Egg donation has been around for decades, but it’s still controversial.

The INSIDER Summary:

  • Young, healthy women can make thousands by donating their eggs to infertile couples.
  • Some doctors say the process is generally safe.
  • Critics, however, worry there may be undiscovered health risks.
  • Similarly, some former donors say the experience is positive and meaningful, while others regret it.
  • INSIDER spoke with doctors and real women who’ve gone through the process to learn what it’s really like — and understand all sides of the debate.

Online ads recruiting egg donors make the process seem like the pinnacle of win-win situations. You give the gift of life to a couple that desperately wants a child. They compensate you with thousands of dollars. Everyone walks away feeling fulfilled.

“Egg donation is a gift that lasts a lifetime,” one ad reads.

“Help a recipient’s dream come true today and take your dream vacation or pay off some bills tomorrow!” says another.

But things don’t seem as rosy if you stumble across one of the many sources claiming egg donation is dangerous and unethical.

A few minutes of Googling reveals pages and pages of personal essaysnews stories, and even a 45-minute documentary detailing the alleged risks of donation and regrets of former donors.

Messages about egg donation can vary dramatically depending on source. And that’s a problem, because egg donation has steadily grown in popularity over the past decade, according to data from the Centers for Disease Control and Prevention (CDC). Potential donors deserve to know whether the process is a safe and altruistic gesture, a high-stakes medical risk, or something in between.

INSIDER interviewed doctors, women who’ve donated their own eggs, and one vocal critic of the egg donation industry to get the full (and very complicated) story. Here’s a closer look at what the process is really like, and what you need to know if you’re considering donation.

The first step in being a donor is getting picked.

Not everyone can be an egg donor.

One of the most important factors is age: The American Society of Reproductive Medicine (ASRM) — a major organization in the fertility industry — recommends that donors be between ages 21 and 34, since female fertility starts to decline rapidly around age 35.

By FDA law, potential egg donors must get screened for HIV, hepatitis, syphilis, chlamydia, and gonorrhea before donating. But most clinics go a lot further than the minimum legal requirement. Genetic, psychological, and even personality tests might be included in screening.

The ASRM has a very long list of guidelines for selecting and testing potential donors. But they’re only guidelines, not rules or laws. Some clinics may follow them to the letter and others might be more or less intensive.

“I took a long personality test and was required to meet with a counselor to discuss a variety of topics,” three-time egg donor Rhiannon Schwisow, 26, told INSIDER. “This included my motivation for donating, my family relationships and support system, my job and education level, my hobbies, what I did in my spare time, and if I was generally happy and satisfied with my life.”

Once a donor has been screened and selected by recipients, everyone involved will usually sign a legal contract that outlines the specific terms of the donation. Some donors opt to hire lawyers to help them fully understand (and potentially negotiate) this contract.

The donation process begins with hormones.

Normally, in each menstrual cycle, the ovaries produce one egg.

And though what happened to Dr. Schneider’s daughter is tragic, stories like hers are still only anecdotal evidence. They don’t indicate that everyone will experience health complications after donating.

But the problem, Dr. Schneider and other critics say, is that we still don’t know for sure. They maintain that egg donors need to be studied on their own.

“You can’t really use that just substitute information [from IVF patients] and say we don’t have to study egg donors,” she said. “I’m saying, as a scientist, that’s not very medically sound.”

Dr. Austin acknowledged the lack of data but seemed optimistic.

“We don’t really have data to prove that it causes a problem,” she said. “Do I think it does? No. [But] you have to caution patients that it’s an unknown.”

That’s an important point, since not all women may get that information before they sign up to donate. A 2010 study found that a majority of advertisements soliciting egg donors violated ASRM guidelines by neglecting to mention either known or unknown risks of the process.

There may never be one tell-all study on possible long-term risks of donation.

Large groups of egg donors could be tracked by researchers and asked to report back on their health problems over time, but such a study wouldn’t be able to determine cause and effect, Minkin explained. The development of cancer can be influenced by so many variables— obesity, smoking, chronic inflammation, viruses, exposure to certain chemicals or radiation. Hormone-related cancers in particular can be influenced by birth control and pregnancy, too.

If an egg donor gets ovarian cancer, say, 20 years after her donation, it’s extremely difficult to prove that donation alone was at fault.

One piece of good news is that most women don’t seem to regret donating.

At least, that’s according to the small amount of available data. Two small surveys of American donors from 2004 and 2010 indicated that a majority of donors were satisfied with their experience. Several studies of donors in other countries also report high levels of satisfaction, but since donation laws and protocols differ, we can’t necessarily apply those results to American donors.

And even though it’s only anecdotal evidence, both Williams and Schwisow were very satisfied with their decision, too.

“I had a wonderful and positive experience at [my clinic]. I felt cared for, appreciated, and like they were helping me do good in the world,” Schwisow said. “I donated three times because [my clinic] made me feel so comfortable, and because they gave me great feedback about the results of my donations.”

Williams expressed similar sentiments.

“It’s honestly one of the most meaningful things I feel I’ve done in my life,” she said.

Then again, egg donation is still dogged by unanswered questions. Tragic things have still happened to women who donated in the past.

“It’s a tough one,” Dr. Minkin said. “We don’t have a lot of great data to say do this or don’t do this. I do think it does come down to a personal decision.”

That might be the best bottom line we can draw. It doesn’t seem like medical experts will ever universally celebrate or condemn egg donation. The decision to donate ultimately lies with each woman examining the benefits and the potential risks, then weighing them against her current situation.

It’s not a satisfying conclusion, but — for now — it’s the one we have.

Correction: A previous version of this post said that there is a 5% chance of ovarian torsion for patients undergoing hormone treatment prior to egg donation. The risk was misstated and is actually much lower.

We couldn’t have said it better, that is why this is a direct repost from Insider