Looking back: egg donors retrospective evaluations of

their motivations, expectations, and experiences

during their first donation cycle
Nancy J. Kenney, Ph.D.,a and Michelle L. McGowan, Ph.D.b
a

Department of Psychology and Women Studies, University of Washington, Seattle, Washington; and b Department of Bioethics,
Case Western Reserve University, Cleveland, Ohio

Objective: To survey motivations, expectations, and experiences of egg donors in the United States and their assessments of physical, psychological, and social after-effects of their donation(s).
Design: Questionnaire comprising open-ended and multiple-choice items, administered on the Internet or by mail.
Participant(s): A total of 80 women who first donated eggs between 1989 and 2002 (at least 2 years before survey
completion) in 20 states.
Main Outcome Measure(s): Self-report questionnaire assessing donors demographic characteristics, their initial
awareness of and interest in egg donation, first egg donation experience, and reflections on it.
Result(s): Participants cited both altruistic and financial reasons for becoming egg donors. Donors self-reported
awareness of physical risks before their first donation was not well-matched with the physical side effects they
actually experienced. Psychological risk awareness before donation reflected more challenging outcomes than
the women actually experienced. The majority of donors reported postdonation satisfaction, although a minority
reported long-term physical and psychological concerns that they attribute to having donated eggs.
Conclusion(s): These data offer a comprehensive overview of issues important to the recruitment and well-being
of egg donors and suggest some issues related to the donors satisfaction with the process and to their long-term
health for future study. (Fertil Steril 2010;93:45566. 2010 by American Society for Reproductive Medicine.)
Key Words: Egg donors, physical and psychological aspects, risk assessment, long-term assessment

Over the last 2 decades, anonymous egg donation has played

an increasingly important role in the array of available fertility treatments in the United States. In 2005 (the last year for
which statistics are available), donor eggs were used in
approximately 13.7% of all IVF cycles (14,646 cycles overall) (1). In the U.S., egg donation occurs under conditions
that are relatively unique on the worldwide stage in that there
is limited insurance coverage for such fertility treatments,
and individuals primarily pay for their assisted reproductive
medical services out of pocket. In addition, egg donation
has been very loosely regulated by the U.S. government;
oversight of egg donation in the U.S. has primarily occurred
through the issuance of professional guidelines by the American Society of Reproductive Medicine [2] and through the
annual collection of statistics of egg donation cycles [as volunteered by clinics] by the Centers for Disease Control and
Prevention. It is also common practice for egg donors to be
recruited by clinics, often through advertising media, and offered a financial incentive for donating eggs to couples
seeking fertility treatment. Recruitment procedures typically
Received June 25, 2008; revised September 20, 2008; accepted September 30, 2008; published online November 19, 2008.
N.J.K. has nothing to disclose. M.L.M. has nothing to disclose.
Support for this research was provided by a grant from the University of
Washingtons Royalty Research Fund (Spring 2003 Proposal #3009).
Reprint requests: Nancy J. Kenney, Ph.D., Departments of Psychology
and Women Studies, University of Washington, Box 351525, Seattle,
WA 98915-1525 (FAX: 206-685-3157; E-mail: nkenney@u.washington.
edu).

0015-0282/10/$36.00
doi:10.1016/j.fertnstert.2008.09.081

connect donor remuneration with her role in helping infertile

couples reach their goal of reproductive success. Financial
incentives are intended as reimbursement for the donors
time and effort related to the egg donation procedures and
for the medical risks she undertakes by participating in the
procedure (3).
In most Western European countries and in Canada, in contrast to the U.S., egg donation has been closely regulated by
the state and occurs without remuneration to donors. In the
United Kingdom (UK), for example, egg donation is viewed
as similar to organ or tissue donation. Eggs can be neither
bought nor sold; they can only be given freely. The UK regulatory conditions do permit indirect monetary gain for egg
donation through egg-sharing programs. Women undergoing
egg harvesting for personal IVF procedures may have the
costs of their own treatment reduced if they are willing to donate some of their harvested eggs to another party seeking
fertility treatments.
Studies assessing the reasons why women donate eggs in
countries such as Canada and Finland, where payment for
egg donation is either severely limited or prohibited, report
that women have largely altruistic reasons for their participation in the procedure (47). These studies also indicate that
donors tolerate the procedures well, are largely satisfied
with their experiences, have few (if any) regrets about donating, and have some willingness to donate eggs again. In the
UK, where direct payment is banned but indirect monetary
gain is a possibility, egg donors report both altruistic and

Fertility and Sterility Vol. 93, No. 2, January 15, 2010

Copyright 2010 American Society for Reproductive Medicine, Published by Elsevier Inc.

