expect. So I say, you know, you're hypersensitive your first time because you're what's that? What's that? What's that? Is that okay? Is that okay? And then they get through it. And they're like, Oh, when's my next cycle? That was so much easier than I thought it was going to be.

And so they really, a lot of them are upset when they're being retired at their sixth cycle, because they say, I want to keep helping people for free. Can't I just keep helping? I know, I've heard that. Amazing.

I know. And I'm just so thankful that we get to convey this to our listeners, because, you know, it's great technology. And this is something that we've been doing for four decades.

But this was not an option, often for our parents. And so this is just a great option. And, and I think, overwhelmingly, the families who have done this are so and we get to see this, and we're just so blessed to be able to see it and people on the other and don't see all the humanity involved, but that everyone's so thankful, grateful, full of love, and overwhelming.

The donors are very empathetic, like beautiful women on the inside and out. And they truly have given the best, you know, gift of life that, you know, the gift of life is the best gift ever. Absolutely.

Just want to thank you for your inside perspective of this and then just hope that this has helped people, the egg donors, the recipients on both sides, just to see, you know, just what a wonderful process this is, that we can help give to people. So I thank you very much. Absolutely.

Thank you. The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.