fertility laws

As the 2024 election in the US approaches, conversations about reproductive rights are front and center across the country. In fact, recent survey data found that 90% of American women are concerned about potential restrictions on fertility treatments. While the focus has largely been on abortion rights—especially following the overturning of Roe v. Wade—it’s important to know that other areas of reproductive healthcare, including egg donation and IVF, could also be influenced by election outcomes.

At Cofertility, we’re committed to helping intended parents navigate their family-building journey with clarity and confidence. As this election season unfolds, we’re closely monitoring how political shifts could impact donor egg IVF and the future of fertility care. In this article, we’ll walk you through what you need to know to stay prepared and informed on these important issues so you can make the best choices to protect your options for the future.

Issues facing egg donation and reproductive healthcare access

This election season, reproductive healthcare policies are under intense scrutiny, especially in states where abortion restrictions are either already in place or on the horizon. Currently, fertility treatments like egg retrieval, egg freezing, and in vitro fertilization (IVF) remain widely accessible. However, ongoing changes in reproductive health policies may introduce new questions about accessibility, oversight, and insurance coverage for these treatments. In light of these shifts, staying informed is more essential than ever, helping intended parents feel secure and prepared as they navigate their options.

Understanding state-level implications for donor egg IVF

Because reproductive healthcare policies are largely determined at the state level, intended parents considering donor eggs will find their options are heavily dependent on where they (and their donor) live. In states with robust protections for reproductive healthcare, donor egg IVF remains reliably accessible. These states often have fewer regulatory barriers and, in some cases, expanded insurance coverage for fertility treatments.

In states with more restrictive policies—like the recent Alabama Supreme Court ruling— intended parents pursuing donor egg IVF may have more hurdles to overcome. While these laws don’t typically focus on egg donation specifically, changes in how embryos are handled, fertility clinic operations, or insurance mandates could still influence the logistics or costs of care. For intended parents pursuing egg donation, IVF is an essential step in the family-building journey, whether the intended mother plans to carry the pregnancy or if you’re working with a surrogate. Understanding the nuances of state-level policies is crucial, and completing your care in a state with strong protections for reproductive healthcare can help ensure smoother access to the support and services you need.

Insurance gaps and high costs

As more people pursue fertility treatments, there’s a growing movement for broader access and better support for individuals seeking assistance with growing their families. This election season, expanding insurance coverage for fertility treatments has become a central issue, with advocates pushing for policies that make family-building more accessible and equitable.

With this momentum, there’s a growing emphasis on providing inclusive care options for all intended parents, regardless of background or location. By breaking down cost barriers, these policy changes could empower more families and underscore the fertility industry’s commitment to accessible, inclusive care.

Impact on LGBTQ+ intended parents

Access to fertility treatments isn’t consistent for everyone, and LGBTQ+ intended parents face added challenges, especially when insurance coverage is limited to heterosexual couples. This can create additional financial and logistical hurdles for LGBTQ+ families seeking to build their families through egg donation.

As the election nears, policies that shape access to fertility treatments could play an important role in ensuring that all intended parents—regardless of gender, sexual orientation, or marital status—can pursue family-building. Equal access to fertility care is essential, as restrictive policies could worsen existing disparities and further limit family-building options for LGBTQ+ individuals and couples.

Access to egg donation and donor egg IVF amid political changes

Despite the focus on reproductive healthcare access in today’s political climate, IVF remains widely accessible for intended parents across the U.S. While policy discussions around reproductive healthcare often focus on abortion, new rulings and legislative proposals about embryo handling and clinic oversight are also introducing considerations for fertility treatments like donor egg IVF. Staying informed on these shifts may be helpful, as they could indirectly impact access to egg donation in some areas.

To support consistent and secure family-building options, many fertility providers are concentrating their services in states with strong reproductive protections. Some states have even responded to these discussions by expanding insurance coverage for fertility treatments, recognizing the essential role these treatments play in supporting diverse paths to parenthood.

At Cofertility, we’re here to help you navigate these changes with confidence. Our clinic-agnostic model and partnerships in states prioritizing reproductive healthcare protections allow us to offer flexible, secure options that meet your needs, whether you’re just starting out or further along on your journey to parenthood. We’re committed to helping you make informed choices in this evolving landscape.