455

self-interested motives (815). Comparison of statistics on

the frequency of use of donor eggs in IVF cycles in the
U.S. and in countries that limit or prohibit payment to egg donors suggests that the offer of direct remuneration increases
the number of women participating in the process. The
most recently available statistics from Canada, Finland, and
the UK (all of which restrict direct payment) indicate that donor eggs are used in only an estimated 5% of all IVF cycles in
those countries, fewer than half the proportion of cycles involving donated eggs in the U.S. (1618).
Although such statistics suggest that remuneration plays
a major role in womens decision to donate eggs in the
U.S., studies of the motivations of U.S. egg donors indicate
that their reasons for donating are both similar to and different from those of their counterparts in other countries. Research clearly indicates that U.S. egg donors are motivated
by both monetary compensation and altruism. The financial
incentive has been cited as a primary motivator for many donors in the U.S., particularly as the amount of financial remuneration increases (1922). Partrick et al. (22) posited that
this financial compensation may be especially important for
young donors who are college students who may have more
limited financial resources and higher debt. Additionally,
Klock et al. (20) reported that repeat donors are more likely
to be motivated by financial factors.
Even though the offer of financial compensation is a standard tool used to recruit U.S. egg donors, advertisements
seeking egg donors in the U.S. also emphasize the altruistic
impetus for egg donation; and U.S. donors have reported
that the possibility of helping others played a major role in
their decision to donate their eggs (1921, 2325). Kalfoglou
and Gittelsohn (19) found that even when donors were initially attracted by the financial compensation, some later reported more altruistic reasons for donating.
Studies that have evaluated donors postdonation perceptions of the process have reported that most donors are satisfied with the procedure but suggest that there are some areas
for concern. In general, studies of U.S. egg donors have indicated high postdonation satisfaction rates and some willingness to donate again (20, 23, 2527). First-time donors
who had high financial motivations for donating reported being less satisfied with the process and were also less likely to
express willingness to donate again (22, 23). Rosenberg and
Epstein (28) reported that donors saw egg donation as having
a positive impact on their lives, although both these researchers and Kalfoglou and Gittelsohn (19) reported that donors are not always satisfied with their clinical experience,
the physical discomforts of egg donation, and/or the financial
compensation that they received.
To date, egg donors long-term attitudes towards the experience have not been well understood. The need for this information is pressing, especially given that 95% of the 422
clinics reporting to the Centers for Disease Control and
Prevention in 2005 offered egg donation services (1). Most
of the retrospective assessments of donors attitudes con456

Kenney and McGowan

Looking back

ducted in the U.S. rely on donors who had all donated at a single clinic (21, 22, 27) or assess donor reactions relatively
shortly after the donation (19, 20, 23, 26). None of the previously published studies assessed womens expectations
about the procedures and how those expectations matched
(or failed to match) their actual donation experience. The
present study assessed the motivations, expectations, experiences, and self-perceived long-term physical and psychological sequelae of having donated eggs, using a sample of
women who donated at a wide variety of clinics scattered
across 20 states. The goal was to assess the womens views
at a time distal to the actual donation; all of the women surveyed first donated their eggs at least 2 years before completing this survey. Although assessing womens attribution of
their current physical and psychological health concerns
does not address the actual sequelae of donation, it does provide insight into the types of education that should be provided before donation and suggests issues for follow-up in
larger, longitudinal studies.

MATERIALS AND METHODS

All recruitment and survey procedures were approved by the
Institutional Review Board of the University of Washington.
Two sampling tools were used to recruit participants for this
study. The first was an advertisement for participants through
posted flyers and advertisements in print and Internet-based
media, and the second was a targeted sampling of former donors from an egg donor matching agency based in California
which recruited, screened, and matched potential egg donors
with recipient candidates nationwide but was not linked to
a specific medical clinic. In an attempt to ensure a broad geographic distribution of egg donors throughout the U.S., the researchers posted flyers around colleges and universities in the
Pacific Northwest and ran advertisements on the web site
Craigs List (http://www.craigslist.org) and in the alternative
newspapers LAWeekly, Miami New Times, San Francisco Bay
Guardian, San Francisco Weekly, The Stranger, and The Village Voice calling for former egg donors to participate in an
online survey. Nineteen egg donors responded to these recruitment tools and participated in an anonymous online survey. In the targeted recruitment of donors affiliated with the
egg donor matching agency, paper copies of the study questionnaire were mailed to 298 women who had donated before
2003. Individuals receiving the mailed questionnaire also received a letter describing the intent of the survey and $1.00 as
token of appreciation for their time. One hundred six of the
packets were returned as undeliverable, which is likely due
to outdated contact information that the egg donor matching
agency had on file. Excluding the undeliverable mailings,
the potential sample size was 192 donors. Of these, 61 egg donors affiliated with the egg donor agency responded to the call
for participants, resulting in a survey completion rate of
31.8%. Staff limitations at the egg donor matching agency
and funding concerns precluded additional mailings to boost
participation in the study. This, as well as the anonymity of the
survey tool and the researchers lack of prior relationship with
Vol. 93, No. 2, January 15, 2010

the potential respondents, may have affected response rate

(29).
In all, 80 women who had donated eggs for the first time
at least 2 years before the time of the study completed the
study questionnaire between May 2004 and May 2005.
The questionnaire had 84 items, including both open-ended
and multiple-choice questions. The questions addressed a variety of demographic characteristics of the participants that
are commonly included in advertisements recruiting egg donors (i.e., age, height, weight, height/weight proportionality,
race/ethnicity, and educational level), how they learned of
and became interested in egg donation, details regarding
their first egg donation experience, whether they donated
eggs more than once, and whether subsequent experiences
with egg donation were similar to or different from the first
experience. Because this was an anonymous, voluntary survey, comparisons cannot be made between responders and
nonresponders. Unless otherwise indicated, all details about
the donation experience pertain to the donors first egg
donation.
Responses were entered into an Excel spreadsheet (Microsoft, Redmond, WA) for analysis. Reflecting the purpose of
this research, data analysis involved descriptive statistical
analyses of multiple-choice and quantitative responses, coding of some qualitative responses for quantitative analysis,
and textual analysis of the qualitative material to draw out
common themes in the donors responses. Donor motivations, experiences, and long-term attitudes were each assessed by responses to a series of questions, some of which
were forced-choice and others of which were open ended.
For example, postdonation satisfaction was gauged by responses to three related questions: a multiple choice question
asking the participant to describe the long-term effect of her
first egg donation on her life with five possible responses
ranging from very positive to very negative, a follow-up question asking her to describe any long-term effects the donation
had on her life in an open-ended response, and a more general
open-ended question, Looking back, how do you feel about
the egg donation experience now?.

