By Anna Harvey
It’s summer, so I only have one layer of clothing to push aside to pinch a chunk of skin on my stomach, and choose a spot to inject myself for the first time. But I’m not a newly diagnosed diabetic; nor am I injecting hormones to prime my body to carry a much-wanted child. In fact, once the medication has stimulated my body to produce enough eggs, they’ll be used to give a family I do not know the chance to have a child. I am an altruistic egg donor. I am also a medical student, at the end of my fifth year of study.
Altruistic egg donation is the process of donating healthy ovum cells to be used by other people who, for various reasons, cannot use their own eggs for conception. This might include same-sex couples; people who have undergone premature ovarian failure, perhaps due to chemotherapy or genetics; and single people.
In the UK, the process is regulated by the Human Embryo and Fertility Authority (HFEA), who ensure that clinics adhere to several pieces of legislation, notably the Human Fertility and Embryology Acts of 1990 and 2008. It is illegal to ‘pay’ an egg donor and ‘expenses’ (for travel and time off work during treatment and retrieval) are limited to £750 per donation cycle.
Some women donate eggs specifically to a friend or family member in a controlled cycle; others, like myself, donate to egg banks, where potential parents can access demographic information about the donor before they select their donor eggs.
Deciding to donate
I can’t pinpoint the exact moment I learnt about altruistic egg donation, though it may well have been during my second year of medical school, where we studied embryology, the lecturer flicking through slide after slide of backlit whorls and dimples that we were expected to somehow connect with the anatomy of the people around us.
A few years later, I encountered the egg bank I would eventually donate with at a Freshers Fair, handing out glitter keyrings shaped like sperm to delighted university students. The fact that the clinic was directly opposite the campus where I spent most of my pre-clinical studies kept the idea of egg donation alive each time I walked past.
My medical studies certainly made me more connected to my place in society and the way my behaviour might affect others in it. I first signed up to donate blood, and added my details to the bone marrow donation register. But egg donation was a bigger commitment, I knew, though I wasn’t sure of the specifics. It remained at the back of my mind as I moved into clinical rotations, which culminated in a placement in obstetrics and gynaecology. The experience of caring for patients during birth led to a feeling that donating eggs, and allowing families to experience these precious moments of their own, was something I could – and should – do.
The donation process
Having made my decision, I booked an appointment for an initial consultation with a ‘fertility officer,’ who shyly confessed to me that I was her first ever solo patient, having just finished her training. She explained that I would be screened for various infections and genetic diseases, as well as some fertility markers to assess my suitability for donation. The idea of having a fertility and genetic ‘MOT’ in the process was appealing. I was also given the details for a counselling service provided by the egg bank that could be utilised at any point during the process, in person or on the phone.
The fertility officer also explained that egg or sperm donors may be contacted by any donor-conceived children, who have the option to receive identifying information about the donor on their 18th birthday.
Peer support networks
I passed the blood tests and other screening processes, and on the first day of my next cycle I visited the clinic to receive my first injection pen and sharps box.
As a donor, I embodied a strange twilight of half-patient-hood. I was not ill. In fact, I was the very opposite, screened for markers in my blood, urine and genes that would prevent me from donating. And yet, I was injecting myself once or twice per day, and visiting a doctor twice per week – all things that are traditionally reserved for the unwell. (And I was fortunate to be free from side effects – even the bloating that I had been warned to expect.)
It reminded me of the duality of my position as a medical student – not quite fitting into either world; still green enough to balk at some of the procedures observed in hospitals, but removed, in some ways, from friends working in jobs that allowed them to leave their work behind at the end of the day. It felt like a privilege to peek behind the curtain and interact with healthcare as a patient, albeit without the frustrations of underfunded NHS services, and of course, without the symptoms that precede a person becoming a patient in the traditional sense of the word.
I was given the option to write a letter to any children conceived from my genetic material and to provide a longer physical and personality description than the discrete terms collected by the forms I filled in alongside the fertility officer.
Writing the letter and personal description was one of the more challenging aspects of the donation preparation process – much more so than the blood tests, scans and counselling needed to assess my suitability as a donor. What do you write to someone who you’re not sure will be born? How do you describe yourself on a page of A4? What do you include, and what do you mindfully miss out? It felt too personal to talk to friends and family about – indeed, I had kept the circle of people who knew I was donating relatively small.
Whilst the counselling offered by the clinic was useful, what I was really looking for was advice from a community – from people who might have experienced these feelings before. I turned, of course, to the internet – but found very few testimonials, anonymous or otherwise, from women like myself. In fact, it was only during research for this piece that I came across communities like We Are Egg Donors, buried in the seventh page of Google search results. Like many similar websites, this group is mainly focused on the experiences of egg donors in countries like the United States, where the process is less well-regulated and donors can command large sums of money, adding a transactional dimension to the experience that is less of an issue here in the UK.
It was strange, to me, so used to being able to Google almost anything and instantly be inundated with information, to find such a drought. I found myself, inexplicably, turning my phone onto private mode in order to creep through internet IVF forums, trying to glean experiences and find community. But these interactions were often tinged with the sadness and quiet hopefulness that surrounds discussions of infertility. Here I was an imposter, even fertile enough to give some away.
In my searching, I also encountered articles pushing back against the positive reasons that had informed my decision to donate. Some of these centred on the lack of evidence for the long term health effects of the egg donation process; others branded the reproductive labour of surrogacy and egg donation anti-feminist. Whilst I respect the right of the authors to hold these opinions, particularly those who wrote their own testimonies of how their health had been damaged by unregulated donation cycles, I was sad to find so many negative voices about a decision that I had put great thought into, and had felt so strongly was positive.
Future efforts
The HEFA estimates that each year around 2000 children in the UK are born with the help of an egg or sperm donor. Interestingly, whilst the HEFA does collect data on the number of newly registered egg donors each year, it’s difficult to know exactly how many women undergo the donation process independently of subsequent IVF. Egg donors are a small but important group within assisted reproduction services, but community support for donors in the UK is difficult to find. As a community egg donors have unique experiences and emotions to process, and whilst it is laudable that most clinics provide counselling services, formal peer support networks would also be a useful intervention in ensuring egg donors have access to the information they need.
As I write I am hopeful that this blog might add a helpful voice to the body of online content by and for those going through the donation process. I also find myself looking forward to a second donation cycle in the near future.
Anna Harvey is a medical student at GKT School of Medicine and the BMJ’s Editorial Scholar. She tweets: @a_c_harvey
Check out our recent blog by medical student Georgia Scott: New Developments in Assisted Reproduction