egg donation egg donation egg donation is the process by which a woman donates eggs to enable another woman to conceive as part of an assisted reproduction treatment or for biomedical research. for assisted reproduction purposes, egg donation typically involves in vitro fertilization technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use. egg donation is a third party reproduction as part of assisted reproductive technology. egg donationmeshd018587 in the united states, the american society for reproductive medicine has issued guidelines for these procedures, and the food and drug administration has a number of guidelines as well. there are boards in countries outside of the us which have the same regulations. however, egg donation agencies in the u.s. can choose whether to abide by the society's regulations or not. history the first child born from egg donation was reported in australia in 1983. in july 1983, a clinic in southern california reported a pregnancy using egg donation, which led to the birth of the first american child born from egg donation on 3 february 1984. this procedure was performed at the harbor ucla medical center and the university of california at los angeles school of medicine. in the procedure, which is no longer used today, a fertilized egg that was just beginning to develop was transferred from one woman in whom it had been conceived by artificial insemination to another woman who gave birth to the infant 38 weeks later. the sperm used in the artificial insemination came from the husband of the woman who bore the baby. before this development, thousands of infertile women, single men and same-sex male couples had adoption as the only path to parenthood. the donation of human oocytes and embryos has since become a common practice similar to other donations such as blood and major organ donations. the practice of egg donation has sparked media attention and public debate, and has had a substantial impact on the field of reproductive medicine. this scientific breakthrough changed the possibilities for those who were unable to have children due to female infertility and for those at high risk for passing on hereditary disorders. as ivf developed, the procedures used in egg donation developed in parallel: the egg donor's eggs are now harvested from her ovaries in an outpatient surgical procedure and fertilized in the laboratory, the same procedure used on ivf patients. the resulting embryo or embryos are then transferred into the intended mother instead of into the woman who provided the egg. donor oocytes thus give women a mechanism to become pregnant and give birth to a child that will be their biological child, but not their genetic child. in cases where the recipient's womb is absent or unable to carry a pregnancy, or in cases involving gay male couples, the embryos are implanted into a gestational surrogate, who carries the embryo to term, per an agreement with the future parents. the combination of egg donation and surrogacy has enabled gay men, including singer elton john and his partner, to have biological children. oocyte and embryo donation now account for approximately 18% of in vitro fertilization recorded births in the us. this work established the technical foundation and legal-ethical framework surrounding the clinical use of human oocyte and embryo donation, a mainstream clinical practice, which has evolved over the past 25 years. since the initial birth announcement in 1984, there have been well over 47,000 live births resulting from donor oocyte embryo transfer recorded by the centers for disease control (cdc) in the united states to infertile women, who would not have been able to have children by any other existing method. the legal status and cost/compensation models of egg donation vary significantly by country. it may be totally illegal (e.g., italy, germany, austria); legal only if anonymous and gratuitous—that is, without any compensation for the egg donor (e.g., france); legal only if non-anonymous and gratuitous (e.g., canada); legal only if anonymous, but egg donors may be compensated (the compensation is often described as being to offset her inconvenience and expenses) (e.g., spain, czech republic, south africa, greece); legal only if non-anonymous, but egg donors may be compensated (e.g., the uk); or legal whether or not it is anonymous, and egg donors may be compensated (e.g., the us). indication a need for egg donation may arise for a number of reasons. infertile couples may resort to egg donation when the female partner cannot have genetic children because her own eggs cannot generate a viable pregnancy, or because they could generate a viable pregnancy but the chances are so low that it is not advisable or financially feasible to do ivf with her own eggs. this situation is often, but not always based on advanced reproductive age. it can also be due to early onset of menopause, which can occur as early as their 20s. in addition, some women are born without ovaries, while some women's reproductive organs have been damaged or surgically removed due to disease or other circumstances. another indication would be a genetic disorder on part of the woman that either renders her infertile or would be dangerous for any offspring, problems that can be circumvented by using eggs from another woman. many women have none of these issues, but continue to be unsuccessful using their own eggs—in other words, they have undiagnosed infertility—and thus turn to donor eggs or donor embryos. as stated above, egg donation is also helpful for gay male couples using surrogacy (see lgbt parenting). congenital absence of eggs turner syndrome gonadal dysgenesis acquired reduced egg quantity / quality oophorectomy premature menopause chemotherapy radiation therapy autoimmunity advanced maternal age compromised ovarian reserve other diseases of x-sex linkage repetitive fertilization or pregnancy failure ovaries inaccessible for egg retrieval types of donors donors includes the following types: donors unrelated to the recipients who do it for altruistic and/or monetary reasons. in the us they are anonymous donors or semi-anonymous donors recruited by egg donor agencies or ivf clinics. such donors may also be non-anonymous donors, i.e., they may exchange identifying and contact information