Elise Prehoda is a medical student in the Class of 2024 at the University of Vermont Larner College of Medicine. She is also a recent egg donor.
In the following blog post, Prehoda writes about how she initially learned about egg donation, her decision-making process when considering donation, and the things she wishes she knew about along the way.
A Class that Changed the Course of My Life
“Donor eggs are sometimes used for people who cannot produce eggs.”
This sentence altered the course of my life for several months and my understanding of infertility forever.
On a blustery mid-November morning, as I sat at my desk reviewing pre-work for an upcoming Human Development & Reproductive Health course session on “Fertility and Infertility,” the sentence jumped out from the page at me. “Donor eggs are sometimes used for people who cannot produce eggs.”
Having no prior knowledge of fertility treatments, also known as Assisted Reproductive Technology or ART, I quickly googled “egg donation” and was met with a barrage of advertisements, including:
“We pay up to $8,000!”
“Make $50,000 in one year!”
“$4,000 per donation, incentives for repeat donors!”
As a student who had recently been anxiously struggling with unanticipated medical expenses, adjusting to a loan-based budget, and earning no viable income, I quickly took a screenshot of some of the advertisements and texted my significant other, “What if I donated my eggs?” His response mirrored my shock at the compensation I had seen. We laughed, brushed the idea aside, and I focused on my upcoming exam.
The following week, I was still thinking about that sentence and the advertisements I’d seen. I found myself further reflecting on reasons why people may need or want egg donors; a diagnosis of ovarian insufficiency, a debilitating genetic condition, or couples with the inability to produce eggs. I also reflected on my relatively good health as I had just definitively reversed an eight-year-long diagnosis of gastroesophageal reflux disease (GERD). I thought about the months-long amount of time during which I would solely be studying for my first United States Medical Licensing Examination® (USMLE Step 1), largely confined to my office and figuratively tied to my desk. I thought about the cost of disproving my erroneous diagnosis and uncovering the true cause of my symptoms. I thought about the patients I might see in my future profession—those struggling with fertility, those who want to make a family but do not have the means, those waiting for months or years to find an egg donor. I thought about my lack of desire to conceive and carry a child in the future; what emotions would I grapple with if one day I woke up with that desire but was unable to?
My thought process was complex but surprisingly quick. Within weeks of that initial Google search, I applied to become a donor.
Tests, Paperwork, & More Tests
After submitting donor interest forms to multiple clinics, I was invited by just one to submit a preliminary screening form. This form covered basic information such as my age, reproductive status, and geographic location. Shortly thereafter, I was invited by the clinic to create a donor profile, which would match my name to an unidentifiable number in order to preserve anonymity. Over the next several days I filled out countless pages of paperwork detailing my own medical history, my family medical history, and basic personal information and physical characteristics, like “blue eyes, brown hair, 5’5”, stays active, enjoys nature and reading, medical student.”
For the next week, in between classes, I underwent blood tests, genetic tests, psychiatric evaluations, and more.
Almost a month after submitting my initial donor interest form, I received word that my battery of test results had arrived, and I was cleared to become a donor. The next day, I went “live” on the portal and my profile was made available for recipients to view. A day later the clinic called. A recipient had selected me as a potential donor and an appointment was scheduled for the following week to begin treatment.
On my first official day as an egg donor, I met with a registered nurse at the clinic to review the treatment regimen.
Initial treatment of an active egg donor consists of five days of oral contraceptive pills, baseline blood work, a repeat baseline ultrasound, and injection training. At my injection training, we reviewed what the course of treatment would look like. Every morning and night for 10 to 12 days I would self-administer injectable hormones and be expected to attend increasingly frequent ultrasounds to check the baseline size of my ovaries and amount, diameter, and rate of growth of my stimulated follicles. After 10 to 12 days, providing my ultrasounds showed expected results, I would receive a 36-hour notice of my scheduled surgery and retrieval at the clinic.
As I continued to read each page of information, signing my name at the bottom of each, I was met with bolded and underlined terms such as “Ovarian Hyperstimulation Syndrome (OHS)” and “ovarian torsion.” My pen hovered over the paper uncertainly as I read about these serious potential side effects of the treatment and retrieval procedure.
