FERTILITY ROAD ARTICLE
Donor Egg and Surrogacy in the USA
Craig Reisser, who had the help of an egg donor and a surrogate when starting his family, helps explain some fundamentals about egg donation and surrogacy in the USA.
I recall the first time I heard the phrase ‘Third Party Reproduction’ when I was starting my own family with the help of an egg donor and a gestational surrogate. For a long while it didn’t quite register, but of course now it makes sense. Simply put you need three things to make a baby: sperm, egg and a uterus. If you are a single intended parent or a same sex intended parent couple, you are clearly missing one or more of these and you need the help of one or more ‘third parties’ to start a family. Heterosexual intended parent couples may similarly also need ‘third party’ help to complete the picture.
This is where sperm donors, egg donors and gestational surrogates (or traditional surrogates in cases where the woman acting as a surrogate is also the egg donor) can help these intended parents start their families.
Every country has their own rules about what is permissible and who can access the different forms of third party reproduction. In some countries like Japan no third-party reproduction is allowed. In many countries, like Germany for instance, only sperm donation is permissible, and in a smaller number of countries, like Spain for example, both sperm and egg donation are possible. In a very small number of countries worldwide, like the UK, USA and Canada for instance, are all three forms of third party reproduction, is available. Even among countries where some or all of third party reproduction treatments are possible, the frequency and availability of these procedures; the number of donors and surrogates; which types of intended parents can access treatment; and the applicable rules and legal protections in place for the parties involved can have important variations.
The USA is the world leader in third party reproduction – particularly donor egg and surrogacy – in terms of the greatest availability of treatments for the full spectrum of intended parents – single individuals, female and male same-sex couples, and heterosexual couples – and for all regardless of their legal relationship status. It also has the largest pools of sperm and egg donors as well as surrogates. In the USA there are tens of thousands of sperm and egg donors active at any one time and several thousands of surrogacy IVF cycles, with and without donor gametes, are completed every year. One estimate is that egg or embryo donation now account for nearly 20% of all IVF births in the USA.
Because of this, the USA is one of, if not the largest, destination for intended parents travelling abroad for these treatments. Because of the greater availability of donor sperm options elsewhere and generally speaking the ease of shipping frozen sperm from a sperm bank in one part of the world to another, most intended parents travelling abroad for third party reproduction tend to be those using donor eggs, or surrogacy or both as these are globally the most restricted treatments. Intended parents considering the USA as a destination for treatment are faced with a vast number of options and providers, which can feel a bit overwhelming at first for many. Knowing a few fundamentals can help.
For intended parents in need of an egg donor in the USA, unless you are going to locate an egg donor on your own without the help of a professional intermediary, there are two basic places to find and be matched with an egg donor. Intended parents will almost always find their egg donor through an IVF clinic operated program or through one of the hundred or more non-clinic egg donor agencies.
IVF Clinic Egg Donor Programs are run by many but not all IVF clinics in the USA. Programs may vary in the number of egg donors, but features that are common include: donors are recruited from the local vicinity so there is generally less travel required; the available donors typically reflects the local demographic and ethnic mix local area; donors are fully screened and medically approved; and because the donors have been to the IVF clinic for testing they are known in-person by the clinic’s donor team. For many intended parents finding a donor through their clinic’s program can be a faster and less costly process.
Non-Clinic Egg Donor Agencies differ from clinic-run programs in a few important ways. They tend to recruit donors over a wider geographic area, and in many cases, nationwide. This means there is a greater chance that a donor will have to travel to your IVF clinic for treatment; however, these programs may offer more diversity when it comes to donor demographics and some agencies specialise in donors of specific ethnicities or backgrounds. Non-clinic programs do not carry out medical screening and in many cases, have not met donors in-person, so intended parents selecting a donor from one of these programs still needs to have her medically approved by their IVF physician. Finding a donor in a non-clinic program may tend to be more costly and carry some risk that a donor is not medically approved, but intended parents may have a wider choice as overall there are more donors in the USA registered with non-clinic egg donor agencies than with clinic-run programs.
