Between increased media coverage and openness by celebrity role models about their struggles with and solutions to infertility, egg donation has become more mainstream, and, as such, a more “acceptable” course for young women to take to gain financial and psychic rewards.

On the plus side, this is good for us and our intended parents, as it gives us a larger pool from which to choose. The downside, of course, is that news coverage is fairly superficial and may create expectations among prospective donors that are pretty far removed from reality.

This was brought home to me in a recent article in Jezebel entitled “Do Egg Donors Lie?”

In answer to the title question, yes, some prospective egg donors do lie, and I have caught a number of them doing so (on issues ranging like physical and mental health concerns, for example). It gets them bounced from consideration. I’ve developed a good radar for this, as a BSN who has worked with egg donors for 18 years and in women’s health for seven years before that. It helps to know what to ask and how to ask it, and our policy of interviewing egg donors face-to-face (in person and via Skype) is hugely beneficial.

Often, what they commit are sins of omission, not commission, but those still may be more plentiful because of the economic environment and, let’s face it, the prospect of “easy money” to offset the financial stresses.

And it doesn’t help that the increasingly competitive environment in our industry has driven compensation to, well, dangerous levels. The danger lies where it is less a reflection of time invested in the donation process (as per ASRM guidelines) and more one that’s essentially a bidding war for genetically ideal eggs. Is a girl who never considered donating until she wound up in dire financial straits being lured or coerced by the compensation? It’s an increasingly important ethical issue.

Of course, once prospective egg donors go beyond the media hype, they understand that egg donation may not be all so quick a buck. There’s a time commitment involved, from the medical and psychological screenings and legal consultations to medical checkups throughout the donation process, that can easily stretch past the three-month mark.

And even so, they may be accepted by the agency as a donor but still not pass the screenings. They may not get matched. They may stimulate poorly. There are no guarantees.

Egg donation is an important component of today’s fertility industry. It’s not something just any woman can do, for any number of reasons. Young women who are realistic with their expectations will happily reap both the psychic and financial rewards.

One of the common questions we see on the discussion boards of the surrogacy communities we follow is typically posed by women who are considering becoming surrogates for the first time:  “Do I do it myself or go through an agency?”

Responses from others who have taken this path before vary, but lean toward recommending registering with an agency for the first time. At the same time, many say they have been do-it-yourselfers for subsequent surrogacies, recommending that route only after learning the ropes via the first agency experience.

Of course, I represent an agency, so forgive my bias. But the fact is that not all agencies are alike. And neither are all surrogacy journeys. There are many complexities involved and details to be managed in being a surrogate. The medical aspects aside, issues range from the legalities (contracts, compensation, meeting state laws over surrogacy arrangements, for example) to the surrogate’s emotional readiness to day-to-day dealings with the intended parents.

Frankly, once our surrogates begin the process, they’re happy to have an agency in their corner. If you’re thinking about embarking on this journey yourself, here are four reasons to consider an agency, and key points to keep in mind as you’re talking to likely candidates.

1. The agency is your advocate in this process, representing your interests in everything from finding the right intended parents for you, helping to navigate issues that arise during your journey, to ensuring that you have someone in your corner with your best interests at heart. If you’re talking to an agency, ask for specific examples of how this role has actually played out with the surrogates with whom they have worked.
2. As part and parcel of this role, the best agencies will ensure that their staff is available to you 24/7, to hold your hand, answer your questions and anticipate your needs.
3. The agency has experience in dealing with all the aspects of the surrogacy journey. It knows what to expect for all the facets and, thus, can anticipate and effectively manage any bumps that may occur on the road.
4. The agency also has developed the resources necessary to meet the surrogate’s interests, from legal specialists in family law to insurance programs to meet supplemental healthcare needs.

Anyone who’s considering becoming a surrogate knows it’s not a decision to be taken lightly. Once you’ve talked to several agencies using these points as a guide, go back to those message boards and ask members of the community to share their experiences, pro and con, with the agencies in question. You’ll benefit by extra careful due diligence in the long run.

It is kind of scary to think about the possibility that hundreds of people – thousands, even – are out there, innocently living out their lives and unaware that the guy who lives next door could be a half-sibling – genetically speaking, that is.

It’s a possibility that has the fertility field (and those with an interest in controlling it) fairly abuzz these days. The number of children who could be created by a single sperm donor during his fling with this particular brand of philanthropy is fairly mind-boggling, when you think about it.