Key election topics to watch this season

As you move forward on your fertility journey, here are a few key areas to keep an eye on this election:

1. Healthcare policy and reproductive rights: Any shifts in reproductive rights could have downstream effects on egg donation and IVF services in some regions. Even when specific treatments aren’t directly targeted, related legislation could influence healthcare providers’ ability to offer certain services‍
2. Insurance and cost coverage: Candidates advocating for expanded insurance mandates for fertility treatments could support broader access. Understanding candidate positions on these mandates can help clarify future coverage possibilities.‍
3. State-by-state differences: With reproductive healthcare policies managed at the state level, where you (or your donor) live can influence your access to donor egg IVF. Following the election, it may be helpful to monitor your and your donor’s state legislative landscape for changes.‍
4. Access for LGBTQ+ families: Policies that define infertility and coverage eligibility could affect who qualifies for fertility treatments. For LGBTQ+ intended parents, inclusive family-building policies are an essential advocacy point

How Cofertility can support your family-building journey

Reproductive health rights are at risk in the United States. Whether it’s abortion, egg freezing, or IVF–there are policymakers who do not believe women should be able to make decisions about their own bodies. As you explore your options, understanding the broader policy landscape can help you make confident decisions about your family-building journey.

At Cofertility, we’re dedicated to supporting intended parents throughout their egg donation journey, providing resources to help you explore your options and advocating for accessible, inclusive care. To ensure stability and security, we’ve proactively partnered with facilities in states that uphold strong reproductive protections. Our clinic-agnostic model empowers you and your donor to establish care in locations where family-building policies align with your values, offering secure and flexible options no matter where you’re located."

This election, as you weigh your options, we encourage you to reflect on the policies that matter most to you. Your voice—and your vote—can help create a future where everyone has the opportunity to build the family they envision.

This article was last updated on March 1, 2024. The Alabama Supreme Court ruling is a quickly unfolding situation. Be sure to consult official news sources or legal experts for the most up-to-date information and guidance. 

On February 16th, 2024, the Alabama Supreme Court ruled that frozen embryos can be considered children under state law, a ruling that sent shockwaves through the reproductive health community and raised widespread concerns regarding its potential impact on fertility care. Several of the state’s in vitro fertilization (IVF) clinics have since paused services, and lawmakers, doctors, and patients are raising concerns about the far-ranging impacts of the ruling on healthcare and reproductive technology.

While there’s still a great degree of uncertainty, in this article, we'll delve deeper into the implications of this significant legal shift, exploring how it specifically impacts donor egg IVF procedures. Additionally, we'll explore what resources may be available to those affected by this ruling and provide insights on how you can engage in advocacy efforts to address these challenges.

What is the Alabama court case about?

The recent ruling by the Alabama Supreme Court was the result of a lawsuit filed by three couples who underwent IVF treatment at a fertility clinic in Alabama. Following successful IVF procedures that resulted in the birth of healthy babies, the couples, like many undergoing such treatments, had additional embryos preserved by the clinic which was located inside of a hospital.

However, in December 2020, a patient at the hospital gained unauthorized access to the fertility clinic's cryo-preservation unit and mishandled the frozen embryos, resulting in their destruction. This tragic incident led the plaintiffs to file lawsuits against both the fertility clinic and the hospital where it was located.

One of the lawsuits centered around the application of Alabama's Wrongful Death of a Minor Act. Initially dismissed by the trial court, which ruled that embryos in vitro did not qualify as minors under the act, the case was escalated to the Supreme Court of Alabama. The Alabama Supreme Court diverged from the trial court's stance. They asserted that the Wrongful Death of a Minor Act applied to all unborn children, regardless of their location—in utero or in vitro—at the time of the incident. By deeming the in vitro embryos as persons under the law, the court allowed the couples to proceed with their lawsuit, seeking punitive damages for what they perceived as the wrongful death of their children.

What are the implications for Alabama fertility patients?

