When hopeful parents decide to use an egg donor, we encourage them to look for someone who fits well into their family . Many of the intended parents we work with have impressive academic backgrounds. As they face the reality that they are "losing" a genetic connection to their child, they look for an egg donor who is also a high achiever. This sometimes prompts questions around education, achievement, and intelligence: is intelligence passed down genetically? Setting the Record StraightFirst things first: Each parent’s top priority when searching for an egg donor should be finding a woman who is healthy and happy to donate her eggs. But we know it’s natural for parents to want to see themselves in their children. As a complex part of human cognition, intelligence is impacted by both genetic and other factors. So how does the intelligence of parents impact the intelligence of a child? Donor Concierge’s founder, Gail Sexton Anderson, shared the short answer: “In most cases if we take an egg from a reasonably intelligent female, fertilized by a reasonably intelligent male, you will have an intelligent child. This child will then be raised in a family of high academic achievers and is likely to do very well in this environment.” The long answer? It’s complicated! We went straight to the experts – Genetic Counselors Gena Shepherd and Emily Mounts of ORM Fertility . They’ve broken it all down below! Our clients often seek donors with high academic achievement. Should they be concerned with the heritability of intelligence?Gena and Emily: “For many years, scientists have attempted to crack the genetic code of intelligence—a lofty goal, as even defining the concept of intelligence is challenging. Most complex traits like intelligence are multifactorial, meaning that both genetic and environmental factors contribute to differences between individuals. To determine how our genes influence multifactorial traits, scientists often turn to twin and adoption studies. Identical twins share the same environment and virtually 100% of their genes, while fraternal twins share their environment, and about 50% of their genes. If a trait is highly genetic, identical twins should share that trait (ex. high IQ) more often than fraternal twins. Adoption studies examine whether children who are adopted have traits that are more similar to their adoptive parents (environment) or their biological parents (genetics). Twin and adoption studies have led researchers to believe that about 50% of the variance in intelligence is due to inherited genetic factors, while the remaining 50% is related to differences in environment (eg. parenting, education, home and school environment, access to resources, nutrition).(1) There are likely hundreds, if not thousands, of genes that all have a small effect on intelligence, most of which have not yet been identified. (1) Considering the number of genes involved, as well as the influence of non-genetic factors, it is unlikely that genetic testing will be able to accurately predict intelligence at any point soon. Intelligence is correlated with high academic achievement; however, multiple other multifactorial traits likely also play a role, including self-motivation, emotional intelligence, personality, and curiosity. (2) Some studies have indicated that high academic achievement may be even more “heritable” than intelligence alone.(2) However, academic achievement is also known to be influenced by many socioeconomic factors including income and financial security, access to education, opportunity, perceived social status/class, and privilege. (3) ” Our take? Smart egg donors come in many forms – that may be an ivy-league donor, someone who left school and started her own business, or maybe an egg donor with a master’s degree. Each of us is unique in our experience, and our intelligence is shaped by more than our test scores and the school we attended. Our goal is to help you match with an egg donor who fits into your family, and who is healthy and willing to undergo the egg donation process. We have decades of experience guiding parents on their egg donor search, and we know we can find you the best egg donor for your family. References: Genetics Home Reference . Created May 2015. National Institute of Health. Accessed June 2020. Krapohl E, Rimfeld K, Shakeshaft NG, et al. The high heritability of educational achievement reflects many genetically influenced traits, not just intelligence. Proc Natl Acad Sci U S A. 2014;111(42):15273-15278. doi:10.1073/pnas.1408777111 American Psychological Association . Created July 2017. Accessed June 2020.

Does Nature or Nurture Matter When Choosing an Egg Donor? Nature vs. Nurture has always been a hotly debated topic and in this age of third-party fertility, and can cause quite a bit of stress for intended parents. A large percentage of our clients are high achievers. Most have masters degrees, have studied at prestigious academic institutions and many are highly accomplished doctors, attorneys, CEOs, tech company managers, writers or banking executives. They often come from families where education is highly valued with parents and grandparents who also have advanced degrees. When choosing an egg donor they want to do their best to find a donor who is as bright and accomplished as they are . Finding an ivy league egg donor - someone who reminds you of yourself - can feel like yet another uphill fertility battle. I always tell my clients to find an egg donor who ‘fits into your family’ and these hopeful parents often look to a donor’s education as a measure of their future child’s intellectual standing. They’re not thinking “will this child measure up” but rather “will this child feel part of my intellectual tribe.” We know it’s not always easy to find an egg donor who matches that of the intended parent’s education levels . There are many reasons why high-achieving young women may not become egg donors. They may come from families that may not approve of egg donation, or perhaps these young women don’t have the financial need to pay off student loans. Many young women who choose to be donors may have grown up in families where they have been nurtured to achieve, but their parents may not have had the same educational opportunities. The problem with focussing on finding an ivy league donor is that most young women may not have had time to accomplish the same sorts of goals as our high-achieving intended parents. Choosing an egg donor is always a leap of faith. Our genetics make us who we are when it comes to our appearance, much of our health, and to some degree our psychological make up. But when it comes to one’s intellect, drive and ability to succeed in the world, nurture has the upper hand. We know that it’s been proven that talking to children and spending time helping them interact ultimately results in more socially developed and intellectually stimulated children.I saw this first hand when I was a research assistant at Yale. I was testing children who were born prematurely and of low birth weight. The goal of that study was to measure the effect of a specific drug administered immediately after birth but what was also observed was that children with parents who talked to and interacted with them from the time they were born showed the most progress. Most of the young women who choose to be egg donors are reasonably intelligent although they may not have attended one of the top 20 universities or have standardized test scores that are in the 99th percentile, as I’ve discussed in a previous post The Myth of The Ivy League Donor . If intended parents choose a donor who physically looks