One Toronto man tells a Canadian newspaper that he was born in 1952 with sperm from a donor who supplied his semen for over 30 years. It’s likely, he says, that his donor/father has between 500 to 1,000 children in Canada, the U.K., and who knows where else? “Freaky” is one word he uses to describe it.

Why is this cause for alarm? Well, the possibility of inadvertent incest, for one. For another, the possibility that these children might share disease-causing genes that might spread exponentially throughout the population.

Similar concerns have been voiced about children born through egg donation, though the scale of the issue there is far, far smaller – for practical reasons, if nothing else. Women produce far fewer eggs than men do sperm. The collection process entails a comparatively onerous medical procedure that’s a far cry from the “one and done,” if you will, of sperm donation. Women undergo a very comprehensive physical and family health history before qualifying as egg donors, which I’m not certain is as standardized for sperm donors.

There are very clear ASRM guidelines on how often a woman should donate her eggs, at least in the U.S.: No more than six cycles. For men, ASRM guidelines on sperm donation limit donors to 25 live births per population area of 850,000. (Some estimate that only between 20 percent to 40 percent of births are reported.)

In neither case, however, is there centralized tracking. While I can’t speak to sperm donor agencies, in the egg donor community, agencies like ours communicate locally and do a good job of monitoring. Yet there is nothing keeping (or to monitor) either sperm or egg donors from moving to new areas and starting all over.

It’s a concern that’s not going to go away, and has prompted calls for tighter regulations. The thought of more government regulation is always one for concern. Better yet that we, as an industry, revisit an idea that has been discussed for years and find a way to make it work: A centralized registry of egg and sperm donors that is scrupulously maintained. And where participation is a badge of honor.

The anonymity of egg donors – a norm of assisted reproductive technology here in
the United States – is steadily coming under question. And while those of use who
find donors to match with intended parents in need tend to worry that the trend will
result in a shortage of willing donors,, that actually may not be the case at all.

Last month, Washington state passed a new law guaranteeing children conceived
with gametes from Washington egg donation agencies access (when they’re 18) to
their donors’ medical histories and their full names— unless the donors specifically
opt out of being identified. It also applies to children born of donated sperm.

Twenty years ago, when we were just starting in this business, donor anonymity
was a huge concern to all of the parties . Today, we see fewer who need that
assurance. And a spot survey Alternative Reproductive Resources recently
conducted of our egg donor base gave us some data to back up the anecdotal
evidence.

Just over half the survey group was new (51.9%) and one-time (29.6%) donors. Of
the entire base, fewer than 10% said anonymity was “very important” in weighing
their decision to donate. A whopping 55.6% called it “somewhat important”; and
nearly 40% said it wasn’t important at all.

So it’s not surprising that over 80% of the respondents said they would still donate
their eggs if anonymous donations were disallowed, and fewer than 20% said they
would opt out of being identified if legislation like Washington’s was more broadly
adopted.

In their comments, it was clear that our donors understood and were comfortable
with the need of children born of donated eggs and/or sperm to know as much as
possible of their biological roots. Their “responsibility” as egg donors was a common
theme.

What was a greater concern was the potential for any legal responsibility.

One donor noted: “I value the anonymity, but I think children will always be curious
where they came from. Making a decision as big as donating eggs comes with a certain
responsibility, and I would give the child the opportunity to find out about me if that was
important to them.”

Another said: “Giving them the opportunity to easily understand where they came from

is potentially part of our duty as donors. However, I do not believe that this knowledge
should ever result in the pursuit of mandated legal obligation for care or finances without
the donor’s reciprocated agreement.”

This is an issue that is not going to go away. We find it interesting that donors, arguably
the group with the most at stake, have adopted a more open attitude toward anonymity in
recent years. Let us know what you think!

As many sad stories as happy ones about surrogacy abound on the Web.

One of the more recent heartbreakers told of a U.K. couple whose surrogate decided, halfway through the pregnancy, to keep the baby she was carrying. Then, the woman, an unmarried welfare mother of two, added insult to injury by suing for child support. As the biological mother (this was a traditional surrogacy), she won – taking away not only £4,500 (nearly $7,400) of the promised  £16,000 ($26,300) payment to cover expenses, but another £568 (nearly $900) in monthly child support.