Two important factors that distinguish egg donation in the USA compared to any other country are the degree to which intended parents are empowered to make the choices right for their them and their family, and cost.
Choice is a key feature for intended parents using egg donation in the USA. Depending on the program they work with to find their donor, intended parents can receive a significant amount of detail about their donor, including: adult and childhood photos, video interviews, physical and personal characteristics, education, personal and immediate family medical information, fertility screening, genetic screening, and reasons for donating. In addition in the USA the full range of contact options is possible from fully anonymous to fully known to somewhere in-between; this is something for the intended parents and donor to determine.
Egg Donor Compensation in the USA has no fixed or legal limit. The typical range is between $6,000 – 10,000 per donation. First time donor compensation will start at the lower end and it is standard for repeat donors to receive incrementally higher compensation. Donors of particular backgrounds are able to require higher compensation levels. Different agencies and clinic-run programs may set limits on donor compensation in their programs. Depending on the agency or clinic-run program, intended parents may need to pay agency or other screening fees. Though more costly in other countries, this does mean that donors should be well screened, which should contribute to positive outcomes.
When it comes to surrogacy in the USA, there are some 150 surrogacy agencies that recruit, screen and match surrogates with intended parents and that help manage what is a lengthy and involved process. Some intended parents seek to ‘do it themselves’ without the help of an agency, but this is a significant undertaking with many potential complications.
A Patchwork of Rules is the best way to describe surrogacy in the USA as there is no national legislation. The relevant rules regarding the legality of surrogacy; the enforceability of a surrogacy agreement; and the rules and procedures relating to parental rights are established on a state-by-state basis. So 50 states in the USA mean there are 50 sets of rules. As a result a surrogacy map the USA looks like a set of traffic lights – some states are green and are legally the most favourable states; a few states are red and prohibit surrogacy; and the remaining states are amber meaning that they are situation specific surrogacy-friendly states.
In addition, policies regarding health insurance coverage are largely determined on a state-by-state basis and this can impact the cost of a surrogacy journey for intended parents. Importantly though it receives less attention is the fact that rules regarding termination of a pregnancy or selective reduction, should intended parents be faced with this difficult decision, are also determined on a state-by-state basis.
The one common feature regardless of the state is that any baby born in the USA is a US citizen and entitled to a US passport. For many international intended parents pursuing surrogacy in the USA, this means that post-birth once they obtain a US passport for their baby, which is a straightforward and quick process, they can return to their home countries.
Surrogacy Agencies come in a few basic forms in the USA – big, medium and small. Some of the biggest agencies have been helping intended parents for 20 years or more – at least one for over 35 years. Many agencies grew out of law firms. Many have been started by former surrogates or by people that were themselves intended parents that used surrogacy to build their families. Surrogacy agencies, as well as egg donor agencies, tend be clustered in certain areas of the USA. Southern California has the largest concentration and the state of Oregon has the second highest number.
Some agencies have a local or regional focus for recruiting their surrogates, whereas others recruit surrogates from across the USA in all surrogacy-friendly states. Agencies will have different fee structures, service levels, approach to screening surrogates, waiting time to be matched with a surrogate and experience working with international intended parents. Given the large choice of surrogacy agencies, intended parents have the ability to find one that best meets their needs.
Cost is a very important factor for intended parents requiring surrogacy. The USA is for sure the most costly of any jurisdiction where surrogacy is possible, but on the other hand it is considered the safest in all respects, is well-established and has all the necessary infrastructure in place for success. The compensation for a surrogate, surrogacy agency fees, legal fees, maternity and new born medical costs for an uncomplicated singleton pregnancy are likely be at least $75,000 – 85,000. The cost of IVF treatment, an egg donor if one is required, and travel for the intended parents will be in addition to this amount.
Compensation for surrogates in the USA has been increasing in the last few years with some states like California, which is well known as being in the forefront of surrogacy, seeing the greatest increases. So intended parents may wish to consider surrogates that are located in other surrogacy friendly-states when considering surrogacy in the USA.