The recent ruling by the Alabama Supreme Court does not explicitly impose any bans or restrictions on IVF procedures. However, legal experts suggest – and we’re already seeing in practice – that the decision may create confusion regarding the legality of certain aspects of IVF within Alabama.

For context, data from the Centers for Disease Control and Prevention indicates that approximately 2% of babies in the United States are conceived using assisted reproductive technology. Among the various treatments available, IVF stands out as the most commonly utilized method. IVF is a complex procedure that begins with a stimulated cycle wherein a woman undergoes hormone injections to prompt her ovaries to produce numerous eggs. These eggs are then harvested and united with sperm, giving rise to embryos that undergo incubation for development.

After a few days, the embryos undergo assessment, with only the most viable ones selected for transfer into the woman's uterus. The goal is for the transferred embryo to implant successfully, leading to a healthy pregnancy and ultimately the birth of a child. Any surplus high-quality embryos from the stimulated cycle are typically cryopreserved for potential future use. Not all harvested eggs are suitable for fertilization and not all embryos may be deemed suitable for transfer. Subpar-quality eggs, abnormally fertilized embryos, and embryos displaying poor quality are routinely discarded as part of the process.

The crux of the matter in the recent ruling lies in the classification of embryos as persons under Alabama law. This designation has already raised significant questions regarding the permissible usage and storage of embryos by fertility clinics. In essence, the interpretation of Alabama law equates the legal protection of frozen embryos to that of living children. Under this interpretation, individuals who inadvertently or intentionally destroy a frozen embryo in Alabama could potentially face severe penalties, including manslaughter or murder charges.

This ruling has the potential to significantly disrupt access to fertility care as it may introduce additional regulatory burdens in an already complex medical landscape and could potentially drive up procedural costs. Although the extreme of the financial implications remains unclear, factors such as additional storage fees and liability expenses may further contribute to the rise in expenses.

On top of existing clinics closing, the ruling might lead to a reduction in IVF providers in the state. Even if clinics reopen, fertility doctors may be hesitant to practice in or relocate to Alabama. In light of the perceived risks tied to freezing or destroying embryos within this legal framework, fertility clinics across the state are already proceeding with caution, opting to restrict their IVF services, including retrievals and cryopreservation. Consequently, patients are already finding themselves compelled to seek treatment outside of Alabama, a situation that might intensify if clinics can’t get back to operating at full capacity.

How does this affect donor egg IVF?

Egg donation itself is not in as much legal limbo as eggs are not considered fetuses under current law. However, given the end goal of fertilizing and transferring the donor eggs, the ruling of course affects the donor egg IVF process.

Donor egg IVF encompasses several stages, including egg retrieval, fertilization, and subsequent embryo transfer to the intended parent's or surrogate's uterus. This ruling may necessitate procedural changes in IVF, potentially influencing the number of embryos created and transferred per cycle. Moreover, frozen embryo transfers are commonly utilized in donor egg IVF for preimplantation genetic screening. The ruling could introduce additional regulations or restrictions on the use of frozen embryos.

Many individuals and couples pursuing donor egg IVF have already been through lengthy, challenging, and expensive fertility journeys. This is particularly true for LGBTQIA+ individuals and couples who often depend on donor egg IVF to grow their families. In short, the Alabama Supreme Court only introduces more complexity and potential hardship to a landscape that’s already fraught with challenges. Regardless of where someone is in this family-building journey, this ruling has the potential to alter their trajectory.

What resources are available to those impacted and how can I get involved?

In response to these challenges, several organizations have stepped up to support individuals and families in Alabama. 

Cofertility's storage partner, TMRW Life Sciences, is offering one year of free cryostorage for frozen eggs and embryos to patients who live in Alabama and who wish to move their embryos to TMRW’s biorepository in NYC. 

Conceive is offering a free one-month membership to Conceive Premium for anyone in Alabama. Conceive Premium provides invaluable assistance and guidance throughout your fertility journey by offering 24/7 support from fertility nurses, peer coaching, community forums, and more.