There are many reasons why our agency will not manage traditional surrogacies, and this illustrates some of them. While this case was set in the U.K., there are enough underlying lessons for intended parents to think twice about this path, no matter where they are located.

Traditional surrogacy, of course, is when the carrier’s own eggs are used, making her the biological mother of the child. With gestational surrogacy, either the intended mother’s eggs or those of a donor are used, making the surrogate truly a “carrier.”

Either way, surrogacy can be a complicated business, a tangle of emotional, psychological, and especially financial and legal issues. The latter category is critical to cover from both the surrogate’s and intended parents’ perspective, but is compounded because laws vary so widely across the U.S. regarding the legal parentage of a child born through surrogacy.

(Illinois provides the opportunity for intended parents to be recognized as a child’s legal parents in a gestational surrogacy through an administrative procedure so long as at least one of the parents is the genetic parent of that child.)

It comes down to risk, and traditional surrogacy poses too much of one for us to get involved, or recommend it to our intended parents.

Unfortunately, the financial issues may trump the legal considerations by the time they get to the stage of needing a surrogate. Often having spent upwards of $20,000 on fertility treatments per IVF cycle without donor eggs, intended parents are looking at another $40,000 to $80,000 for a surrogacy birth. Cutting out the costs associated with the egg donor and the IVF process can reduce the total by as much as 80%.

But is the risk worth it? Consider: With a traditional surrogacy, that child is the surrogate’s unless and until she decides to voluntarily relinquish her rights to the child through an adoption. All the legal agreements in the world will not counter the traditional surrogate’s right to retain the legal rights to her child should she choose not to sign over her parental rights.  Intended Parents may eventually get custody of the child, but the surrogate will continue to be the legal mother.

Moreover, the legal fees that can run up if you challenge her decision will easily eat away at the “savings” you gained in going the traditional route. And, oh, yes, then there are 18 years of child support payments. The father in the U.K. case will end up paying close to $200,000 by the time the child reaches its majority.

We strive to help create happy outcomes for those looking to create families. Traditional surrogacy poses too many emotional and financial risks for us to recommend it.

We recently came across a thread in a Yahoo discussion group from a would-be gestational surrogate. She had completed an agency’s questionnaire to become a surrogate. And while she understood the rationale for the questions (many of which appeared on the surface to be quite intrusive), there was one that had her puzzled for its relevance: “What is your religion?”

That’s a pretty typical question for agencies to ask. It points to the depth that principled and discerning agencies will go to in vetting prospective surrogates.

The religion question can relate to any number of considerations – beliefs that may influence a decision on selective reduction, for example. And, let’s face it, for both Intended Parents and prospective surrogates, religion may be a sticking point whether it’s relevant to the task at hand or not.

Taking a deep dive into the prospective surrogate’s background, beliefs and support network is absolutely essential to ensure she’s emotionally up to it – and, equally important, is a responsible individual who surrounds herself with people who share her principles and behaviors.

The stories about con artists who hold the baby for ransom are the exception, but they’re the ones that people remember. Not surprisingly, they weren’t properly vetted. We’re not about to take that risk.

A typical surrogacy application form can run up to 20 pages. It’s the first screen; subsequent ones include interviews with the agency’s staff and, preferably, independent mental health professionals. It is not something to be completed in an hour, or even a day. Are the questions intrusive? Some are – of necessity. And prospective surrogates should expect no less given the very important role they’re applying to play.

It asks for the candidate’s and her husband/partner’s five-year employment history and educational backgrounds. It asks about family structure – how many children and their ages, and the support network. It asks whether the candidate or her partner have criminal records or substance abuse histories. It asks health questions including a medical and pregnancy history, ranging from how the applicant relieves stress, to whether she’s had an HIV test and the results, to birth control methods and delivery experiences.

And it asks questions to gauge the candidate’s emotional state. What are her hopes, wishes and expectations? Will she work with same-sex couples or unmarried couples? What are her strengths and values? How does she manage difficult times or experiences? Her partner is asked to share feelings about her taking on this role, and how the partner’s family would feel about it, as well. Descriptions of the couple’s children are solicited, along with how they will be prepared and involved in the process.

They’re also asked about issues that must necessarily be grappled with: How will you deal with relinquishing the baby to his or her parents? How do you feel about future contact with the child and his or her parents? How do you feel about carrying multiples, and the issue of a selective reduction if you’re carrying more than two fetuses?