OHS is a condition which causes a person’s ovaries to swell in response to hormonal stimulation, causing fluid to be drawn from other areas of the body and concentrate in the lower abdomen. Ovarian torsion is a surgical emergency in which an ovary twists upon itself, cutting off its own blood supply, the risk of which increases with increasing size of an ovary, such as during egg donation.
The nurse assured me that although my baseline hormones indicated I was at a higher risk for OHS, they would be monitoring me closely for prevention. Regarding my risk for ovarian torsion, she took the opportunity to review my exercise restrictions—no high impact activity such as running, sports, jumping, or yoga after starting hormone injections and until after retrieval. Walking would be okay, but snowshoeing was dangerous due to the risk of falling. Initially taken aback, I assured myself that exercise would be minimal over the following weeks anyway, due to studying for the Step 1 exam.
I signed and we moved on.
My training and intake complete, I left for home.
The next morning I gave myself my first injection.
The Next 12 Days
Every morning for the next 12 days, I awoke and started my new daily routine. Rather than my usual wake up, feed cats, make coffee, study, my routine became wake up, feed cats, make coffee, give injection, study.
The morning injection was a drug called Menopur, which is a combination of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), the daily administration of which provides a signal to the ovaries to begin producing eggs. To inject, I first had to prep the medication by drawing up a small amount of saline into a syringe and inject it into a vial that contained the Menopur in powder form. After the powder dissolved, I drew the medication back up into the syringe. Using an alcohol swab, I sanitized a small section of skin around my abdomen and let it dry. Then, while pinching about an inch of skin between my fingers I inserted the needle at a 45-degree angle and injected the medication, carefully discarding the needle and syringe into the provided sharps container afterwards. The entire process took about 10-15 minutes each morning.
Then I would attend class.
At night after a long day of studying and exactly 12 hours after my morning injection, I repeated the process. The nightly injection was a drug called Gonal-F, which is essentially an additional dose of FSH, causing the ovaries to produce and sustain multiple eggs rather than the standard one. The clinic provided me a calendar to track my appointments and injections, and after each injection I crossed off the reminder on my calendar to prevent any errors.
After a week of twice daily injections, I returned for a follow-up ultrasound. During this ultrasound, my stimulated follicles were measured and the ultrasound tech beamed with pride and enthusiasm as she noted that I would likely start coming in more frequently for closer evaluation. Impressed with my own perceived success, I returned home with a sense of satisfaction and prepared for increased frequency of check-ins.
I mention “perceived” success a lot because I often questioned the accolades and congratulations I received simply for my body responding as expected to the medications I was administering. What would it mean if I did not respond well to them? Would I be considered a failure or a letdown? What does that mean for the individuals I am donating to; would they also be considered failures for the inability to produce eggs? Unsettled by these thoughts but unable to pay them the attention they deserved, I ultimately chose to see such congratulations through a positive lens and allow myself to be propelled forward rather than hindered by them on my journey.
After what seemed like weeks (but in reality, only 12 days), I was finally given the go-ahead to prepare for surgery by administering my “induction” medication, Leuprolide. The purpose of this medication is to suppress ovulation in order to create a window during which retrieval can occur. By the day of my retrieval, I was moody, irritable, bloated, and eight pounds heavier, but thrilled again at my success for having finally reached this day. After a brief meeting with the attending physician, nurse, and anesthesiologist, I was brought back to the surgical suite and the retrieval occurred.
Recovery: Physically, Emotionally, & Mentally
After waking from anesthesia, I was subdued but ecstatic. I was promptly greeted with my much-anticipated check, and an entirely unanticipated gift from the recipient which included a note that meant the world to me. Our first and only communication throughout the entire process, their words of gratitude quieted every voice of doubt and bitterness that I had experienced over the prior two weeks.
Returning home, I was wholly unprepared for the debilitating cramping and pain, the continued swelling, the persistent moodiness, and the overwhelming fatigue that I experienced over the following few days. On day two of post-retrieval, I received a call from the clinic. “You were the perfect donor!” they exclaimed, explaining the number of eggs I produced and the relative ease with which my donation process went. Unwilling to tamp their excitement, I assured them that recovery was going great and I had no concerns. A week later I finally returned to my weekly co-ed recreational soccer game. Physically, I was technically healed. Emotionally, I felt self-conscious, out of shape, and unsteady on my own feet.