like she could fit into their family, has a good family health history, and is reasonably intelligent, that’s an excellent start. In most cases my clients have a significant other who is equally well educated (i.e. intelligent) who will make up the other half of the genetic equation. The resulting child or children will then be raised within a family where they will be exposed to intellectual stimulation and opportunities to learn and grow in an environment where education is valued. In his book Outliers , Malcolm Gladwell says, "It's not enough to ask what successful people are like. (...) It is only by asking where they are from that we can unravel the logic behind who succeeds and who doesn't. (2) One premise of this book is that people thrive and succeed because of their environment and the opportunities that they are exposed to. Another premise comes down to practice makes perfect. A violinist friend of mine gave me two books - The Talent Code: Greatness isn’t Born. It’s Grown. Here’s How-by Daniel Coyle and Nurtured by Love: The Classic Approach to Talent Education by Shinichi Suzuki . I had been sharing with her my desire to help ease the concerns of the intended parents that I assist in making one of the most difficult choices in their lives; the person who will take their place in their family’s gene pool? My friend has taught violin to students who have gone on to play at Lincoln Center and Carnegie Hall. She knows a thing or two about developing talent. Both of these books and her experience support the idea that it is not raw talent, intellect or nature that makes one shine and succeed but nurture. Nurture makes the difference. A while back, I read Proof of Heaven by Ebin Alexander . I bring this up not so much for the main message in his book but because what I learned about Ebin Alexander. He is a neurosurgeon just like his father, the man who adopted him as a baby. He later learned more about his birth parents who were bright but fairly average individuals, not brain surgeons like he and his father. He excelled and succeeded and grew up just like the father who raised him due to the love and support he received from the parents who raised him. Yes, he received good basic genetics from his birth parents but it was nurture that made him into the man that he became. In conclusion, nurture wins. When choosing an egg donor I encourage intended parents to focus more on finding someone who they like rather than worry about choosing the highest academic achiever. I know that it’s hard to let go and even harder to trust but we are not in control of genetics. What we can control is how we love, raise, and nurture our children to be the best that they can be.

When we started finding egg donors in 2006, there was no such thing as Instagram. Few people talked publicly about their fertility journey and even fewer talked about using donor eggs and finding an egg donor. Fast forward to 2020 and finally, egg donation is starting to lose the stigma. Here are a few awesome Instagrammers who share their own donor egg IVF journey. Thank you all! @lenaridley Most intended parents seeking an egg donor have already been through a tumultuous path with fertility, and chances are, you are looking for other parents who have been there and done that. Lena (@LenaRidley) uses her page to share her fertility journey, from IUI, IVF, and donor eggs to parenthood! Lena is a great source of inspiration, but she keeps it real: her posts about the struggles of infertility and parenthood are relatable no matter where you are in your own journey. @definingmum Becky (@DefiningMum)) is a self-proclaimed advocate for fertility and donor conception and a great voice in the fertility community. Becky consistently posts about her own donor egg journey, as well as words of wisdom and messages in support of others going through fertility struggles. Her other page, Fertility Matters At Work (@FertilityMattersAtWork), is dedicated to bringing awareness to fertility issues in the workplace. For anyone struggling with infertility at work, the page frequently highlights women who have been in your shoes! @camilleguaty Camille Guaty (@CamilleGuaty) is an actress famous for her roles on Prison Break and The Good Doctor, but she also made waves recently by opening up about her donor egg pregnancy. Now the mother of a beautiful baby boy, Camille has shared her donor egg journey with the world, and we love that she is helping spread awareness about egg donation! @expectinganything Victoria (@ExpectingAnything) is a blogger and writer who has candidly shared her journey to motherhood with donor eggs and the love, heartbreak, and hope along the way. She is the cofounder of Infertility Unfiltered (@InfertilityUnfiltered), a fertility support program in Newport Beach that seeks to highlight and lift up other #infertilitywarriors. Her page is a great place to find other women at all stages of their infertility journeys. @fried_eggs17 Christie (@Fried_Eggs17) has documented the last few years of her fertility journey on Instagram, sharing the ups and downs of diminished ovarian reserve, premature ovarian failure, donor egg IVF and pregnancy. Christie is a source of hope while shedding light on a difficult topic. For anyone interested in hearing about donor egg IVF firsthand, her Instagram stories are a great place to start. @riotcarrot Melissa (@RiotCarrot) is a nutrition scientist and IVF warrior who has been chronicling her donor egg IVF journey. Her Instagram feed is full of photos of her beautiful baby boy, and if you scroll a little further, you’ll see a detailed account of her donor egg IVF process. Don’t let the baby pics fool you: Melissa has been through the ringer, but we are so happy that after a long fertility journey she has a gorgeous, healthy son. @mrsjennsharp Jennifer (@MrsJennSharp) is the mom of one daughter through egg donor IVF, and currently expecting another girl! Jennifer posts about pregnancy, parenthood, and daily life with a positivity that lifts up her followers, while discussing serious issues like fertility and genetics. For anyone with genetic premature ovarian failure, Jennifer is a must-follow. She’s described in detail her journey through egg donor IVF, and the surprise blessing of another pregnancy. Infertility is a rollercoaster, but we love how Jennifer has shared her story. @motheringsolo Jocelyn (@MotheringSolo) is a 40 year old mama-to-be who is documenting her double donor IVF journey. From Clexane bruising to bump progress pics, Jocelyn has shared the good, the bad and the ugly of double donor pregnancy. We love Jocelyn’s perspective -- if you’re a single mother or pursuing double donor IVF, we wholeheartedly recommend following! @babiesafter35 Shannon (@BabiesAfter35) is a mom via egg donation and an OB/GYN, and she’s a great person to follow for both the personal side and clinical side of pregnancy and parenthood. Shannon shares and supports the pregnancy journeys of other women through reposts, but her videos are our favorite part of her feed! Her TikToks (@TikTokBabyDoc) will have you learning and laughing as she tackles everything from the impact of racism on pregnancy outcomes to the awkwardness of OB/GYN appointments. @thebunlessoven Allie (@TheBunlessOven) is a professor, expat and fertility warrior documenting her journey on her blog and Instagram. After struggling with infertility for years, Allie became pregnant via donor eggs from a close friend and welcomed her beautiful daughter. Allie’s blog is a must read for anyone weighing using a known vs. anonymous egg donor or wondering how and when to tell their child about egg donation.