This is only a sampling of the ground covered in the surrogacy application form. It is exhaustive, though we prefer to think of it as thorough. But that’s what it takes to make sure the surrogacy experience lives up to its promise for everyone involved.

We normally stay away from politics in this blog. Religion, too, for that matter.

But a very troubling movement has been stepping up the pace lately.  Some legislators at the state and national level are proposing measures that would severely cut away at women’s reproductive rights.

Fertility. Infertility. They are opposite sides of one coin. And these proposals have implications for both of them.

Here’s how blogger Keiko Zoll, a self-described “infertility advocate” put it:

“…Infertility patients need to pay attention to healthcare legislation, particularly anti-abortion legislation. Anti-abortion legislation, in a cruel twist of fate, can pose a serious threat to our access to care. Here we are, trying our damndest to have our own children, and yet (I know how ironic this sounds) we need to be vigilant about others’ rights and access to terminate their own pregnancies.”

In Iowa, proposed legislation would define life as beginning at conception, effectively making abortion illegal there. What would that mean for infertility patients? It would mean that if all the eggs collected were fertilized during an IVF cycle, it would be illegal to dispose of any of them, even those not biologically suited to be transferred to the uterus.

In opposing the legislation, the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) pointed out:

“In human reproduction…fewer than 20% of fertilized eggs implant in the uterus. Given the uncertainty…it is unreasonable and imbalanced to give constitutional rights to fertilized eggs or embryos. HF 153 would result in a requirement that all embryos be used for procreation purposes, or be kept in a frozen state forever. We question whether it is the intent…to grant those frozen embryos the right to vote upon reaching 18 years in frozen animation?”

Similar “Personhood” legislation is sweeping across North Dakota, Montana, Texas, and Oklahoma. Then, there’s Georgia, where a bill would require any miscarriage, whether in a hospital or elsewhere, to be reported and investigated. And, of course, there’s the de-funding of Planned Parenthood, a much-needed resource for overall women’s health services going far beyond abortion.

We’re a small business. We don’t have a political action committee. We just want to help people create families, finding and matching them with egg donors and gestational surrogates. But as part of the larger community, we all need to be aware of changes in the environment that might affect both sides of the reproduction coin. And be prepared to give voice to our concerns.

I don’t know whether to put it down to the general public’s prevailing ignorance  about gestational surrogacy and egg donation or shoddy and sensationalist reporting, particularly by the British press.

But the news coverage, especially in Britain, of the birth-by-surrogate over the holidays of a baby boy to rocker king Elton John and his partner David Furnish was pretty stunning on all counts.

The revelation that the child actually had (gasp!) two “mystery” mothers! And now, two fathers!  The fact that nothing is known about either “mother,” like their background, religion, marital status or rights to the child. That it’s not illegal for millionaires like Sir Elton to “buy” a baby in California, which, one piece proclaimed, had the most forward-thinking surrogacy laws in the U.S.

With all the exaggeration by the U.K. popular press when a celebrity utilizes assisted reproductive technology (ART), it’s a small wonder that the laws there concerning these advances remain restrictive.

We’ve been in this business nearly 20 years, and have watched the possibilities with ART, attitudes and the legal landscape change dramatically in that time, at least here in the States. Yet the misconceptions just seem to hang on.

Of course, the background, religion, marital status of the surrogate are largely irrelevant, at least in terms of the child and its future. With gestational surrogacy, the woman who carries the child has no biological connection to it. In terms of the egg donor, what’s typically most important to intended parents are the donor’s genetics. She has no more “rights” to the child than a sperm donor would, and understands that going into the process.

In California, case law has provided some guidance as to children born of gestational surrogacy. Illinois, which truly has been at the forefront with its surrogacy friendly laws, has provided protection for all parties in this arrangement. Intended parents are recognized as a child’s legal parents from the moment that child is born without an adoption or court proceeding so long as the requirements of the act have been followed and at least one of the parents is the genetic parent of that child.

Right now, we’re seeing a substantial increase in prospective parents who can only achieve parenthood with the help of a surrogate. It’s a challenge. It takes a very special person to agree to carry someone else’s child for them. And there are never enough surrogates to meet the demand.

The media scrutiny and its role in perpetuating myths only compounds the problem. Maybe it will take more first-person stories, like the New York Times’ “Meet the Twiblings” piece, to help put it all in the proper perspective.