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declare upon hearing a couple has had a miscarriage. Or you may say to yourselves, “Maybe we were not meant to be parents.” Both are examples of what we call “the curse of the meant to be.” How cruel is it to declare that someone who deeply desires a child is not “meant to be” a parent?

      On the other hand, there is a blessing of the “meant to be.” The blessing comes when things unfold in an unexpected way and the outcome, although not the one originally intended, is a good one. You have twins through donor eggs. They are wonderful. It was meant to be. You adopt a little girl from China. She captivates you and you are certain it was meant to be.

      The Chinese believe that there is a tiny, not quite visible, red thread that connects people who belong together. The blessing of the “meant to be” and a belief in “the red thread” offer comfort.

      Some other things you should know about this book

      Our readers

      Although we would be delighted to hear that this book was helpful to a range of readers, we have written it with certain populations in mind. We assume that most of our readers will be women who have learned, for various reasons, that they are unable to become pregnant using their own eggs. We hope that their husbands or partners will also read this book and, perhaps, that they will share it will family members, especially if the family is involved in intrafamily donation.

      We are both in the US (although in different cities and regions) and, hence, much of our reference point is the US. However, we have spoken with people around the world for this book and have included their voices and perspectives within it.

      Our language

      We are aware that some people object to the use of the word donor when a woman receives payment, even if it seems clear that the payment is for her time and effort. Some would advise us to say provider rather than donor. Although we feel that there are instances in which provider is the more appropriate term, we like to believe that the majority of women who give their eggs to someone else do see it as a gift. The word donor appears to honor that gift more than does the word provider.

      On the other hand, we will not use the word disclosure. This word is often used in reference to truth telling with children. To us, the word disclosure implies a secret. Since we see no secret, we will simply say—again and again—that we feel parents need to be truthful with their children.

      Perhaps the biggest semantic challenge we faced in writing this book was figuring out how to refer to those egg donors who are neither family members nor friends. They have often been called anonymous donors, but since we have reservations about them remaining anonymous to their recipients and to the offspring, this word did not seem an apt description. Nor did we want to call them paid donors, since the fees they receive are considered compensation for time and effort, not payment for eggs. Similarly, commercial donors did not seem right. Since all donors enter into contracts, the term contractual donors didn’t work, either. Finally, we decided that the clearest term to distinguish between those donors who were friends or family members of their recipients beforehand and those who did not know their recipients beforehand was to refer to the way in which they were located and matched with a recipient—by being recruited by a medical practice or agency program. We will refer to them as program-recruited donors.

      Often you will hear the technical words oocytes, ova and ovum referring to human eggs. While these are the correct words medically, we have chosen to use the colloquial egg in this edition and to always refer to the process as egg donation.

      We refer to the process by which an embryo that originates in one family is transferred to another as embryo placement, as opposed to embryo donation or embryo adoption.

      Finally, rather than using the cumbersome “he or she” and “his or her,” we have, in most cases, referred to the child born through egg donation as “he.” This has also helped to clarify meaning when we refer, in the same sentence, to the mother or egg donor as “she.”

      This book is meant to be both challenging and supportive. We hope you will enjoy it and find it helpful.

      – 2 –

An Overview of Egg Donation

      Egg donation is changing the way we think about family building. Now that gestational and genetic motherhood can be separated, young women born without ovaries can carry, deliver and parent children conceived with another woman’s eggs. Women who survive cancer at the expense of their fertility are able to experience pregnancy and the joy of bringing new life into the world. Women can extend their fertility beyond their biological clocks. New families are being formed, together with new definitions of kinship.

      Egg donation is still evolving, and, should you choose this path, you will be part of its early history. In this chapter we attempt to provide you with a context in which to view egg donation, past, present and future. From there we will move on to the “departure lounge of egg donation” so that you can meet your fellow travelers.

      Historical perspective

      So how did it all begin? There are published records from as early as the late 1800s of experiments conducted on women who lost their ovaries at a young age. However, it was not until the arrival of in vitro fertilization (IVF) in 1978 that physicians had a means for enabling a woman to become pregnant with another woman’s eggs. The first child conceived through egg donation was born in Australia in 1983.

      In its early years egg donation, though possible, was not readily available. The first donors were either sisters or cousins of their recipients or they were infertile women who were undergoing IVF. Since cryopreservation of embryos was not available to all, some of these women had extra eggs for which they had only two options: discard or donate to other infertile women. Another group of early egg donors were women seeking tubal ligation who were invited to donate their eggs in exchange for the cost of their procedure. Either way, donated eggs were relatively few and far between and, for the most part, came from women whose donation was based more on practicality or expediency than on an affirmative decision to help an infertile couple. The scarcity of eggs made the experience challenging for would-be recipients who had little way of knowing if and when donated eggs would become available to them. One mother of a now 23-year-old through egg donation recalls taking medications over an extended period of time to ensure her uterus was ready for implantation should a donated egg come along. She was literally “on call” for news that an egg was available. When the call came, there was no asking about who the donor was or what her genetic history revealed. The recipient was instructed to go immediately to the fertility clinic where she underwent a full laparatomy (a surgical incision in the abdominal area) and a gamete intrafallopian transfer (GIFT procedure) in which the donor’s eggs were mixed with the recipient’s husband’s sperm and placed in her tubes.

      Much has changed. Not only has IVF fully replaced GIFT as a vehicle for egg donation, but, beginning in the late 1980s, women were actively recruited for voluntary egg donation. This began in medical clinics, some of whom continue to recruit donors. However, in the United States, independent egg donor agencies rapidly replaced medical programs as the main source of donated eggs. By the late 1990s it was common to see advertisements like the following in college newspapers:

      Make a dream come true. Help a childless couple become parents. If you are under 34, healthy, a non-smoker, please consider donating some of your eggs. You will be compensated for your time and effort.

      The arrival of these programs transformed egg donation from something extremely difficult to arrange to something that, with financial/health insurance resources and access to medical treatment, can be launched with a few visits to internet websites. One need simply type in “egg donation” to be connected to agencies with names ranging from Precious Wonders to Tiny Treasures to An Angel’s Gift to Peas in a Pod and Our Fairy Godmother. At the time of writing, there are nearly 100 egg donor agencies listed on the website of the American Society for Reproductive Medicine (ASRM). Most have tantalizing websites that offer hope to infertile couples, many of whose journey to parenthood has so far been filled with only disappointment and loss. They also offer the promise of financial and emotional reward to young women who are invited to undergo ovarian stimulation and egg retrieval.

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