Fairfax EggBank recognizes that many stakeholders in the assisted reproduction community care deeply about making sure that egg donors are treated ethically and provided with all relevant information to be able to make an informed decision about joining a donor program. We also know that intended parents want to choose donors that have been carefully vetted from a physical and mental health perspective and counseled regarding their donation.
Fairfax EggBank has developed its processes by taking into account the American Society for Reproductive Medicine (ASRM) guidelines, input from our medical experts and mental health professional partners, and feedback from our intended parent clients and donors. We are proud of the processes we have developed and are pleased to be able to provide this series of blog posts explaining how we prioritize health, safety, and psychological support for our donors as they are evaluated for our donor program.
At the same time, we know that this is an evolving field and we can always improve our processes as the landscape changes. We appreciate hearing feedback from people whose lives are most affected by egg donation, including donors, intended parents, and donor-conceived individuals. After reading this Egg Donor Process Education Series, please take the opportunity to share your thoughts at [email protected].
Fairfax EggBank donors must successfully complete extensive physical and mental health screenings to be approved into the program. During the screening process, a donor is referred to a Mental Health Professional (MHP). Psychological testing is performed to ensure there is no indication of clinical psychopathology and the egg donor’s clinical, psychological profile is within normal limits. We want to do everything we can to ensure each donor is stable, is not experiencing undue stress and has an extensive support system.
One of our roster of highly-qualified MHPs is Ellen Winters Miller, MA Licensed Marriage, Family, Child Therapist, who engages in extensive conversation with prospective donors. Ellen has 30+ years of clinical experience, with a focus in the field of assisted reproduction for the past 25+ years. We sat down with Miller to discuss the topics she feels are most important to discuss with donors.
Miller conducts an extensive mental health evaluation, and provides donor applicants with counseling to ensure that they are mentally prepared and aware of the commitment they are making, as well as considering their future fertility, the emotional impact on their families, and the donor conceived children that may result from their donation.
“My goal is to be the potential egg donor’s advocate,” said Miller. “The donor needs to understand the lifelong ramifications of what she is agreeing to. She needs to understand that her genetic material will be in other families, that there could be children out there that look like her and act like her. The implications are much more serious than donating blood. I hear from donors all the time that they really want to help people. My role is to make sure they understand the gravity of what they are doing.”
Egg donors have a lifetime limit on the number of times they can donate. The ASRM says egg donors have a maximum of 6 donations. At Fairfax EggBank, we capture information about previous cycles and include them in the lifetime calculation to ensure we maintain ASRM’s guidelines for cycle limits.
“An egg donor’s genetic material can be in more than 6 families, which many of the donor applicants don’t understand before our discussion, so it is important that they are clear on how this could potentially affect them now and down the line.
“If they are living with family members, they are going to have medications to administer that will need to be refrigerated. They are going to give themselves shots. They must think through the family pressures and belief systems, and how they are going to discuss this with others in the future. This includes their partners and their own children.”
It’s important to us that our donors understand that there is no such thing as anonymity anymore and our MHPs spend significant time discussing with potential donors the strong possibility that they or their family members will be identified and contacted by people conceived using their eggs.
Additionally, internet image search tools can be used to identify donors based on pictures shared on the donor’s profile on an egg bank’s website.
Miller notes: “A donor’s child or one of their relatives could do a genetic test like Ancestry or 23&Me, or any of the donor conceived children can do one and they are going to be matched” via those websites. Miller emphasizes this possibility when she speaks with prospective donors and takes their reactions and feedback into account when advising Fairfax EggBank on whether they should be accepted to the program.
There is an important level of thoughtfulness and mutual respect between Fairfax EggBank and its mental health professional partners. Miller has been counseling donors for 20 years and is compassionate and effective when working with egg donors.
“I run an objective psychological test with each donor. The donor and I review their answers to the test. Then I review what the analysis of the test is, because I believe they have a right to know.
“We discuss the retrieval process, the physical implications to their body, and overall expectations.
“Donors must be comfortable with needles and self-administering injections. They must be comfortable with vaginal scans/procedures. Donors may experience some bloating and must abstain from sex for a period of time while on the medication.
“Donors also have to be mature, responsible adults who can be flexible with scheduling and reliable, arriving at appointments when they are expected.
“Donors must be altruistic, sensitive to those who want to have children, and have a strong sense of family values and relationships. I ask them directly why they want to do this.” Miller also evaluates the donors’ motivations. She points out that compensation is often among the reasons motivating donors to donate, but one thing that unifies donors is that they are always motivated by altruism. For example, explains Miller, “They often know someone who is gay or who has struggled with infertility.”
Miller takes her responsibility as a mental health professional beyond her commitment to screening the donors.
“As a mental health professional, I take any encounter very seriously. I feel a sense of responsibility to these young women. Anyone who needs to prioritize addressing a major concern with her mental health is not a good candidate for the donor program, and I recommend that she get outside counseling.”
Miller cites the example of a potential donor who presents with signs of serious depression. The individual would be told that this is not a good time for her to be an egg donor and Fairfax EggBank would remove her from the remaining screening process. She will not be admitted to the egg donor program because Miller and Fairfax EggBank want her to prioritize her mental health concerns.
“My priority is to the person, and my advice is you have to take care of yourself. Beyond my role evaluating candidates for the program, I have followed up with them on my own to ask them if they have sought treatment.”
After meeting with a prospective donor, our partner MHPs carefully analyze the donor’s responses, demeanor, and overall presentation to determine whether the donor is fit to proceed in the program. This includes evaluating the donor’s stated reasons for participation, whether the donor appears to be motivated by altruism, whether the donor is in financial need or otherwise suffering any life instability that could be affecting her desire to participate, and whether the donor understands the current and future implications of being an egg donor. If there are any concerns about the donor’s motivations for participation, understanding of the implications, or overall maturity or readiness to donate, the MHP will not clear the individual for participation in the program.
If the MHP does clear the individual for participation in the program, this clearance is just one of many items reviewed by Fairfax EggBank program staff. We perform a comprehensive evaluation of the donor’s full application package. We review the donor’s application in depth, conduct and review our own interview of the candidate, discuss any donor concerns with the applicant, and review the physician’s evaluation and medical history form. We review each of these items individually and then compare the information and responses in each of the documents to ensure they are consistent and demonstrate the candidate’s fitness and preparedness to proceed.
In addition to undergoing an extensive mental health evaluation and counseling, our prospective donors are carefully examined and counseled by our partner physicians regarding the side effects of egg retrieval cycles and the potential risks of the procedures.
This is covered in Part 2 of our Egg Donor Process Education Series.
At Fairfax EggBank, we understand the importance of learning from the assisted reproduction and fertility community and its stakeholders. As we mentioned above, we invite you to share your feedback on this blog series at [email protected].
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