Furthermore, there are various ways individuals can get involved with advocacy efforts aimed at supporting  Alabama families and protecting IVF access across the country. You can show your support for organizations that fight to uphold reproductive rights and ensure equitable access to fertility treatments like the American Society for Reproductive Medicine (ASRM) and RESOLVE, the National Infertility Association. To stay in the loop, sign up for alerts from RESOLVE’s Advocacy Network and follow @resolveorg on Instagram.

Sharing personal stories through public channels like social media can help raise awareness and amplify the voices of those affected. You can also use easily-accessible, online forms to send a letter to Congress and encourage them to address the issue. Lastly, local support groups, such as RESOLVE peer-led support groups in Alabama, provide a supportive environment for individuals to connect with others facing similar challenges.

Cofertility’s position

We at Cofertility are deeply concerned about the recent verdict and have been monitoring the situation closely. Our team is diligently tracking developments and working with our legal and professional advisors in order to navigate any potential implications side by side with our members. We understand the importance of safeguarding the rights and interests of donors and intended parents alike.

We believe the decision to seek medical support in family planning is profoundly personal and should be guided solely by patients and their healthcare providers. We believe that access to safe and effective medical care should be available to all individuals on their journey to parenthood, regardless of their location.

As a proactive measure until the law becomes clearer, we are temporarily suspending the facilitation of retrievals in Alabama where legislative uncertainty or restrictions pose potential risks to our members. We are also actively engaging with any intended parents in Alabama to assess their specific situations and explore potential paths forward. We’re focused on providing these members of our community with comprehensive support and guidance as they navigate these challenging times. If you are a Cofertility member and have any questions, concerns, or would like to get in contact with our team to talk through the specifics of your situation and how we may be able to help, please don’t hesitate to reach out.

While donor egg IVF offers hope for individuals and couples facing infertility, as well as same-sex couples looking to have children, the significant cost associated with retrieving donor eggs can be a barrier to access for many patients. The increasing demand for donor eggs has highlighted the need to make it more accessible and affordable. 

The good news is that there are ways to lessen the financial burden. This article explores various payment options and financial solutions that can help you navigate the financial challenges of pursuing donor eggs. From financing programs and employer stipends to tax credits, Health Savings Accounts (HSA)/Flexible Spending Accounts (FSA), egg sharing, and grants, we provide a comprehensive analysis of these avenues to make donor eggs more financially attainable.

1. Financing donor eggs

Some fertility clinics offer financing programs that allow you to pay for egg donation services over time, often with little to no interest. These programs can make the cost of egg donation more manageable by breaking it down into smaller, more affordable payments. However, it's essential to understand the terms and conditions of the financing program, including any fees or penalties that may apply.

If you’ve decided you want to go the loan route, you have many options to choose from. There are general lending companies as well as companies that specialize in loans just for fertility treatments.

If you’re pursuing egg donation and are interested in working with us to find your perfect match, we've partnered with Sunfish to offer you fertility financial resources and support throughout your journey. Sunfish offers the most comprehensive marketplace of financial options for IVF, egg freezing, embryo preservations, gestational surrogacy, egg donations, and more, up to $100,000 at industry-low rates. 

Sunfish has also waived their application and membership fees for all intended parents who are working with Cofertility. To take advantage of Cofertility’s infertility loan partnership with Sunfish, click here.

2. Employer stipends and insurance coverage for donor eggs

Some employers recognize the significance of fertility treatments and offer comprehensive benefits that include coverage for donor eggs. Employer-sponsored fertility programs and stipends can significantly reduce the financial burden for individuals pursuing donor eggs. It is crucial for patients to review their insurance policies to determine the extent of coverage for fertility treatments. By understanding the benefits offered by their employers, individuals can maximize their financial resources for this reproductive option.

3. Tax credits and deductions for donor egg IVF

The tax landscape offers potential relief for individuals pursuing donor eggs. Several tax credits and deductions are available for qualifying medical expenses, including fertility treatments. 

In order for donor egg IVF to be tax-deductible in the United States, it must be deemed medically necessary. This means that the procedure must be recommended by a healthcare provider and must be performed to treat a medical condition. For example, if a woman is unable to conceive naturally due to premature ovarian failure, then donor egg IVF may be deemed medically necessary. But if two men in a same-sex relationship need an egg donor to build their family, unfortunately the IRS does not view this as tax deductible. 