with the recipients. in most countries other than the us and uk, the law requires such donors to remain anonymous. us donors are often recruited by agencies who act as intermediaries, typical with promises of money and altruistic rewards. designated donors, e.g. a friend or relative brought by the patients to serve as a donor specifically to help them. in sweden and france, couples who can bring such a donor still get another person as a donor, but instead get advanced on the waiting list for the procedure, and that donor rather becomes a "cross donor". in other words, the couple brings a designated donor, she donates anonymously to another couple, and the couple that brought her receives eggs from another anonymous donor much more quickly than they would have if they had not been able to provide a designated donor. patients taking part in shared oocyte programmes. women who go through in vitro fertilization may be willing to donate unused eggs to such a program, where the egg recipients together help paying the cost of the in vitro fertilisation (ivf) procedure. it is very cost-effective compared to other alternatives. the pregnancy rate with use of shared oocytes is similar to that with altruistic donors. procedure after being recruited and screened, an egg donor must give informed consent before participating in the ivf process. once the egg donor is recruited, she undergoes ivf stimulation therapy, followed by the egg retrieval procedure. after retrieval, the ova are fertilized by the sperm of the male partner (or sperm donor) in the laboratory, and, after several days, the best resulting embryo(s) is/are placed in the uterus of the recipient, whose uterine lining has been appropriately prepared for embryo transfer beforehand. if a large number of viable embryos are generated, they can be cryopreserved for future implantation attempts. the recipient is usually, but not always, the person who requested the service and then will carry and deliver the pregnancy and keep the baby. the egg donor's process in detail before any intensive medical, psychological, or genetic testing is done on a donor, they must first be chosen by a recipient from the profiles on agency or clinic databases (or, in countries where donors are required to remain anonymous, they are chosen by the recipient's doctor based on their physical and temperamental resemblance to the recipient woman). this is due to the fact that all of the mentioned examinations are expensive and the agencies must first confirm that a match is possible or guaranteed before investing in the process. each egg donor is first referred to a psychologist who will evaluate if she is mentally prepared to undertake and complete the donation process. these evaluations are necessary to ensure that the donor is fully prepared and capable of completing the donation cycle safely and successfully. the donor is then required to undergo a thorough medical examination, including a pelvic exam, a blood test to evaluate hormone levels(notably anti-müllerian hormone), infection risk, rh factor, blood type, and drug use, and an ultrasound to examine her ovaries, uterus and other pelvic organs. a family history of approximately the past three generations is also required, meaning that adoptees are usually not accepted because of the lack of past health knowledge. genetic testing is also usually done on donors to ensure that they do not carry mutations (e.g., cystic fibrosis) that could harm the resulting children; however, not all clinics automatically perform such testing and thus recipients must clarify with their clinics whether such testing will be done. once the screening is complete and a legal contract signed, the donor will begin the donation cycle, which typically takes between three and six weeks. an egg retrieval procedure comprises both the egg donor's cycle and the recipient's cycle. birth control pills are administered during the first few weeks of the egg donation process to synchronize the donor's cycle with the recipient's, followed by a series of injections which halt the normal functioning of the donor's ovaries. these injections may be self-administered on a daily basis for a period of one to three weeks. next, follicle-stimulating hormones (fsh) are given to the donor to stimulate egg production and increases the number of mature eggs produced by the ovaries. throughout the cycle the donor is monitored often by a physician using blood tests and ultrasound exams to determine the donor's reaction to the hormones and the progress of follicle growth. once the doctor decides the follicles are mature, they will establish the date and time for the egg retrieval procedure. approximately 36 hours before retrieval, the donor must administer one last injection of hcg hormone to ensure that her eggs are ready to be harvested. this hormone will produce a lh hormone concentration peak and induce follicular development. the oocytes are then retrieved from developed follicles via ovarian punction. this extraction must occur before ovulation, as oocytes are too small to be identified once they leave the follicle, and if the appropriate time window is missed the donation cycle will need to be repeated. the egg retrieval itself is a minimally invasive surgical procedure lasting 20–30 minutes, performed under sedation by an anesthetist, to ensure the donor is kept completely pain free. egg donors may also be advised to take a pain-relieving medicine one hour before egg collection, to ensure minimum discomfort after the procedure. a small ultrasound-guided needle is inserted through the vagina to aspirate the follicles in both ovaries, which extracts the eggs. after resting in a recovery room for an hour or two, the donor is released. most donors resume regular activities by the next day. results in the united states, egg donor cycles have a success rate of over 60%. (see statistics at http://www.sart.org.) when a "fresh cycle" is followed by a "frozen cycle", the success rate with donor eggs is approximately 80%. with egg donation, women who are past their reproductive years or menopause can still become pregnant. adriana iliescu held the record as the oldest woman to give birth using ivf and donated egg, when she gave birth in 2004 at the age of 66, a record passed in 2006. according to