How Informed Consent Works at Cofertility

Egg donation plays a crucial role in helping many individuals and couples achieve their dreams of parenthood. At Cofertility, we recognize the significance of this decision for our donors and are committed to ensuring that every aspect of the donation process is conducted with the utmost care, transparency, and respect for our donors' autonomy.

This article provides a comprehensive overview of how informed consent works at Cofertility, where women can freeze their eggs for free when donating half to a family that could not otherwise conceive. 

We'll explore the various aspects of informed consent, including its definition, its specific application to egg donation, and the medical, psychological, genetic, and legal considerations involved. By the end of this article, you'll have a clearer understanding of our commitment to ethical practices and donor well-being throughout the egg donation journey.

What is informed consent?

Informed consent is a fundamental ethical and legal principle in healthcare and medical research. It refers to the process by which a fully informed patient or participant can participate in choices about their healthcare or involvement in research. For consent to be considered "informed," several key elements must be present:

1. Disclosure: The healthcare provider or researcher must provide all relevant information about the proposed treatment, procedure, or study. This includes potential risks, benefits, alternatives, and the option to refuse or withdraw.
2. Understanding: The patient or participant must comprehend the information provided. This may involve explaining complex medical terms in plain language or using visual aids to ensure clarity.
3. Voluntariness: The decision to consent must be made freely, without coercion, undue influence, or pressure from healthcare providers, researchers, family members, or others.
4. Competence: The individual must have the mental capacity to make the decision. This means they must be of legal age and sound mind to understand the implications of their choice.
5. Consent: The patient or participant must explicitly agree to the treatment, procedure, or participation in the study, usually by signing a consent form.

Informed consent in egg donation

At Cofertility, we take donor consent very seriously. In the context of egg donation, informed consent ensures that donors fully understand all aspects of the donation process, including medical procedures, potential risks, psychological implications, and legal considerations. It empowers donors to make autonomous decisions about their bodies and genetic material, protecting their rights and well-being throughout the donation process.

To ensure that an egg donor is making a knowledgeable and autonomous decision about becoming an egg donor through our Split program, the potential donor is required to be fully educated about all aspects of the donation process. This includes:

• Medical implications: Understanding the procedures involved and potential health risks.
• Psychological considerations: Exploring the emotional aspects of egg donation.
• Genetic implications: Comprehending the long-term genetic connections created through donation.
• Legal aspects: Understanding the rights and responsibilities of egg donors.
• Egg sharing vs. financial implications: Grasping the differences between our Split program and traditional financial compensation models.

It is crucial that the donor demonstrates she understands all the information provided and has ample opportunity to ask questions before deciding to move forward. Another important aspect of informed consent is that it must be given voluntarily, without coercion or undue influence. The egg donor must understand that she has the right to withdraw from the process at any time before the egg retrieval.

This process of informed consent is just one aspect of how we work to educate each member through various aspects of the process— on top of providing support and guidance— all in the name of supporting our donors in making the best decision for themselves.

Medical risks and side effects

Just like any other medical procedure, egg donation has medical risks and side effects. Understanding the medical side effects of egg donation is vital for ensuring that donors can give informed consent, prepare for and manage potential risks, and safeguard their physical well-being. It also empowers donors to make confident, informed decisions about their participation in the donation process.

Typically, during the menstrual cycle only one egg is released. So when donating eggs,  medications are given to help produce multiple eggs at one time. Sometimes ovaries over respond to these medications and cause side effects. Ovarian Hyperstimulation Syndrome (OHSS) is one possible side effect. The ovaries swell because they are producing more than what is typical and can become painful. Symptoms can range from mild bloating and nausea to severe symptoms such as shortness of breath, blood clots, and even kidney failure. According to the Cleveland Clinic, OHSS occurs in less than 5% of women undergoing retrieval. And severe cases are less than 1%.

Because a needle is involved to remove eggs from the ovaries, an infection is possible. However, according to the American Society for Reproductive Medicine (ASRM), pelvic infections after egg retrieval are pretty rare. Severe infections may require hospitalization and/or treatment with intravenous antibiotics. Rarely, surgery may be required to remove one or both of the ovaries, tubes, and/or uterus. Light vaginal bleeding or spotting for 1–2 days after an egg retrieval procedure is also very normal. Since the retrieval involves puncturing and aspirating ovarian follicles, it can lead to varying degrees of bleeding.

These and other potential side effects will be fully discussed and covered in detail before any procedure begins. The donor will have ample opportunity to learn about all the possible side effects and opportunity to ask questions until she feels fully informed and comfortable with moving forward. We believe that being aware of the medical side effects empowers donors to take an active role in their healthcare. This knowledge allows them to advocate for themselves, ask the right questions, and make decisions that are in their best interest.

Psychological and emotional considerations

The decision to donate eggs involves a lot of personal considerations as well, not just medical. And donors must be counseled on the potential emotional and psychological impacts of donation, including the potential for regret. Donors may experience stress related to the medical procedures, the hormones used, and the overall commitment required. But the emotional and psychological impacts can impact a donor well past the donation phase and into the future. The knowledge that their genetic material may result in the birth of a child can create a sense of connection or identity-related concerns. Donors may wonder about their genetic offspring and may feel a sense of loss or confusion regarding their role in the child's life. Donors may find that their decision affects their relationships with partners, family members, or friends, particularly if those around them have differing views on egg donation. 