David and Claire came to us looking for an egg donor who not only looked like Claire, but also had blood type A negative (A-). For this German couple, finding a donor with the same blood type as at least one of them, was extremely important. “I asked them why they wanted an egg donor with a specific blood type, encouraging them to be a little more open,” says Krystal Lemcke, a Senior Case Manager at Donor Concierge. Krystal emphasized that many donors, especially first time egg donors, don’t always know their blood type. “David and Claire were concerned that because blood type is a common subject for elementary school science classes in Europe. They didn’t want their child to be faced with awkward questions from teachers or friends.” Gloria Li says blood type is very important to many of her clients, particularly those who come from China. “Many people in Chinese culture feel the stigma of infertility and want to keep their fertility journey a secret from not only their family, but often the child themselves.” We recognize that finding a donor with a compatible blood type is important to some families, so we’ve broken it down below. What is Blood Type? A person’s blood type is a blood classification based on the presence or absence of two antigens – A and B – on the surface of red blood cells. The blood cells also can contain a protein called the Rh factor, which is either present (+) or absent (-). The combinations of antigens A and B and presence or absence of the Rh factor create the 8 most common blood types: A+, A-, B+, B-, O+, O-, AB+, and AB-. How is Blood Type Inherited? Every person’s blood type is inherited genetically. Each biological parent carries two alleles for both blood group and Rh factor, of which only one is passed on to their offspring. The chart below shows the different possibilities of child blood type, based on parents’ blood type. What Does Blood Type Mean for Egg Donation? The blood type of an egg donor does not have a medical bearing on the outcome of fertility treatments, or health of the child. Therefore, it is not often considered important criteria for parents seeking an egg donor. Many donors, especially first time donors, don’t know their blood type so trying to find someone with a compatible blood type to you, can add another layer of complexity to your choice. Agencies may require a fee to have a blood typing test, which can delay your cycle. And if the donor has all the characteristics you’re seeking, but isn’t the ‘right’ blood type, you may be left disappointed. Choosing an egg donor with a different blood type may mean being honest with the child about their unique creation. The child may require future medical treatment where blood typing is necessary. We encourage parents to look holistically at each egg donor, and keep in mind that seeking a specific blood type will greatly reduce their egg donor options. The conversation around egg donation will often happen naturally, without parents feeling their hand is forced by their child’s blood type, and there are plenty of resources for parents who may be struggling with how to start the conversation. We know that cultural restraints and each parent’s unique background can play a role in how transparent they are willing to be about their child’s creation. Ultimately, parents will make the decision that is right for their family in choosing how and when to speak with their child about egg donation, and whether their child’s blood type will play a role in that conversation.

Most babies are born healthy, but 3-5% have a birth defect or problem with development. Some of those problems happen by chance, and some can be inherited. For those building their family through egg or sperm donation, how can a genetic counselor help to avoid the risks? We talked to Amy Vance, of Bay Area Genetic Counseling  about her role in the fertility journey and how genetics and family health history play a role in the journey to becoming a parent through egg donation. What is a Genetic Counselor? Genetic counselors are masters-trained licensed health professionals with expertise in the science of genetics who are trained to translate technical and complex science and research into user-friendly terms for patients and providers. Genetic counseling is not the same thing as genetic testing. With the vast amount of genetic information and testing available, Genetic Counselors are an invaluable resource for the IVF clinic However, one basic component of risk assessment before a pregnancy for all gamete providers that’s important, and often overlooked, is the family history evaluation. Family history is the cornerstone of the genetic risk assessment. A thorough family history evaluation by a Genetic Counselor provides the foundation for evaluating risks for genetic conditions and offering appropriate testing before undergoing fertility treatment and before a pregnancy occurs. What happens when an egg donor meets with a genetic counselor? First, the donor will complete a health questionnaire through her agency. Collecting family health history involves asking questions about a person’s health and their family. Most people have family members with different health issues, some of which can be inherited. Most of these inherited genetic conditions are not detectable by standard genetic screening done by fertility clinics. For an egg donor cycle, both the egg donor and the sperm contributor may provide this information. Next, the questionnaire is reviewed by the genetic counselor Taking a detailed family history helps ensure that important genetic information is not overlooked and that any appropriate testing and/or information is provided to the patient or donor prior to pregnancy. Guidelines from the American Society for Reproductive Medicine (ASRM) suggest a review of personal and family history of genetic disease and prior genetic test results that may affect the course of treatment, with patients being counseled about additional genetic testing that may be indicated before starting treatment relating to their personal or family history. Genetics Consult After the review of the questionnaire, the donor is provided with detailed instructions about the purpose of the consultation, how to prepare, and some tips about talking with family members. I’ll schedule a call with her and we’ll have the Genetics Consult. Family history risk assessment for ovum donors by a genetic counselor provides a thorough, standardized method of screening ovum donors. This is a really important step because the consult, combined with the health questionnaire, identifies at least 20% more important family history information. One reason is because of the preparation and instruction