Additionally, the expenses associated with donor egg IVF must be significant enough to meet the threshold for medical expense deductions. In the United States, this threshold is currently set at 7.5% of a person's adjusted gross income (AGI). This means that if your AGI is $50,000, you can only deduct medical expenses that exceed $3,750.

It's also worth noting that not all expenses associated with donor egg IVF are tax-deductible. It’s best to speak with a tax professional or financial advisor to determine your eligibility for tax-deductible donor egg IVF and to ensure that you are following all necessary procedures for claiming the deduction.

Read more in Is Egg Donation IVF Tax-Deductible?‍

4. Using health insurance for donor eggs

Across the country, 17 states (and counting!) have laws requiring insurance companies to cover or offer coverage for infertility diagnosis and treatment. 

However, the specifics of these laws vary widely from state to state, and not all necessarily mandate coverage for procedures involving donor eggs. While most laws are vague without any mention of donor eggs, a few specifically require coverage of donor eggs. Let’s look at those:

Delaware 

The DE law states that “in vitro fertilization, including IVF using donor eggs, sperm, or embryos and IVF where the embryo is transferred to a gestational carrier or surrogate must be covered”

Maine 

The ME law states that health plans must cover fertility diagnostics and treatment, without “any limitations on coverage for any fertility services based on an enrollee's use of donor gametes”. However, any nonmedical costs for using donor eggs can be excluded from coverage.

Massachusetts

The MA law requires insurance plans to cover treatment of infertility including donor egg procurement.

New Hampshire

The NH law states that health plans must provide coverage for medically necessary fertility treatment, including “treatments associated with the procurement of donor eggs.”

New Jersey

NJ law requires health plans to provide coverage for four egg retrievals per lifetime, and 

IVF using donor eggs.

Even if your state has infertility coverage laws in place, your specific health plan might not be required to comply, or may have specific qualifications (like being under age 40 or in a heterosexual partnership). Self-insured or self-funded insurance plans are exempt from state law and employers do not have to follow the state insurance laws. Some states also exempt employers under a certain size from having to provide coverage. The best way to find out is to talk to your health plan directly.

Read more in Does Health Insurance Cover Donor Eggs?

5. Using HSA/FSA accounts for donor eggs

HSA/FSA accounts present an opportunity to utilize pre-tax funds for fertility treatments, including the cost of donor eggs. Contributions made to these accounts can be used to cover eligible medical expenses. Patients should be aware of the eligibility criteria, contribution limits, and documentation requirements associated with HSA/FSA accounts to ensure compliance and maximize their use for donor eggs. It’s best to talk with a tax professional to understand which parts of donor egg IVF can be paid for using HSA/FSA.

6. Egg sharing programs

Egg sharing programs, like Cofertility, provide a more affordable and ethical egg donation experience. Instead of cash compensation, an egg donor gets to keep half of the eggs retrieved for her own future use. 

One significant advantage of the egg sharing model is that donors have a personal stake in the outcomes. When donors contribute a portion of their eggs in exchange for their own IVF treatment down the line, they are invested not only in helping intended parents but also in achieving their own fertility goals. This shared interest leads to a greater sense of commitment and dedication from the donors, potentially resulting in higher-quality eggs and improved success rates.

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing.

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.

We aim to be the best egg-sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Human-centered. We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Donor empowerment. Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud of the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Baby guarantee. We truly want to help you bring your baby home, and we will re-match you for free until that happens.
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!

Read more in Six Reasons Why Egg Sharing is a Better Egg Donation Model for Intended Parents

7. Grants and financial assistance programs

Grants and financial assistance programs specifically designed for fertility treatments can offer significant financial relief to individuals pursuing donor eggs. These programs provide funds to eligible patients based on various criteria such as financial need, medical conditions, or specific demographic considerations. 

You can research and explore available grants and financial assistance programs, carefully review eligibility criteria, and complete the application process diligently to increase their chances of receiving financial support.

