Third-party reproduction is a unique category of IVF (in vitro fertilization) which involves donor sperm and/or donor eggs and sometimes a surrogate, a person who carries a genetically unrelated baby for another family. The surrogate is often referred to as a “gestational carrier.” In addition to helping grow LGBTQ+ families, third-party reproduction serves as a high-success option for couples and individuals at the end of a long road of unsuccessful pregnancy attempts and fertility treatments. Third-party reproduction makes up nearly 2% of all births in the US and there are nearly 500 medical centers in the US that perform egg donation and surrogacy. Now that many insurance policies cover fertility treatment, it is more accessible than ever.
If you are having trouble conceiving, your doctor may recommend donor eggs. If you are able to conceive but are unable to carry, you may consider a gestational carrier. Or, you may need both. In many cases the causes of infertility aren’t clear. When age is a concern, it is egg quality, which actually refers to the proportion of eggs we can expect to be genetically normal, as well as ovarian reserve, which determines success – not the age of your uterus. That is why egg donation is so effective. A real medical reason is also required for surrogacy. It is never just a preference to “outsource” pregnancy.
If you’re considering third-party reproduction to start or grow your family, here’s what you should know about your options:
There are a number of sources for finding egg donors: the most common nowadays are frozen egg banks. The industry trend is to use banked frozen eggs to keep the costs down: the donor is paid relatively modestly, and the eggs retrieved are frozen in batches so that more than one recipient can be served by a single retrieval (each retrieval can yield 12-25 eggs, on average). Your local IVF clinic probably has an arrangement with one of the major frozen egg banks, so you would likely begin with a reference from your doctor. Your clinic may also have a selection of donors for fresh cycles. This means that as soon as the eggs are retrieved, they are fertilized with the recipients’ sperm (rather than thawing frozen eggs and then fertilizing them). You would typically share a retrieval with another recipient in an effort to pool resources and reduce costs. The success rates for fresh are generally higher, although frozen is less expensive and the process is faster.
Most frozen egg banks and clinics only offer mutually anonymous arrangements: you may see baby photos or current photos of donors, but you would not know the donor’s identity. For those who want more selection of candidates and flexibility, there are independent egg donor programs, such as ours at The Northeast Assisted Fertility Group. [Other less common arrangements are having a friend or relative serve as an egg donor, or using a donated frozen embryo. These make up a very small fraction of egg donor babies in the US, but are probably the least expensive route.] The cost for a batch of frozen eggs is about $10,000-15,000. Private agencies are more expensive but offer a greater selection, no requirement to share the eggs with other recipients, and an opportunity for less strict anonymity. The medical costs are separate and can be around $15,000-20,000.
Ordinarily, you receive a donor’s general biography and family medical history, but you have no direct contact with them: this is an “anonymous” egg donation. However, anonymity falls on a spectrum, from just seeing photos to actually meeting your donor in person (at these meetings, full names do not have to be exchanged). Some recipients want their children to have to chance to reach out to their donors in the future should they choose to: messages can be exchanged through a separate intermediary if the donor wants to maintain their privacy. Some donors are more open than others, and it is more generally accepted today for parents to want to share the information with their children. There are a number of support resources available for navigating this experience.
At first, the search for an egg donor can seem clinical and transactional, as you sift through catalogs of donor profiles. Eventually, most people I work with warm up to the process as they connect with a special candidate, the sting of disappointment fading as hope for a family is renewed.
If the issue is the inability to carry a baby to term, a gestational carrier is essential. The embryo (from your genetic material or a donor) would be transferred to the carrier’s uterus. Unless you have a friend or relative serve as your surrogate, you will need to engage a reputable program such as The Northeast Assisted Fertility Group to find one for you. An agency will vet the surrogate fully: reviewing their past prenatal and birth records making sure there were no complications, investigating their living conditions and support systems, etc. All surrogates are rigorously screened to ensure they are physically and mentally fit for the process. Many do not qualify. [It is not recommended to find a carrier through personal ads or message boards, which could prove unreliable.] An agency would present a carrier biography to you, and the surrogate would see your biography at the same time because a mutual match between both parties is necessary.
The surrogate’s medical screening and embryo transfer would take place at your clinic. All monitoring, prenatal care, and delivery would be with the surrogate’s own doctor in their hometown. The level of communication and involvement with your carrier during the pregnancy is decided upon mutually. In our experience, surrogate births are exceptionally joyful and emotional.
The process is expensive, no way around it: the surrogate would get a base fee paid in stages along the way of about $35,000-50,000. All of their travel, medical expenses, insurance, legal fees, and incidentals add up to another $40,000-80,000. You cannot use your own insurance to pay for their medical expenses, and typically the surrogate cannot use their own insurance to carry someone else’s baby for compensation.
Katherine Benardo is the egg donor coordinator at Takes3.com and The Northeast Assisted Fertility Group.