given to the donor prior to the consult. The conversational nature of the consultation allows for additional information to be requested as needed. I may ask her to follow up with family members to gather more information based on what comes up during our session. Occasionally I may even request a medical document on a family member if there is a condition that requires that level of detailed evaluation. But I had Genetic Carrier Screening, isn’t that enough? There is a misconception that genetic carrier screening panels take the place of a family history. The family history seeks to identify actual conditions that may run in a family that increase the risk to offspring. The genetic carrier screening is for hidden genetic traits and is used for matching purposes. Most of the diseases on the carrier screening panels are recessive, and carriers for most recessive diseases don’t have symptoms- that is why the testing is used. Conversely, family history can’t identify which recessive traits a person carries. There are other patterns of inheritance such as autosomal dominant (when only onegenetic parent is a carrier and therefore there is a 50% chance of the child inheriting thegene) and multifactorial (inheritance pattern involving multiple genes - most common diseasesare inherited this way -there is a risk to close relatives of affected individuals) which the familyhistory is meant to capture since these can confer a risk to offspring. Real Life Cases As the following cases demonstrate, implementation of a routine genetic counseling screeningprogram for all egg and sperm donors is an important step in identifying possible genetic riskfactors that may be present in the donor’s family so that the intended parents have anopportunity for informed decision-making about potential genetic risks prior to donor selectionand pregnancy. Case 1 : A 5-time egg donor was referred by a clinic for genetics consult (family history assessment by genetic counselor). During the consultation, it was discovered that the donor’s maternal grandmother and maternal great grandmother have a genetic eye disease. The donor’s mother is too young to have symptoms appear and there has been no genetic testing in the family and the mother has not been evaluated. This condition follows an autosomal dominant inheritance pattern and there is an increased risk to the donor’s offspring. According to the ASRM criteria, she is not considered an ‘eligible’ donor (IPs can still choose to use the donor after comprehensive genetic counseling). The donor asked me, “why is this the first time I am having the genetics consult? Why have I been allowed to donate 5 times before and this has never come up?” The answer is that the consult was not required as part of the other donations. Unfortunately, now the previous intended parents must be informed of this new information and the potential risk to their offspring. This puts everyone in a difficult position that could have been avoided had this information been available from the beginning. Case 2 : A Donor’s paternal uncle has a brittle bone disorder, diagnosed as a teen, causing over 20 broken bones. This condition is autosomal dominant and can be highly variable even within a family. Some people have symptoms that only a trained geneticist may identify, but even mildly affected people can have more severely affected offspring. The donor’s father has not had a genetics evaluation and there has been no genetic testing done in the family. As in the case above, this condition is autosomal dominant and there is an increased risk to the donor’s offspring and by ASRM criteria, she is not considered an ‘eligible’ donor. The question from the agency was, “why don’t we screen for dominant conditions (by genetic testing).” Genetic testing for dominant conditions is not part of carrier screening, because that would be ‘diagnostic testing’, since people with a single mutation for a dominant condition are ‘affected’. That is not the purpose of genetic carrier screening for egg donors but it IS the purpose of the family history. As a side note, none of the information above was included in the donors’ profiles. This information became available as a result of the targeted follow-up and detailed information requested as part of the genetic consult. Most of the time the donors don’t know this information about their own family until the consultation process is complete. Is a genetic consult with a genetic counselor required? A genetic consult is not always required but I feel it's good practice. I think that many clinicians don’t understand the value of family history evaluation and there is an ongoing misconception that carrier screening identifies all risks to offspring. Additionally, there is a cost for genetic counseling, but it is minimal. In my practice a donor family history is $325. The turnaround time for the reports is less than a week. If the consult is factored into the overall cycle as part of routine screening, there is no time delay. Even if the clinic does not require the genetics consult, if the intended parent feels it would be desirable they can always request it. References: Family history risk assessment by a genetic counselor for ovum donors: data for 582 in house ovum donors from a single clinic demonstrates its value. Amy Vance, MS, LCGC fertstert.org Family history by a genetic counselor is a critical step in screening all patients in the ART clinic. Amy Vance, MS, LCGC www.ncbi.nlm.nih.gov The importance of family history risk assessment in the infertility setting. Fertil Steril. 2005;84(Supplement 1):S125. doi: 10.1016/j.fertnstert.2005.07.305. [ CrossRef ] [ Google Scholar ] Vance A, Zouves C. Family history risk assessment: data for 723 consecutive ovum donors from a single agency demonstrates the value of the genetics consult. Fertil Steril. 2011;96(3):S218. Vance A. doi: 10.1016/j.fertnstert.2011.07.839. [ CrossRef ] [ Google Scholar ] Amy Vance is a licensed, board-certified genetic counselor in practice for 32 years. She founded Bay Area Genetic Counseling  in 2001, a boutique private practice focusing primarily on serving couples and egg donors pre-IVF, but also offering cancer risk assessment and genetic counseling for other genetic indications. Her passion has been continuing to educate providers about the value of genetic counseling in the ART practice, focusing specific attention to family history. She has authored several articles and abstracts and delivered dozens of invited presentations on the topic of the importance of family history for egg donors and couples preconceptionally, genetic testing and carrier screening, cancer risk assessment, and preimplantation genetic testing.