RESULTS
Demographics
Eighty women responded to this survey. Data from the 19 donors who responded to general advertising did not differ systematically from those of the 61 donors identified through the
agency. All results presented are for the combined sample of
80 donors. When they completed the questionnaire, respondents averaged 30.6  4.0 (mean  SD) years of age. In response to an open-ended question, the majority of the donors
identified themselves as white, Caucasian, or European
American (73 women or 91.2% of the sample). Although labeling themselves as white or Caucasian, three women indicated that they were, in part, Native American (3.8% of the
sample). Two others characterized themselves as Jewish as
well as white (2.5%). Four donors identified themselves as
Fertility and Sterility

Hispanic (5%), and two (2.5%) labeled themselves as Caucasian-Asian or Eurasian. One woman (1.2%) described herself
as African American and Native American.
The survey respondents donated eggs for the first time 2
15 years before completing this survey. The earliest first donation was in 1989, and the most recent initial donation was
in 2002. More than half (64.5%) underwent their first donation cycle between 1998 and 2002. Most first donations
occurred in 1999 (12), 2000 (17), and 2001 (16). The donations took place in 20 different states, with the majority in
California (23), Massachusetts (7), New York (7), Washington (7), and New Jersey (6).
At the time of their first egg donation, the respondents were
between 20 and 32 years of age (mean  SD, 25.1  3.0 years).
Thirty-six of the participants (45.0% of the sample) were students when they first donated, with 11 donors (13.8%) going
to school part time and 25 (31.2%) attending full time. Fortysix of the women (57.5%) were employed full time, and 18
(22.5%) were employed part time at the time of their first donation. Fifteen (18.8%) reported being unemployed at the
time of their first egg donation. Those employed detailed their
occupations in an open-ended response. Donors occupations
included positions in the service, education, and professional
sectors, such as wait staff, barista, bartender, teacher, teaching assistant, exercise physiologist, medical assistant, tattooist,
and mental health case worker, as well as a variety of white-collar administrative positions and a few performers/actors.
Fifty-six (70%) of the women who completed this survey
donated eggs more than once, with the number of donations
ranging from 1 to 9 (mean, 2.4; median, 2). Most repeat donors underwent the procedure two or three times (Table 1).
The length of time between donations ranged from as little
as 2 months to as long as 48 months. The most common interval between procedures was 1 year (n 15). The second
most common period of time between donations was

TABLE 1
Number of donation cycles for each
respondent.a
No. of donations

Percentage of respondents
(n [ 80)

1
2
3
4
5
6
7
8
9
a

30.0
32.5
18.8
7.5
5.0
2.5
1.2
0
1.2

One respondent indicated that she donated multiple

times but did not specify an exact number.

Kenney. Looking back. Fertil Steril 2010.

457

6 months (n 10). Twenty-three of the repeat donors

(41.8%) reported that all of their donations took place in
the same geographic area, whereas 32 (58.2% of the repeat
donors) said that they had donated in more than one geographic region. One repeat donor chose not to respond to
the question on geographic dispersal.
Most of the women (70.5%) indicated, in response to an
open-ended question, that they first learned about egg donation through advertising or articles/reports in print or broadcast media. One quarter of the donors (20 women)
specifically noted that their first source of information on
egg donation was a college or university newspaper. Three
others reported trade papers for the performing arts as the
original source of their information. Other women (n 33)
said they first learned of the process from television programming or through advertising or articles in community newspapers or mass-circulation magazines.
After media sources, the next most common first source of
information on egg donation was a friend or family member
(20% of the sample). Two of the donors (2.5%) learned about
egg donation from friends who were experiencing fertility
problems and were considering using donated eggs. One
had an infertile friend specifically request her help as a donor
(although, in the end, this woman donated anonymously and
not to her friend). Two women (2.5%) learned of the process
through their work in fertility clinics. Two donors (2.5%) did
not identify the source of this information.

Motivations to Donate
When asked in an open-ended question why they donated, the
women gave a variety of answers, most of which related to
their own financial needs and/or their desire to help others
(Fig. 1).

Twenty-six women (32.2%) reported that their motivations

were based entirely on helping others. Altruistic explanations
included the following:
I am truly looking forward to the opportunity to be
pregnant and have a child with the person I love. I
feel that every woman should have the chance to experience that at least once in her life. (Donor 4)
My brother is infertile. I wanted to help another infertile couple. (Donor 30)
I had used a sperm donor to conceive 3 of my children
and felt the need to help others. (Donor 5)
Fifteen women (18.8%) indicated that their motivations
were strictly financial:
I needed money. (Donor 1)
Honestly, I could use the money to pay for school and
that is exactly what I used it for. (Donor 16)
A greater proportion of donors (33 women or 41.2% of the
sample) reported that both money and helping others played
a role in their decision to donate. Of these, 19 (23.8%) cited
financial reasons first, as in the following examples:
.needed money, thought I was helping someone.
(Donor 37)
The money attracted me, initially, to be honest. But, I
became more excited about it once I talked to the parents and heard their story. (Donor 46)
Responses from 14 women (17.5%) suggested that their
primary motivation for donating was altruism and that financial compensation was a secondary factor:
I thought that it was a wonderful thing to do; and, as
a law student, the extra money was nice. (Donor 10)
I am so fertile and wanted to help couples who desperately wanted children to have a baby. I could not

FIGURE 1
Percentage of donor sample who reported that their motivations were altruistic, financial, or a combination of the
two. In cases in which dual motives were cited, the motive given first is listed first.