• Local grants: You may not have to look too far to find the money you need. Several IVF grants are limited to folks living in very specific geographic regions. At the Starfish Fertility Foundation, for example, one grant is awarded only to uninsured folks living within 50 miles of Nashville, TN. Others are offered through specific clinics. 
• State grants: Time to cast your net a little wider? There are grants out there that cover entire states. In New York, for example, the state’s Department of Health funds grants that are open to residents across the Empire State (provided they use an approved clinic). Other grants come via non-profits that cover care in specific states, and sometimes, you don’t even need to actually be a resident of that state—just willing to travel there for treatment. 
• National grants: These grants come from non-profits located throughout the country. The good news? You don’t have to travel far from home to find fertility help, as the funds can often be used at clinics across the US. The bad news? The competition for national grants is fierce. You’re no longer up against just the folks in your town or state. You’re competing against applicants from everywhere. 
• LGBTQ+ grants: Our partners at GayParentsToBe maintain a list of LGBTQ+ friendly grants for family-building.

The financial cost of donor eggs should not be an insurmountable barrier for individuals and couples seeking fertility treatment. Continued efforts by healthcare providers, policymakers, and advocacy groups (like Resolve!) are necessary to promote equitable access to fertility care and support individuals in their journey toward building a family.

Find an amazing egg donor at Cofertility

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing. 

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.

We aim to be the best egg sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Baby guarantee. We truly want to help you bring your baby home, and we will re-match you for free until that happens.
• Donor empowerment. Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud about the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Human-centered. We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!

Intended parents are often asking me if they should choose a first-time or proven egg donor. While it may initially seem like a major consideration, in reality, it often plays a relatively minor role in the overall process. In this article, I hope to clarify this question and guide you towards more consequential aspects in your decision-making process.

Understanding egg donation

Egg donation involves a woman donating her eggs to help another family conceive via in-vitro fertilization (IVF). These donated eggs are fertilized in a laboratory, and the resulting embryos are then transferred into the recipient's uterus or a gestational carrier. Most donors are first-time donors who have never donated before, but some are proven donors who have previously donated eggs which have resulted in successful pregnancies.

First-time vs. repeat egg donors

A first-time donor has no history of successful pregnancies, however this does not mean that she is not a wonderful donor. Even though it may provide some pause that the donor has not donated before, the number of eggs likely to be retrieved in a donation cycle can be predicted based on markers like anti-Mullerian hormone (AMH) levels and antral follicle count (AFC). These metrics provide solid indicators of ovarian reserve and, consequently, the potential success of an egg retrieval procedure.

On the other hand, proven donors have a track record of successful pregnancies through their donated eggs, which can offer some reassurance to intended parents going through egg donation. It’s another data point to give you confidence. However, a proven donor's history of successful pregnancies doesn't guarantee future success. Plus, a donor who has donated more than once means that your future child is more likely to have biological half-siblings. 

What matters most: family fit

As shared above, reliable estimates for the quantity of eggs that are likely to be retrieved during a donation cycle can be made based on biomarkers such as AMH and AMC. These critical measures serve as robust predictors of ovarian reserve and, therefore, help project the likely outcome of the egg retrieval process. A donor who has been medically cleared by a fertility doctor – whether she has donated before or not – has a good chance of a successful retrieval. In fact, donor egg IVF has better outcomes than other forms of ART.

Once an egg donor has been medically cleared, we think the "fit" of the donor with your family is arguably more critical. This fit might involve physical attributes, ethnicity, education, or other aspects that matter to you in relation to your future child. Donor profiles and interviews can provide valuable insights into these aspects, guiding your choice towards a donor who aligns with your vision for your family.

A downside of a “proven” donor: the biological half-sibling factor

A less commonly discussed aspect of using a proven donor is that your child may have biological half-siblings resulting from previous successful donations. While this fact doesn't influence the potential success of your IVF process, it's an important ethical and emotional consideration for many potential parents. For some, this potential genetic connection to other families might be concerning or undesirable. 