The journey of infertility often begins with the who, what, why, when, and where: you build your fertility team, figure out what fertility treatment you will pursue, and make a plan for timing. Then comes the how . As in, “How do we begin, and how much will fertility treatments cost?” Approximately 10 percent of U.S. women of childbearing age have used assisted reproductive technology . Here are some tips about fertility options for financing your fertility journey. Below, we’ve laid out some of the most common third-party fertility financing options and financial avenues for intended parents. Sperm Donation The cost of sperm donation can range from under $1000 for at-home insemination to upwards of $50,000 if you require IUI or IVF with sperm donation - this is the cost for your clinic fees, medications, egg retrieval, embryo creation and transfer. Your fertility doctor is the best person to advise you on which treatment will be most effective. How much does it cost to use a donor egg and/or a surrogate? Many intended parents with diminished ovarian reserve use egg donors to conceive. Whether you find a family member who is willing to donate her eggs, or go through an egg donor agency, there are many parties involved. Egg donation usually requires intended parents to finance the donor costs, lawyer fee, clinic costs, psychological and medical evaluations, insurance plans, and more, which can cost from $20,000 to $40,000+. Donor Concierge provide intended parents with streamlined support navigating the complexities of this process and can in the end save money by ensuring that intended parents choose an egg donor who is likely to provide optimal results. Surrogacy can often go hand in hand with egg donation, and is also a complex process, involving many moving parts. Common costs associated with surrogacy include: Agency fees of $20,000 to $30,000 to match parents with a surrogate The surrogate's compensation, which can range from $35,000 to $60,000 depending on experience and location. life and medical insurance for the surrogate can range from $5000 to $30,000 the IVF transfer to the surrogate which ranges from $7,000 to $9,000 per cycle The medications at $600 to $3,000 depending on insurance lawyers and escrow fees from $15,000 smaller needs of the surrogate like a clothing allowance and parking fees for doctor's visits. Estimates for the entire surrogacy process range from $100,000 to $200,000. HERE ARE SOME FINANCING OPTIONS: HEALTH INSURANCE and Company Benefits: To finance fertility treatments, first check your insurance coverage in your state. California and Texas have laws that require insurance companies to offer coverage for infertility treatment. The remaining fourteen require insurance companies to cover infertility treatment. Arkansas, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia have laws around infertility diagnosis and treatment coverage. Many larger companies are now offering generous fertility benefits through companies like Carrot Fertility , hoping to attract people who understand the value of preserving their fertility. Always check with your HR department and see what fertility benefits are offered. Resolve , the National Infertility advocacy organization, has information available to help you ask for fertility benefits and insurance coverage. FERTILITY FINANCING LOANS: Organizations offering these loans include Sunfish Prosper Healthcare Lending),New Life Fertility Finance), and CapexMD. Many of these plans depend on estimated costs provided by doctors or agencies, and offer access to loans up to $100,000. EggFund and EmBorrow are additional state-specific fertility loan resources. Fertility loans can be a good option, but some of these loans can have high interest rates, so make sure you know what you're accepting before moving forward. And if you’re having difficulty navigating the financials of your fertility journey, companies like Seed Coach , offered through surrogacy agencies can help you make a plan. With awareness of surrogacy and egg donation growing, more options are becoming available to intended parents. Aside from insurance coverage and fertility loans, fertility and surrogacy grants are becoming an increasingly common option. The Tinina Q. Cade Foundation , Baby Quest Foundation , Pay it Forward Fertility , Family Formation Charitable Trust , Journey to Parenthood Grant , Parental Hope , and Life Grants are foundations that offer grants to intended parents who are unable to cover costs of IVF or surrogacy. Many grants typically cover up to $10,000. OTHER ROUTES Many intended parents save money by using less conventional avenues, from finding egg donors or surrogates through personal connections, fundraising, or comparing costs of medications in other countries. One mother even set up her company as a C-Corporation , so she could run all surrogacy-related expenses through the business, deductible as employee benefit expenses. While the DIY approach may seem like a cheaper alternative, remember that you get what you pay for - experts in the field, like agencies and reproductive attorneys can help you save money by not making common mistakes. Tread very carefully if you try to do this on your own. OVERVIEW While there are options for parents struggling with infertility, the best way to ultimately save money across the board is to reach out to experts, ask questions, and research. Every family is different and every intended parent’s situation is unique -- some may save money by opting to “DIY” aspects of their journey, while others may save money by finding an agency or organization that can do the work more quickly. Additionally, there are some grants and foundations specifically catered to certain regions , religious groups, and communities. The key is to communicate with doctors, professionals, and your own support system, so that you can begin this process with as much information about your needs as possible. Luckily, there is a great community of other parents and experts who are eager to offer advice and resources as you start your journey. And above all, know that you aren’t alone in this process. Many out there are facing the same struggles, and parents, legislators, doctors and experts across the country and world are advocating for more fertility support and access.