Kenney. Looking back. Fertil Steril 2010.

458

Kenney and McGowan

Looking back

Vol. 93, No. 2, January 15, 2010

imagine wanting a child so badly but being unable to

have one how unfair! Of course, the payment was
also a big factor used it to pay off my student loans.
(Donor 66)
Four women (5.0%) gave responses that did not fit into any
of these categories, and two women (2.5%) did not answer
this question.
Whether or not they cited finances as motivating their decision, most of the survey respondents (73.8%) indicated on
a Likert scale of 1 (not significant at all) to 6 (very significant)
that financial compensation played a significant role in their
decision to donate, with 58.8% of the donors labeling remuneration as very significant to their decision. Twenty-five percent of the donors rated financial compensation as relatively
insignificant to their decision, with four women (5.0%) indicating that financial incentive was not at all significant to their
decision. The 36 women who were full-time or part-time students at the time of the donation were more likely to be financially motivated to become egg donors than nonstudents, with
94.4% of students indicating that financial compensation was
a significant factor in their decision to donate eggs, as compared with 56.8% of the 44 donors who were not students.
All of the donors received financial compensation for their
donation, although four women did not report the amount of
the payment. Because donations spanned a period of approximately 11 years, payments reported by the donors were converted to 2002 U.S. dollars (2002 being the most recent first
donation year). Conversions were done using the purchasing
power calculator based on the Consumer Price Index through
http://www.measuringworth.com/ppowerus/index.php. Reported payments ranged from $1,104 ($1,000 in 1998) to
$7,313 ($7,000 in 2000) (mean  SD, $3,965  $1,406). Payments significantly increased over time, averaging $3,586 
$1,590 for the 38 women reporting their remunerations for
donations between 1989 and 1999 and $4,334  $1,100 for
the 39 women reporting payments for donations between
2000 and 2002 (P.0185). Compensation varied widely during both time periods, ranging between $1,104 ($1,000 in
1998) to $7,254 ($5,000 in 1989) for the women first donating
between 1989 and 1999 and between $2,089 ($2,000 in 2000)
to $7,313 ($7,000 in 2000) for the women first donating
between 2000 and 2002.
Donors who reported that financial compensation was very
significant to their decision to donate (n 18 or 22.5%) received higher payments on average ($4,453  $1,285) than
those who said remuneration was irrelevant to their actions
($3,413  $3,397; n 4 or 5%). However, the payment
that women received for donating eggs did not reflect the importance that they attributed to compensation. To illustrate,
remuneration to women who reported that payment played
a very significant role in their decision to donate ranged
from $2,007 ($1,700 in 1995) to $7,254 ($5000 in 1989),
whereas that for women who said that financial compensation
was not significant at all to their decision was between $1,104
($1,000 in 1998) and $7,313 ($7,000 in 2000).
Fertility and Sterility

When asked whether the financial compensation they received was too little, just about right, or too much, a majority
of the donors (62.5%) reported that the financial compensation was just about right for their role in the donation. Slightly
more than one third of the women (36.2%) reported that their
compensation was too little. However, the average compensation between these groups did not differ, with the women
who indicated that their financial compensation was just right
receiving an average of $3,917  $1,383 and those who
judged their compensation to be inadequate receiving an average of $,3962  $1,486. Both the highest paid ($7,313
[$7,000 in 2000]) and one of the lowest paid ($1,245
[$1,000 in 1993]) donors reported their compensation to be
inadequate, demonstrating the complexity of donors motivations and reactions to donating their ova. Two donors, each of
whom received $5,000 (one in 2000 and the other in 2001),
reported that their compensation was too high for their role
in the process. Eighty-three percent of the women who donated only once rated financial remuneration as important
to their decision. In contrast, only 69.6% of women who donated more than once indicated that such compensation was
important to their decision to donate.
Expectations Before Egg Donation
Prior Knowledge of Physical Risks Most of the donors (80%)
reported that they were aware of some physical risks associated with the procedures before their first donation. Table 2
provides a summary of the risks the women noted in response
to an open-ended question asking what risks they were aware
of before they first donated. It is important to emphasize that
this table does not enumerate clinically designated risks associated with egg donation; rather, the risks associated with
ovum donation listed in this table are those identified by
the respondents to this survey with no prompts provided.
The proportion of the respondents who indicated awareness of any one of the various physical risks that could be associated with hormone treatment and/or egg harvesting
before initiating treatment is surprisingly low. Ovarian hyperstimulation was the most commonly recalled potential risk,
and this was noted by only 27 survey respondents (33.8%).
Risk of future infertility or decreased fertility and risks
from surgery, including bleeding and infection, each were
noted by 16 (20%) of the donors. Other possible risks were
noted by only a small proportion of the total donor sample.
Most of the women (62.8%) reported on a Likert scale of 1
(very serious) to 6 (very minor) that before donating they
viewed the potential physical risks associated with the procedure as minor, with 21.4% of the women evaluating the risks
as very minor. A total of 37.1% of the respondents viewed the
potential risks as serious, and 11.4% indicated that they perceived the risks as very serious. Although most of the women
acknowledged being aware of at least some physical risks associated with egg donation, it is interesting to note that 20%
of the sample reported that they did not recall being aware of
any physical risks associated with the donation process at the
time of their first donation.
459