However, simply because a first time donor has not donated eggs before, it does not mean she will not potentially donate to other families in the future. This would also lead to biological half-siblings for your children. This is not something to be nervous or hesitant about though as it can be a beautiful thing. It has been seen that children born from the same donor sometimes seek each other out, and find family in the USA or around the world, and have stories to share between each other of being a donor conceived child. A very unique bond can be established between donor conceived children.

It's important to note that the possibility of having numerous genetic half-siblings doesn't inherently detract from the unique bond and relationship you will develop with your child. Yet, it's a factor to be aware of and something to consider based on your personal values and vision for your future family.

How many times can an egg donor donate?

There is a limit to how many times a woman can donate eggs, primarily based on ethical and safety guidelines. In the United States, for example, the American Society for Reproductive Medicine (ASRM) recommends that donors should not donate eggs more than six times during their lifetime. This guideline aims to minimize potential health risks for the donor and limit the number of offspring born from any one donor's eggs (although to be clear, even if a donor donates six times through an egg bank, those eggs could be distributed to far more than six families). At Cofertility, we follow these guidelines and actually find that most of our donors don’t plan on donating to more than one or two families because they are not doing it for cash compensation. 

Summing it up

Remember that while the choice of an egg donor is significant, it is just one aspect of the broader journey to parenthood. Other aspects, like ensuring the health of the mother or gestational carrier, preparing for the emotional and financial commitment of parenthood, and creating a nurturing environment for your child, are critical contributors to your child’s life.

While the decision between a first-time and proven egg donor can seem overwhelming, remember that this is just one factor among many in your fertility journey. Reliable fertility markers, such as AMH and AFC, offer significant predictors of egg retrieval success. Furthermore, the alignment of a donor with your vision of your future family is of paramount importance.

Each family's journey is unique, and there is no 'one size fits all' answer. Being patient with the process, staying informed, and leaning on the support of medical and mental health professionals can guide you towards the decisions that feel right for you and your family.

How Cofertility is different 

We started this company with the vision of serving all families, regardless of what brought them here. We promise to provide you with the care we would want for our families. With our commitment to transparency, inclusivity, and innovation, we are striving to be the best in the industry.

Our unique egg sharing model empowers donors and enables families to find the perfect egg donor match quickly and easily, setting a new standard for excellence in our field. Whether you are just becoming educated on egg donation or are ready to move forward, we want to help you achieve your goals and build the family of your dreams.

Create a free account to get started today!

Can a gay couple put both names on the birth certificate?

Who is on the birth certificate with gay dads?

The question of whose names appear on a birth certificate when a child has two dads is one we hear a lot. This question not only touches on the legal mechanisms at play but also the emotional and societal implications of such recognition, or the lack thereof, for LGBTQ+ families.

In this article, we’ll discuss parental recognition, and how birth certificates work for babies with gay dads.

Can gay men legally become parents?

Gay men can absolutely become parents, but the legal landscape surrounding LGBTQ+ parenting rights can be complex, and there are still some challenges that gay dads may unfortunately face. You’ll need a great lawyer who knows the specific laws of your state (if you work with Cofertility, we can help you find one). 

There are no federal laws that prevent gay men from using donor eggs and a gestational carrier, but the laws can vary depending on the state. Some states have laws that specifically prohibit surrogacy arrangements, or only allow it when both parents are genetically related to the child. Other states make it difficult to get both parents on the birth certificate. 

Can gay dads put both names on the birth certificate?

The short answer to this question is that it depends on where the baby is born. The legal acknowledgment of gay fathers on birth certificates is not uniform across jurisdictions, reflecting a patchwork of policies that navigate parental rights. 

In many countries and states within the United States, legal advancements have facilitated the listing of both fathers on a child's birth certificate, particularly in cases of adoption or when using assisted reproductive technologies (ART), including surrogacy and donor egg in vitro fertilization (IVF).

However, this progress is not universal. Unfortunately, in jurisdictions with more conservative legal frameworks, challenges persist. There, the non-biological parent among gay fathers may have to undergo adoption procedures to be recognized legally, a process that can be both time-consuming and financially burdensome.