At Donor Concierge, we love to highlight parents’ egg donation stories. Thank you Georgia* for sharing your experience with us, and allowing us to be a part of your journey. I had my first child at 42 years old, which in this day and age, I thought was “no big deal.” But little did I know that with my age, FSH levels and stressful lifestyle… He was literally a miracle baby. When we learned all that, we had to consider our options. Egg stimulation wasn’t a good way to go given my age, but I was devoted to my son having siblings, so we began looking for donors. The egg donor process was complicated, but throughout it all, I learned three important things. First, I was picking a donor for my son as much as for us parents. Second, I wanted to meet our donor in person for a “gut check.” And third, I realized that as much as we try to “line everything up,” there is no magic formula to guarantee having a child. It’s in God’s hands. I believed that regardless of the medical intervention, these were MY children, and I had faith that God would give us children if he chose. Having faith throughout the process was key for me, because we did four cycles, all to no avail. Luckily, our donor agreed to do another round for us, and thank goodness she said OK! On the first transfer of the second round, I did the one thing I had never done before: After the transfer, I immediately took a cab to the nearest hotel in San Francisco and I literally LAID DOWN FOR 24 HOURS. Literally. I got room service, so I got up to answer the door and had them put the tray on the bed so I could lay back down and eat. It might be crazy, but… it worked! We got pregnant at first with triplets! My doctor talked with me about "reduction." I said NO WAY! But I did start praying that God would only allow two, since I thought triplets could be a huge strain on our family. A month later there were only two embryos. We went 39 weeks and they were born 7lb 5oz and 6lb 11oz - two baby girls! And I was 46 years old. It was awesome!! During all these attempts, we leaned on the support of friends. I kept asking for more and more prayers. However, this had one negative effect – a LOT of people knew our business. First, a good friend came to see us at the hospital, and asked, “What does their mom think?” I said, “"I think they are awesome! I am their mom. The other person is a donor." Wow. Second, a few weeks after my girls were born, a friend came to me. She said she had run into someone in the grocery store and said, "Georgia had her babies!!" To which the other woman remarked, "You know those aren't hers, right? She used a donor." This INFURIATED me! So I called that gal later in the day and said nicely, "Please do not discuss my personal information with anyone. How could you do such a thing? These are MY babies!” What a ding dong! She apologized and learned something new that day, if only to keep her mouth closed. NO ONE Had gone to more trouble than us to have those babies. Goodness gracious! To others going through this process, be mindful of how many people know about your story and how you foresee it playing out in the future. The two situations above made me believe that I needed to be forthcoming with my girls to avoid a "bombshell" incident later in life. (Such as, "You know she isn't your real mom, right?) So I always told them there was a woman who "helped us have you." When they got older, into middle school, this came up and I always treated it as if it were no big deal, just matter-of-fact – yeah, this great woman helped daddy and I have you. One day one of the girls said, "But she didn't give you an EGG, right?” I said, "Yes, she did." OH. MY. GOSH. BIG. ISSUE. After that conversation, we had a few months of "You're not my real mom!" when they were angry, to which I would always answer, "Yes, I am honey. In every way. I am as real as it gets." Later I said, "You know that really hurts me when you say that. No one wanted you girls more than me. And I am so blessed that someone helped me to have you!" And within 6 months or so, they never said this again. My donor lives about 40 miles away and we are friends on Facebook. She is now married and has two boys about 7-8 years younger than my girls, and her husband knows about the donation. She is so gracious and has said if my girls want to meet her someday, she is open to it. Anyway - after I got pregnant and they were just little tiny beads-with-heartbeats, I never looked back. They were always mine. MY gifts from God to me as a mother, to their brother as siblings and to us as a family. That someone else contributed a microscopic piece of DNA was a blessing, but made them no less my own.

We know there is a lot of misinformation about egg donation and why someone would donate their eggs. We talked with an egg donor we know personally, about why she chose to donate her eggs. Here are Jewel’s answers to the most common misconceptions and why she decided to donate her eggs. Why would you ever choose to be an egg donor? I heard of a friend donating to a local clinic about 5 years before I actually decided to donate. She was a young single mother and after hearing her experience, I understood it to be very clinical and did not even contemplate the intended parents' perspective at that time. It wasn't until several years later that I was faced with the idea that I might not be able to have children with my husband. In a specialist waiting room, I was reintroduced to egg donation. I understood donation on a completely different level. If there was someone out there who could help ME have children, wouldn't that be a beautiful thing? Egg donors only do it for the money, right? I'm not going to pretend that the compensation doesn't play an important factor. In many places across the world, compensated egg donation is illegal, and in those places, the waitlist for an egg donor can be years. Egg donors are typically establishing themselves in life and the compensation they receive may help pay down student loans or go towards important purchases. They commit a significant amount of time and energy into a cycle, for which they should be compensated. Many donors feel that is what they are being compensated for and not for the eggs they donate. With that said, being selected as an egg donor was an incredibly emotional experience for me and I've found many donors have similar experiences. They may wish to know more about the parents or child in the future. Many donors come to egg donation after seeing a loved one go through the struggle of infertility and wanting to help someone else going through a similar struggle. I believe that we are all wired with this innate desire to want to help others. Egg donation can be an incredibly fulfilling and rewarding process, with or without compensation. But compensation definitely helps. Anyone can be an egg donor? Not true. Let's run through the qualification process quickly. You apply to a clinic or agency to be an egg donor. Right away, they ask initial questions that can immediately disqualify you. Questions on your basic health: how old are you (over 30 need not apply!), are you currently taking any medications (anxiety, depression and sometimes even acne medication can disqualify you!), etc? Based