TABLE 2
Physical risks donors reported being aware of before their first donation and physical effects the
donors reported having experienced during or immediately after the donation.
Percentage of donors Percentage of donors reporting
reporting awareness of
actually experiencing the
the risk (n [ 80)
risk (n [ 80)

Risk
Ovarian hyperstimulation
Infertility/decreased fertility
Surgical risk including bleeding/infection
Damage to ovary, scarring, torsion, twisting
Risks from anesthesia
Increased risk of cancer/ovarian cancer/
uterine cancer
Side effects of hormones
Pain/injection pain/cramping/abdominal pain
Unintended pregnancy/multiple pregnancy
Mood changes/irritability
Weight gain or loss
Headaches
Bloating
Fatigue
Heavy period after cycle
Nausea
Ovarian cysts

33.8
20.0
20.0
15.0
12.5
11.2

12.5
1.3
1.3
2.5
3.8
0

10.0
8.8
7.5
7.5
3.8
3.8
2.5
2.5
0
0
0

7.5
45.0
0
15.0
11.3
4.5
31.3
2.5
7.5
6.3
2.5

Kenney. Looking back. Fertil Steril 2010.

Prior Knowledge of Psychological Risks Most of the women

(72.5%) reported that they were aware of some psychological
risks associated with egg donation before undergoing the procedure. Only 17 (21.2%) reported on a Likert scale from 1
(very serious) to 6 (very minor) that they thought that the psychological risks were serious before initiating treatment. Table 3 summarizes the responses of the donors to an openended question asking what psychological risks they were
aware of before donation. Many of the women reported being
aware of the possibility that they might develop concern for
and/or attachment to their eggs and/or potential or resultant
offspring, concern that the donor or resultant child might
want a relationship with them in the future, and unease or
curiosity about the possible existence of genetic children
related to them out there in the world (Table 3). Other psychological risks that the donors recalled being aware of
before initiating the donation cycle reflected emotional
changes related to hormone stimulation and/or stress resulting from the donation process as a whole.
Experiences of Egg Donation
Physical Responses to the Donation Procedures When
asked to rate their physical reactions to the egg donation procedures on a Likert scale ranging from 1 (very positive) to 6
(very negative), the donors were almost evenly split on
whether they recalled their physical reactions to be positive
or negative, with 40 donors (50.0%) responding with ratings
on the positive end of the scale and 37 women (46.2%) report460

Kenney and McGowan

Looking back

ing that their physical responses were on the negative side.

(Three donors did not respond to this question.) Although
most of the women rated their physical reactions midway between positive and negative (ratings 3 and 4), 14 women
(17.5%) rated their physical reactions as positive or very positive, and 13 women (16.2%) rated their reactions as negative
or very negative. Women who labeled their physical responses to the treatment as very positive reported either
that they experienced no physical reactions to the procedure
or that they had slight bloating during the donation cycle. The
women who rated their physical reactions to the donation
process as very negative also described their reactions as
very serious. These reported outcomes are addressed below.
Thirty-six women (45%) reported that they experienced
pain from the injections and/or from egg retrieval (Table 2).
Although only 2 women listed bloating as a potential physical
risk that they recalled being aware of before the procedure, 25
women reported experiencing bloating during the process.
Other physical reactions respondents reported experiencing
included mood changes and irritability (12 women), ovarian
hyperstimulation (10 women), weight gain or loss (9
women), heavy period after treatment (6 women), nausea
(5 women), and headache (4 women). Nine of the women
(11.3%) reported that they had no physical reactions to the
donation regimen.
Most of the women (73.8%) rated their physical reactions
to the procedures on a Likert scale of 1 (very serious) to
Vol. 93, No. 2, January 15, 2010

TABLE 3
Donors awareness of psychological risks before donation.
Percentage of respondents indicating
awareness of the risk before
donation (n [ 80)

Risk
Sense of loss and emotional attachment to eggs and/or children
born as a result of the donation
Regret/mental anguish
Depression/sadness
Uneasiness about the possibility of a child out there with
donors DNA
Feeling that resultant child(ren) should have relationship with his/
her genetic mother
Curiosity about the end result of the donation and any possible
resultant child(ren)
Risk that a resulting child might later seek out donor or that donor
would want to locate child
Mood swings
Desire to back out of donation agreement when time came to
harvest eggs
Stress related to donation procedures

31.3
11.3
10.0
8.8
7.5
6.3
5.0
3.8
2.5
2.5

Kenney. Looking back. Fertil Steril 2010.

6 (very minor) as somewhat minor or very minor; but 17

women (21.2%) reported that their physical reactions to the
treatment were serious, and six women (7.5%) rated their reactions as very serious. In response to an open-ended question asking what, if any, physical reactions they had to the
procedures, two women who rated their reactions as very serious (and very negative as noted above) reported being hospitalized in the days immediately after the procedure, and one
woman reported being treated in an emergency room shortly
after retrieval. Two of these donors attributed their need for
follow-up care to hyperstimulation, whereas the remaining
woman said that the care was needed because of severe reactions to medications used during or after retrieval. Another
woman who rated her physical reaction as negative and serious attributed subsequent development of a fibroid on the
broad ligament of the uterus to the procedure, and a donor
who had required in-hospital aftercare associated a fibrous
mass in her breast discovered shortly after the donation cycle
with the process. Two additional donors reported experiencing severe pain in the days after retrieval. Note again that the
attribution of these outcomes to the donation process was
made by the donors in response to open-ended questions,
and the connection was not necessarily verified by medical
practitioners.
Psychological Responses to the Donation Procedures When
asked to rank the emotional reactions they experienced immediately after the donation procedure on a Likert scale ranging from 1 (very positive) to 6 (very negative), 72.5% of
donors (n 58) recalled a positive emotional reaction,
2.5% (n 2) noted that they had a neutral response, and
Fertility and Sterility