The next day I received another call from the clinic. “We were wondering when you would be willing to go live on the portal again,” they asked.
Reflections & What I Wish I’d Known
Throughout my experience of donation, I attempted to keep a journal; to reflect on my mental and physical well-being, to occupy myself in lieu of exercise, and to document the process I was going through. I imagined I would be able to produce some succinct, de facto statement regarding egg donation that I could herald to all those interested in donating. The result of my journaling could not have been further from that goal.
What I came to realize were the following personal truths:
Even now as I write this blog post in the setting of an overturned Roe v. Wade, I cannot help but consider the privilege that comes with my ability to donate eggs – the privilege to live in a state where reproductive rights are protected; the privilege to possess features sought out by recipient parents, leading them to quickly select me as a donor; and most notably, the privilege to obtain an egg donor with features like mine should that be a path I choose or require later in life.
As a staunch advocate for gender equity and intersectional feminism, when discussing reproductive rights I often focus on the right of individuals not to reproduce – the right to consent; the right to contraception; the right to a safe abortion; the right to adequate sex education. Rarely, however, have I focused on the right of individuals to reproduce, a subject that receives an overwhelming lack of attention.
The right of reproduction receives so little attention, in fact, that other than personal stories and anecdotal evidence, there is no real data in the United States to offer an accurate picture of egg donor race or ethnicity. Though US data is lacking, a study conducted by the Human Fertility and Embryology Authority in the United Kingdom revealed that just 2.3% of egg donors in the UK in 2017 identified as Black. Even now, with the overturning of Roe v. Wade, not only is the right not to reproduce being dramatically infringed upon, but the right to reproduce is being threatened as well – putting both donors and recipients of eggs at risk. To BIPOC individuals in this country, however, this assault on their reproductive freedoms is no novel occurrence, but the latest in a centuries old onslaught.
Despite the many systems of support I had, I was entirely unprepared for the feelings of isolation that came with egg donation. Whether it was someone praising me for my generosity or someone congratulating me on the sum of money I would earn, no dialogue around my experience felt right. When receiving praise I felt almost hypocritical; the first thing that caught my eye about donation was the financial compensation – I don’t deserve any praise for my actions. When receiving congratulations for the financial compensation, I felt belittled; I’m doing this for so much more than money – they just don’t get it. Other reactions to my donation process included shock, concern for my health and well-being, and more; even the rare, confusing, and hurtful “so you’re basically going to be a parent?” comment. I was ill-equipped with the resources and time necessary to adequately respond to each of these sentiments. Unwilling to quell the shock at my decision, unable to satisfy concerns about my well-being, and uninterested in even beginning to delve into a discussion on how far from parenthood this process made me feel, I chose not to discuss. Whether the feelings of isolation were worse when talking about it or when keeping to myself I cannot say, but I never expected that in contributing to bringing another life into this world I would feel so completely alone.
Throughout this experience I came to realize that while compensation may have originally caught my eye months earlier, it was certainly not enough to keep me invested in the process. After the bloating, mood changes, and countless injections, the only thing that truly kept me dedicated to continuation of the process was the thought that a recipient was relying on me to help them create a family. That was enough to motivate me through and ultimately is the only reason I would consider donating again.
Something I have yet to discuss in this detailed sharing of my experience is how my journey impacted my identity as a medical student. Remarkably, my field of interest in medicine was wholly unaffected by the entirety of the process. That said, I did learn more about the type of physician I want to be; one who does not make assumptions about a patient’s wants and desires, one who ensures patient comfort from the first seconds of interaction, and one who encourages patient transparency through modeling it in themselves. Outside of my identity of a medical student, I learned more about myself, my wants, and my needs through this experience than I ever thought I would. I was able to institute changes and safeguards to protect my mental health that I never thought of before, and for the first time in a long time was able to prioritize myself and my needs with what I felt to be an “acceptable” justification. I learned that my predilections around maternity, childbearing, and the meaning of family, are not set in stone but malleable ideologies that change with each new experience. I learned more about my resilience, compassion, and motivation, and started to discover myself along the way.