on your response to these questions, they might invite you to complete a more thorough questionnaire. They want to know about you, your immediate and even extended family health. They want to know education, personal philosophies, reproductive health. If the preliminary review of your profile passes the mini requirements set forth by ASRM, you are able to create a profile. If and when you match with a couple, the fertility clinic that the intended parents work with will thoroughly vet this donor. They used to run a genetic panel of 10 genetic mutations that would disqualify a donor. They are now screening for hundreds of mutations to give the intended parents the best insight into the donors' health. On top of genetic testing, donors need to have a good ovarian reserve and appropriate hormone levels. Donors undergo Psychological screening and Genetic Counseling (different than genetic testing!). Donors typically have to complete FDA screening twice throughout the duration of a single cycle and will be tested for drugs and nicotine. Is egg donation really painful/dangerous? It can be. As with any surgical procedure or medication, there are side effects and potential complications. Most often, I see donors concerned about the injections, which are really quite painless. The surgical procedure usually takes 10- 15 mins. Most donors complain of mild cramping, similar to that of their menstrual cycle the day of. OHSS (Ovarian Hyperstimulation Syndrome) can be dangerous and painful. Clinics take great measures to ensure they are stimulating donors properly. The monitoring appointments that take place throughout the cycle provide them crucial information as to how a donor's body is responding to the medication. They may increase or decrease medication based on how a donor is responding. Donating my eggs will mean I will deplete my own egg supply and I will become infertile, right? I see this question/ concern all the time and it was a concern of mine as well. With the first egg donor cycle completed in 1984, researchers have had time to study the effects of egg donation on women's future fertility. So far there is no evidence to support any claims that donating eggs will harm future fertility. *Jewel has since given birth to two healthy children of her own - Donor Concierge Being a donor means I will have to travel and take time off of school or work? You have the option of going to a clinic near you and registering to be a donor with their program- in which case travel would not be needed. If you decide to register with an agency, then travel is likely as the chances of the couple being local to you are small. Most of the egg donor cycles take place at the fertility clinic where the intended parents are established, patients. If you match with a couple not local to you, you will need to travel to their clinic on two occasions. Once for a "donor day" where you complete your screening, sign medical consents and have injection training and then again for the retrieval week (plan on 7-10 days for travel). It’s only older women who need egg donors. There are a number of women who cannot conceive using their own eggs and for a variety of reasons. The most common reason we see women decide to work with an egg donor is egg quality (which decreases as you get older- but this can affect younger women as well). There are also women who chose not to use their own genetics due to health concerns in the family that would likely be passed down to their children. *Not the only reasons, others include: cancer treatments in females, same-sex couples, Premature Menapause among others - Donor Concierge Can an egg donor might be responsible for any child born from the donation? When you decide to be an egg donor, you will enter into a legal agreement transferring the custody of the eggs to the clinic or intended parent. *All egg donors should have their own attorney who specializes in egg donation, help them to review the contracts. The fee will be covered by the intended parents when they sign the agency match agreement. - Donor Concierge Is egg donation anonymous? You can choose to have an anonymous or open donation. The majority of donations are anonymous. Keep in mind in this day with ancestry kits and reverse image searching capabilities, complete anonymity is very difficult to promise. This is why the legal agreement is important - to establish mutual boundaries for the type of relationship you will have. Did you tell anyone? What did your family and friends think of you being an egg donor? I shared with my immediate family only. My husband fully supported my decision. I had various responses from my family. Some had some health concerns and while others had emotional concerns, wondering if I would regret my decision later in life. With that said, I've never regretted my decision to donate. I hope that my participation in the cycle process brought happiness to another family.

Many intended parents looking for an egg donor are scared when they find out that their egg donor is a carrier of an inherited disease. This information may be on the donor’s profile, after she’s been through a successful donation cycle. They often make a rash decision not to match with a donor who has a known carrier status, fearing that this means their child will be born with a non-treatable genetic illness. But this fear may also mean they lose out on a great egg donor whose carrier status implies no significant risk to their offspring. We all have a number of recessive genes mutations that do not cause disease as we have a normal functioning copy of the gene that is enough to avoid the disease. Many types of genetic disorders are transmitted by the autosomal recessive pattern. It means that if a person has both of the defective genes from their parents they could develop the disease. However if they are only a carrier they won’t show any sign or symptom of the disease but there is a chance that they transmit the carrier status to their biological child. So the short answer to this question “would my child get the disease if my egg donor is a carrier?” is NO, if the genetic transmission pattern is autosomal recessive and the father is not a carrier of the same disease. It is important for intended parents to understand that there is a difference between being a carrier of a specific disease and having the actual disease. It is also essential for them to understand the chances of having a baby with that particular disease when the genetic maternal link – the egg donor - is a carrier. If intended parents are worried about anything, we always recommend that they consult with a genetic counselor, who will discuss their family history and that of the donor. Our advice to intended parents is always to refer your fears to your fertility doctor and a qualified genetic counselor . While some of these genetic markers may sound ominous, they could be a normal part of our own genetic makeup with no bearing on the health of your future children. - Dr. Shiva Fate is a Medical Consultant and Senior Case Manager at Donor Concierge. Shiva holds a Medical Doctorate degree from Azad Medical University of Tehran and also a Masters degree in Counseling Psychology from Dominican University of California.