18.8% (n 15) indicated that their immediate emotional reaction was negative. Five participants did not respond to this
question. When participants were asked in an open-ended
question to describe their immediate emotional response,
their responses did not map clearly onto the expected outcomes reported in Table 3 and, therefore, are noted in Table
4. Thirty women (37.5%) recalled only positive psychological reactions, such as excitement or hope, elation or happiness, and pride, 23 women (28.8%) reported that they had
no immediate emotional reaction to having donated eggs,
and 21.2% (n 17) recalled only negative reactions, such
as mood swings, crying hysterically, dislike for injections,
and anger at treatment by medical staff. A small number of
participants (n 5, 6.3%) described experiencing both positive
and negative emotional responses immediately after donation.
Bivariate correlation analyses did not yield any significant
correlations between participants age, financial compensation
received, or the number of times they donated and their
immediate psychological reactions to having donated.
Alignment Between Expectations and Experience
When asked to rank on a Likert scale of 1 (perfectly) to 6 (not
at all) how their overall experience of the egg donation process compared to their expectations, most of the women surveyed (80.0%) reported that their experience matched their
expectations to some degree, with 62.5% of the women
claiming a perfect or nearly perfect match between expectation and reality. Sixteen women (20.0% of the sample) reported that the reality of egg donation differed from their
expectations to some degree. The more common ways in
461

TABLE 4
Psychological reactions donors reported
experiencing immediately after the donation.

Reaction
None
Excited/hopeful/
anxious that the
donation would be
successful
Elated/happy/joyful
Mood swings
Pride in doing
something to help
a couple build a family
Relief that the process
was over
Crying hysterically
Curiosity about the end
result of the donation
and any possible
resultant child(ren)
Dislike for injections
Anger at medical
treatment or the way
they were treated by
medical staff

Percentage of
donors reporting
the reaction (n [ 80)
27.5
17.5

16.3
10.0
10.0

6.3
3.8
2.5

2.5
2.5

Kenney. Looking back. Fertil Steril 2010.

which reality and expectations differed, which participants

detailed in response to an open-ended follow-up question,
are summarized in Table 5. It is notable that three of the
differences recalled by respondents indicated that the
actual process of donation was more positive than they

had expected it would be. Four of the five women who

said they did not expect the physical complications that resulted from the donation process had reported, in response
to the earlier question, being aware of only a limited number of risks before beginning the donation process, such as
hyperstimulation, unintended pregnancy, or moodiness due
to hormone treatment.
Self-Reported Long-Term Physical or Psychological
Effects of Donation
At the time the survey was conducted, 13 of the women
(16.3%) were experiencing physical symptoms that they attributed to the donation process. Three former donors
(3.8% of the sample) attributed current concerns regarding
their own impaired fertility to having donated eggs. Another
three were currently experiencing ovarian cysts or fibroids
that they linked to the donation process. Two women maintained that their body weight was currently higher owing to
the donation procedure, and two others reported that they
were experiencing abdominal pain, which they attributed to
having donated eggs.
Sixteen women (20.0%) reported that the donation process resulted in lasting psychological effects. Seven of
these women (8.8% of the whole sample) indicated that
they experience ongoing curiosity about the outcome of
the procedure and any child(ren) that may have resulted
from the process. Three women reported an ongoing sense
of pride that they had helped an infertile couple establish
a family. Two donors indicated that they had developed ongoing concerns that a child that they bear and raise might,
by chance, meet and develop a relationship with her donor
offspring.
Long-Term Attitudes Toward Egg Donation
As was noted earlier, the egg donors who participated in this
study had donated for the first time between 2 and 15 years
earlier. In response to an open-ended question (Looking
back, how do you feel about the egg donation experience

TABLE 5
Dimensions on which the reality of egg donation differed from the donors expectations.
Percentage of sample endorsing
the dimension (n [ 80)

Dimension
Less physically and/or emotionally taxing than anticipated
More physically and/or emotionally taxing than expected (bloating,
discomfort, pain, difficulty of self-injection)
Did not expect physical complications (hyperstimulation, fibroid in breast,
pain at injection site, reaction to anesthesia)
More time-consuming than anticipated
Felt disrespected by medical staff
Process was more rewarding than anticipated
Risks were downplayed or not explained by medical staff
Felt better informed about the process than expected

8.8
8.8
6.3
6.3
5.0
2.5
2.5
2.5

Kenney. Looking back. Fertil Steril 2010.