Read more in Navigating the Legal Landscape: A Guide to Egg Donation & Surrogacy Laws for Gay Dads

What you should know about birth certificates and surrogacy

Donor egg IVF plays a pivotal role for gay fathers in starting their families, and the legal system significantly affects whose names appear on the birth certificate. In cases where a gestational carrier is involved, legal parentage may initially rest with the surrogate and, depending on the location, the biological father (the one whose sperm was used). Subsequent legal steps are often necessary to establish the non-biological father's legal parentage.

Countries and states that have embraced more inclusive definitions of family have implemented procedures to simplify the recognition of gay fathers from the outset. For instance, pre-birth orders and parentage judgments can establish both fathers' legal parentage before the child's birth, ensuring their names are on the birth certificate from day one.

The unfair psychological and social implications of parental right challenges for gay dads

The inclusion of both gay fathers on a birth certificate transcends legal formalities, bearing significant psychological and social implications for the entire family. This recognition affirms the fathers' relationship to their child and each other, providing a sense of legitimacy and security that benefits the child's emotional well-being. It can also impact practical matters, from medical decisions and schooling to inheritance rights and social services.

The absence of a legal bond can render the non-biological parent's relationship with their child vulnerable, particularly in situations of medical emergencies or separation. It's a stark reminder of the ongoing disparities facing LGBTQ+ families, despite strides toward equality.

The legal battle for fair parental recognition

Legal battles have often paved the way for changes in policy regarding the recognition of gay fathers on birth certificates. Cases brought before courts have challenged discriminatory practices, leading to landmark rulings that favor the equal treatment of LGBTQ+ families. These legal precedents not only affect the families involved but also set the stage for broader legal and societal shifts.

Resolve, a non-profit I’m on the board of, has tirelessly fought to help forward positive family building bills as well as work to stop harmful legislation from being enacted into law. As part of our overall mission to increase access to care, we will continue fighting for future families for the LGBTQ+ community.

Resolve tracks and advocate for LGBTQ+ legislation in gestational surrogacy, adoption policies and bills, and increasing infertility insurance coverage. Here is where you can learn more about Resolve’s LGBTQ+ specific legislative initiatives.

What is second-parent adoption?

Even if a child is biologically related to one of the dads, without a legal adoption, the non-biological parent may not have any legal parenting rights to their child. This means that if the biological parent passes away or becomes incapacitated, the non-biological parent, even if they have been an equal parent, may not have any legal rights to parenting. This is where second-parent adoption comes in.

In some states, the non-biological parent may be able to establish legal parentage through a pre-birth order or a marriage or domestic partnership. However, second-parent adoption is often the most secure way for non-biological parents to establish their parental rights and ensure that their child is legally protected.

Individual state laws surrounding this process can be complex. The National Center for Lesbian Rights has a great PDF outlining  Adoption by LGBT Parents. The states that make it hardest for unmarried same-sex couples include:

• Alabama
• Arizona
• Kansas
• Kentucky
• Mississippi
• Nebraska
• North Carolina
• Ohio 
• Utah
• Wisconsin 

Especially if you live in one of these states, you’ll want to work with an experienced attorney who can guide you through the legal landscape and ensure that your family is protected.

Summing it up

If you are a gay dad expecting a child through donor eggs and surrogacy, you’ll need to know the laws and parental recognition requirements of the state and country where the child is born as well as where you reside. We highly recommend working with a family lawyer who specialties in third party reproduction. If you work with us at Cofertility, we can help recommend a lawyer from our network. 

All parents – regardless of sexual orientation – deserve to be on their child’s birth certificate. As legal and social narratives continue to evolve, the hope is for a future where the question of whose names appear on a birth certificate is merely procedural, not a battleground for recognition or rights.

While significant strides have been made, the variability in legal recognition across jurisdictions highlights the need for ongoing advocacy and reform. Ultimately, the goal is to ensure that all families, regardless of their makeup, are afforded equal respect and protection under the law, reflecting the diverse and evolving nature of family in the 21st century.

Read more:

• LGBTQ+ Fertility Information and Resources
• What Fertility Options are Out There for LGBTQ Families?
• The Gay Dad's Guide to Egg Donation
• Navigating the Legal Landscape: A Guide to Egg Donation & Surrogacy Laws for Gay Dads