This and other psychologically complex reasons are why donors undergo an extensive psychological screening to assess their emotional readiness and understanding of the potential psychological impacts of egg donation. Understanding the potential mental health implications ensures that they are prepared for the emotional journey ahead. By being aware of these potential effects, donors can make more informed decisions, seek appropriate support, and manage their mental health throughout and after the donation process. We provide access to professional mental health support that can help donors process their emotions and manage any psychological challenges that arise.

Over time, a donor's feelings about their decision might evolve. What seemed like a straightforward decision at one point in life might be reconsidered as the donor’s circumstances or perspective changes, potentially leading to feelings of regret or doubt.  So before proceeding with the donation, we discuss this with our donors to reduce the likelihood of misunderstandings or regrets later in life. This is where we spend time discussing the genetic implications of egg donation. 

Genetic implications of egg donation

The egg provided by the donor contains half of the genetic material that will combine with sperm to form an embryo. This means that the donors and recipients' family tree will be tied forever. We want our donors to understand the significance of this implication. Being informed about potential future impacts allows donors to develop coping strategies and seek support networks, whether through professional counseling, support groups, or trusted individuals in their lives.

At Cofertility, we offer potential egg donors the choice of how, if at all, they want to be connected to the family they help. Two broad options for the the relationship include: 

• Disclosed, you exchange contact information and can communicate directly. The scope and degree of communication (both during and post-match) is what both parties make of it. 
• Undisclosed, you do not exchange contact information and only communicate through Cofertility. With an undisclosed donation, you and the family can choose to allow the donor-conceived child to receive your contact information when they turn a certain age (usually 18). This is called Open ID, an increasingly popular option.

Some egg donation agencies promise the opportunity to be anonymous. However, with the rise of direct-to-consumer genetic testing services, we know that anonymity is simply not possible. It has become easier for children conceived through egg donation to discover their genetic origins and potentially locate the egg donor and other biological relatives. It’s important for donors to carefully consider this implication and discuss them with medical, psychological, and legal professionals before proceeding with the donation. 

Legal rights and responsibilities

Before the donation process begins, the donor must sign legal contracts that outline their rights, responsibilities, and the terms of the donation. The legal rights and responsibilities of an egg donor are carefully defined in a legal contract to protect both the donor and the recipients. These rights and responsibilities involve issues of parental rights, disclosure, and confidentiality and are legally binding. 

In the contract it will be explicitly directed that the egg donor relinquish all parental rights to any children born as a result of their donation. This means they have no legal responsibilities or rights regarding the child. So the donor has no legal claim to the child, no right to contact or visitation, and no responsibility for the child's upbringing. Although research and guidelines encourage transparency, suggesting that children should be informed about their genetic origins, it is up to the recipient parents to decide if and when they will disclose the egg donation to their child. 

At Cofertility donors are required to have independent legal counsel to review these contracts and ensure they fully understand their rights and obligations. There is no cost to the donor. 

Egg sharing vs. financial compensation

Egg sharing is a program in which a woman shares some of her eggs with another individual or couple who need donor eggs. In the case of Cofertility, the donor gives half of her retrieved eggs to a family who cannot conceive otherwise and keeps the rest for herself. Every expense associated - medications, supplement, travel, insurance, freezing, legal etc - are completely free of charge.

Egg sharing and financial compensation are two very different models used in the context of egg donation. Both involve women donating their eggs, but the motivations, benefits, and processes differ. 

Egg sharing is a program in which a woman shares some of her eggs with another individual or couple who need donor eggs. In the case of Cofertility, the donor gives half of her retrieved eggs to a family who cannot conceive otherwise and keeps the rest for herself. Every expense associated— medications, supplement, travel, insurance, freezing, legal, and 10 years of storage— are completely free of charge. What’s beautiful about egg sharing is that both the donor / egg sharer and the recipient benefit from the process. The donor gains access to free egg freezing, while the recipient receives donor eggs that increase their chances of conception. 

In a financial based model of egg donation, a woman donates her eggs in exchange for a direct financial payment. This compensation is for her time, effort, and the physical and emotional demands of the donation process. Donors receive a pre-agreed sum of money as compensation for the donation. This payment is not for the eggs themselves but for the donor’s participation in the process, covering time, discomfort, and any associated risks. 

With cash compensation, ethical issues can arise regarding the commodification of human eggs, the motivations of donors (financial need versus altruism), and the potential for exploitation, especially in economically disadvantaged populations. Plus, a 2021 Harvard study found that 62% of donor-conceived adults felt the exchange of money for donor gametes was wrong, and 41% were troubled by the fact that money was exchanged around their conception. 

The bottom line

Egg donation is a complex process, and it is important for potential donors to receive comprehensive information before giving their consent. This includes information regarding medical, psychological, genetic, legal, and egg sharing vs financial implications, before voluntarily agreeing to participate. They have the right to ask questions and receive clear, unbiased answers to ensure that they are making fully informed decisions at every stage of the donation process. This right is crucial for safeguarding their health, legal rights, emotional well-being, and autonomy. It also upholds ethical standards by ensuring transparency, trust, and the protection of donors from exploitation or coercion.