462

Kenney and McGowan

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Vol. 93, No. 2, January 15, 2010

now?), the majority of donors (66.2%) reported long-term

postdonation satisfaction, although 13.8% reported longterm negative feelings about having donated, and 12.5%
reported having both positive and negative feelings about
having donated. Five donors reported feeling neutral about
having donated, and one donor did not respond to the question. Of the 59 donors who indicated that financial compensation was significant to their decision to become donors,
61% had long-term positive attitudes toward having donated,
compared with 84.2% of their counterparts, who reported that
financial compensation was less significant or insignificant to
their original decision to become an egg donor.
For donors who felt positively about having donated, typical responses included the following:
I feel it was wonderful and know/hope that I was doing a positive thing for a less fortunate couple. I hope it
worked out for them and the child is healthy as well as
the parents. (Donor 69)
It was a great thing to do for someone else that I
could feel good about and the money made the discomfort worth going through. (Donor 28)
For those who had lasting negative feelings about having
donated, donors expressed frustration over the anonymity
of the process, fears about the relationship between egg donation and fertility problems, and feelings that the inconvenience and physical risks of egg donation were not worth
the compensation. For those who expressed both positive
and negative feelings about having donated, most had mixed
feelings about weighing the risks and benefits of egg donation. For example:
I am happy I donated my eggs. I dont have any feelings of loss or regret at all. Id love to know the recipients involved and see their children, but understand
that I signed those rights away a long time ago. In
some ways, I do feel a little left behind in the process.
I made a conscious decision to do this, so I dont feel
used per se, but I do wish that all communication
with the recipients and the program hadnt ended the
second I was handed a check. (Donor 18)
The older I get, the more I know I did a wonderful
thing. The experience was very positive but the older I
get, I cant help but wonder if Ive put my own fertility
at risk. (Donor 44)
DISCUSSION
This study examined the motivations, expectations, and experiences of 80 women who donated eggs one to nine times between 1989 and 2002 at clinics in 20 states across the U.S.
This sampling strategy assured that the responses received
were not dependent upon the procedures or activities of a specific clinic, although 76.2% of participants (n 61) donated
through a single egg donor matching agency, so it is possible
that these participants expectations of the donation process
may have been shaped by any preparatory materials provided
by that particular agency. The questionnaire was targeted toFertility and Sterility

ward women who first donated at least 2 years before data collection. Our goal was to avoid any immediate postdonation
reactions to the procedure and to allow time for the respondents
to have assessed the longer-term physical, psychological, and
social effects of the donation. Clearly, achieving this goal
came at a cost, as participants in the study were asked to reflect
upon events in their lives that occurred years earlier. Their recall of their motivations and the full range of possible side effects and risks covered during predonation counseling may
have been imperfect, because the ways in which individuals
narrate the events in their lives change over time (30). Nevertheless, it is important to understand how women construct
and interpret their role in egg donation years afterward.
Motivations to Donate
Our respondents motivations for donating their ova were
complex and intertwined. The women who responded to
this survey, like those queried by other researchers (1925),
cited both altruistic and financial reasons for their donations.
The respondents comments suggest that an individual donors perceptions of the benefits of donating may be fluid
over time. Some donors initiated the process for money but
found that concern for the infertile couple became more significant to them as the process unfolded. Others emphasized
that financial gain alone cannot compensate for the difficulties endured during the donation process; a donor must recognize that they are providing an important service to make the
donation worthwhile. The degree to which respondents reported motivations to donate were influenced by social desirability effects cannot be definitively determined. Yet it is
important to consider that the donors responses may have
been influenced by their desire to portray themselves in a positive, selfless, and gender-appropriate manner. Rene Almeling (31) has argued that egg donor agencies in the U.S.
encourage prospective donors to represent themselves in an
altruistic manner because altruistic motivations are read by
agencies to be more gender-appropriate than being financially driven to donate; thus, those who cite altruistic reasons
are deemed better candidates by agencies.
Altruism alone is not enough to attract most donors, however. This is apparent in the limited number of women who
volunteer to donate in regions of the world where payment
is severely limited or forbidden, and it is apparent in the accounts of the U.S. egg donors surveyed here. The vast majority of our respondents noted that the prospect of financial
compensation was significant to their willingness to become
egg donors; but the amount of payment that donors received
did not correlate with the importance that they attributed to
the financial compensation they would receive. Some donors
who claimed that money was extremely important to their decision received compensation at the lower end of the remuneration scale, whereas some donors who claimed payment
was of little relevance to them were among the highest paid
in this sample. At the same time, donors perceptions of the
financial value on their participation in egg donation varied
considerably, with both the highest- and lowest-paid donors
reporting that they were undercompensated and two donors
463

reporting that they were overcompensated. Nevertheless, the

majority of the donors were satisfied with the financial remuneration that they received. Clearly the intermingling of donor motivations is highly complex, and one should not
expect that simply offering more money or simply arousing
altruism by educating potential donors about the plight of
the involuntarily childless will yield more donations.
Previous research has suggested that remuneration may be
more important to young college students who may face educational debt and limited income (22). Both ethicists and clinicians have raised concerns about the motivations of
a financially vulnerable potential donor pool, such as college
students (2), and data from the present study indicate that
these concerns may be well placed. For example, in the present sample, donors who were students at the time of the donation were more likely to cite financial reasons for becoming
egg donors than those who were not students at the time,
with 94.4% of students indicating that financial compensation
was a significant factor in their decision to donate eggs, as opposed to 56.8% of nonstudent donors. In addition, a quarter of
the donors reported that they first learned of ovum donation
through university or college newspapers, which indicates
that advertising techniques used by clinics and egg donor
matching services, which often rely on financial incentives,
may have captured the attention of these would-be donors.
Klock et al. (20) reported that repeat donors were more
likely to be financially motivated to participate in egg donation than one-time donors. This finding was not supported
here. In the present sample, women who donated more than
once put somewhat less stake in the importance of payment
for their participation in egg donation, with 69.6% of repeat
donors rating the importance of payment as high or very
high, as opposed to 83.3% of one-time donors. It is possible
that donors entered into the process with different expectations about the level of compensation they would receive or
differing levels of financial need. Any contrast between
expected and actual return or need and remuneration might
explain, at least in part, the differing levels of satisfaction
women reported with the actual compensation they received.
More systematic research into the motivations and importance of financial compensation to single-time and repeat
egg donors is required to evaluate the role of altruistic and financial motivations in repeat donation.
Predonation Awareness of Risk and the Experience of Egg
Donation
Although most surveyed donors reported being aware of
some physical risks associated with egg donation, a rather
large and troubling minority (20%) of the respondents reported that they were unaware of any possible physical risks
before initiating their first donation cycle. This reported lack
of awareness of risk is difficult to interpret given the length of
time that elapsed between predonation counseling and recall
of information for this survey. Recall and/or reporting healthrelated behaviors is often inaccurate (see, e.g., 32) but can
also be both accurate and detailed many years after the event
464