We are often asked which is better: a first-time egg donor or a repeat egg donor. The short answer is one is not better than the other. There is no difference in success rates between using a first time egg donor and a repeat egg donor. Donors of all kinds have to go through the same egg donation process, though there are unique considerations for each type of egg donor candidate. Repeat egg donors Why did my doctor recommend a repeat egg donor? There are pros to choosing a repeat egg donor that your doctor is aware of. Your fertility team has information about how her cycles have gone in the past, which is appealing. Record of previous responses to stimulation and/or positive pregnancy. Your egg donor was able to follow through with the protocol and make it to retrieval, all reassuring data to have before heading into a cycle. What your doctor is focused on is science, not the financial, emotional or issues of human nature. A repeat donor can be a great choice if you can find someone that you like, who is available to travel to your clinic and is can cycle when you are ready to cycle. She'll often have had her genetic and fertility testing completed and will understand the process and how she will respond to the medications. Here are a few drawbacks to a repeat donor that you may encounter: Repeat donors are in high demand Their fees are higher Finding a repeat donor who you like and is available can be challenging Waiting for your turn to work with the repeat donor of your dreams can fall through. Being an egg donor is not a walk in the park it is not unusual for donors to decide they don’t want to do a future cycle when it’s your turn First-time egg donors Here are a few reasons to also look at first time donors: Every egg donor was a first time donor at some time First time egg donors are excited about the process and the possibility of helping you First time egg donor fees are usually significantly lower than a repeat donor First time egg donors can be tested for ovarian reserve prior to you committing to work with them First time egg donors may be open to doing an exclusive donation arrangement with your family We always recommend that intended parents look at both first time donors egg donors as well as repeat donors . It is hard enough to find candidates that feel “familiar” you don’t want to eliminate the majority of candidates because they have never done this before it may even be a plus when creating your family. Interested in building your family with Donor Concierge? Schedule your free consultation today .

How DO you choose the best egg donor for you? It seems easy at first – someone who likes like you, lives near your clinic and is healthy? Soon, many intended parents become bogged down in the finite details of individual donors and come to us, overwhelmed by the decision making process and worried that 'the one' just isn't out there. Think again. As corny as it may sound we are all far more unique than we realize. When it comes to choosing an egg donor you can desire anything you want but you can’t have everything you want all in one person. Here are a few guidelines: • Choose a donor who is healthy and has a good family health history • Make sure she is available to cycle now not some time in the future • If she is a first-time donor, ask to have her ovarian reserve checked • Make sure she can travel to your clinic • Choose a donor who looks and feels like they could fit into your family • Find someone who you like for who she is not because she is just like you Out of the six guidelines, the first three are must haves from a medical perspective. But if that were all future parents cared about all intended parents would be able to find egg donors from their clinic’s database. For most of our clients, it’s finding an egg donor that feels “familiar” that gets them to let go of their genetic connection so that they can go to cycle. They want to feel a connection to the young woman who is taking their place in the family genetics. Many intangible characteristics help future parents feel they are ready. While we are always checking the donor’s health information, it is the look and feel that helps the prospective parents to decide they can let go of their reservations. Start with your ultimate egg donor wish list. Then decide what qualifications are the must-haves or deal breakers and which are the nice to have or icing on the cake. A client came to us with a lengthy ‘must-have’ list of his perfect egg donor – she had to be Jewish with an SAT in the 90% from a top 30 college. While many Jewish women are bright and highly educated, those with SAT scores in the 90% rarely sign up to be egg donors. There are bright young women who have excellent scores, but they may not be Jewish. Many intended parents may then decide qualification is of greater importance to them. For some, the egg donor's Jewish heritage is more important while for others it’s the academics. When you start to review profiles, you will quickly realize which of these qualifications is going to be the deal-breaker or the icing on the cake. Your Donor Concierge case manager will help you see all those candidates who come close to your desired criteria and ultimately, help you make the best choice for you and your family.

Donor Concierge works with a variety of men - married and single , gay and straight. In our experience, men have a different perspective on finding an egg donor than women do. We’ve found that women searching for an egg donor tend to look for someone like themselves. Men, on the other hand, seem to be searching for the ‘ideal woman’ to be their egg donor. They often seek ‘perfection’, without understanding that although all egg donors are women, not all women are egg donors. Some common requests that we get from men who are looking for an egg donor: Model beautiful Ivy League education 90th percentile on SAT or ACT 5’7” or taller Plays a Division I sport While we can find very bright, university-educated women who are tall, healthy and attractive, someone who meets all of the above criteria is a rarity. Most women have absolutely no interest in being an egg donor, regardless of the compensation. Those who do choose to be egg donors have done enough soul searching to feel comfortable with their decision. Most egg donors are motivated both by altruism and the financial rewards. Many women would never entertain the idea of donating their eggs because they would see it as giving away their children. The time commitment and discomfort associated with the egg donation process can also be a deterrent for many young women. An egg donor must give herself subcutaneous hormone injections to prepare her body for donation. She will retain a lot of excess abdominal fluid during this process that may cause bloating, cramping and general discomfort. The donor also needs to limit her physical activity so that she doesn’t damage to her ovaries while they have swollen. There are risks involved in any surgical procedure and some women are not prepared to take this risk to become egg donors. Finally, social acceptability may affect a woman’s willingness to be an egg donor. While she may see it as a financially rewarding altruistic act, not everyone in the donor’s family and social circles will see it in that light. This is particularly true among more traditional Asian , Jewish , East Indian and Middle Eastern families and is a deterrent that keeps many women from wanting to be an egg donor. It can also be socially unacceptable at Ivy League or other top schools. Many of these highly accomplished young women are simply too busy with school and don’t have the time or the monetary motivation to be egg donors. While there are many wonderful, healthy, bright, caring and lovely women who are willing to be egg donors, it is a process of self-selection. For men, choosing an egg donor means understanding that we will always be limited to those women that choose to do this, and to focus on finding someone who is healthy, available and willing to donate who offers the best chance of a successful pregnancy.