Kenney and McGowan

Looking back

(see, e.g., 33). Prospective research in which risk awareness

can be measured both at the time of donation and years later
is needed to determine the extent to which recall bias may
play a role donors recollections of their risk awareness.
The majority of the donors (62.8%) reported that they perceived the physical risks they faced as egg donors to be minor
before donation, and most (73.8%) reported that their actual
physical reactions to the procedures were minor. However,
the potential risks that the donors acknowledged being aware
of before their first donation cycle were not well-matched to
the physical side effects that they actually experienced as donors. For example, only a small minority (8.8%) of the sample reported predonation awareness of pain from injections or
egg retrieval, whereas nearly half (45%) of the respondents
indicated experiencing notable pain as a result of these procedures. Only one third of donors reported awareness of the risk
of ovarian hyperstimulation, a serious side effect that that was
actually experienced by 12.5% of the current sample. There
are a number of possible explanations for this apparent disconnect between awareness of physical effects before donation and actual experiences during the donation process. As
noted above, participants recall of the medical risks of the
procedure of which they had been informed may not have
been accurate. Given that participants donated eggs between
2 and 15 years earlier, the potential for forgetting and/or biased recall must be seriously considered. It is also possible
that donors did not categorize potential physical responses
about which they were told before the donation as risks per
se but assigned them more benign labels, such as side effects. Or, in their drive to reap the positive benefits of serving as an egg donor, the donors may have consciously or
unconsciously overlooked mention of the physical risks
they were undertaking. Of course, this disconnect may also
reflect a lack of adequate counseling of prospective donors
regarding the potential risks involved in egg donation. Additional research is needed on the efficacy of various means of
communicating to donors the short-term physical side effects
that may accompany ovarian stimulation and egg retrieval,
as well longitudinal research to assess the accuracy of selfreported knowledge of physical risks associated with egg
donation.
There was a similar disjunction between the psychological
risks the donors recalled being aware of before the donation
and the actual psychological sequelae the donors reported. In
this case, however, the risk awareness reflected more challenging outcomes than the women actually experienced. Donors reported knowledge of a number of possible long-term
psychological stressors that could result from egg donation,
with many noting the potential for experiencing a sense of
loss or attachment to their gametes. The emotional reactions
the donors reported experiencing immediately after the donation ranged from no emotional reaction at all to being happy
and hopeful for the recipient couple to experiencing dramatic
mood swings. Of the 20% of donors who reported lasting psychological effects they attributed to having donated, most
said it was expressed as curiosity about the outcome and
Vol. 93, No. 2, January 15, 2010

any children resulting from the egg donation. Donors reported that predonation counseling they received about the
potential psychological impact of egg donation addressed
such long-term feelings more than it addressed the immediate
or short-term emotional reactions they experienced. For instance, only 2.5% of donors noted that their immediate emotional reaction to having donated was expressed as curiosity
about the end result of the donation, but in reflecting upon the
long-lasting physical and psychological impact of egg donation, 8.8% of donors mentioned that they had ongoing curiosity about the outcome of their donation and frustration about
the anonymity of the process. Kalfoglou and Gittelsohn (19)
also reported this as a common desire among anonymous egg
donors. The results of these studies suggests that egg donors
degree of curiosity about the outcome may be fluid over time
and that clinics and egg donor matching agencies might consider the possibility of standardizing the delivery of nonidentifiable information regarding outcomes of anonymous egg
donation, particularly if a donation resulted in a pregnancy
and/or live birth. Although such a procedural change might
entail some logistical difficulties, this might alleviate some
of the anxiety and curiosity that some participants reported
feeling years after having first donated. Of course, such an arrangement would need to be agreed upon with the recipient
couple before the initiation of the egg donation, and additional research would be necessary to assess the logistical
and emotional complexities of opening the lines of communication between egg donors, recipient couples, and any children resulting from the egg donation.
Similar to the findings of previous studies (20, 23, 2527),
the majority of donors in this study reported satisfaction with
having been egg donors and a high willingness to donate
again. Donors who indicated that financial compensation
was significant to their original decision to become donors
were somewhat less likely to report long-term positive attitudes toward having donated than their counterparts for
whom financial compensation was less significant or insignificant to their decision to donate their eggs.
Most donors reported that their experience of egg donation
met their expectations. These findings suggest that clinicians
and counselors are largely doing an adequate job of preparing
their donors for what to expect, and that most donors retain
positive feelings about their experience. Any negative discrepancies between expectations and reality could largely
be avoided through additional educational efforts on the
part of the counselors and clinicians who recruit and prepare
donors for the process. For example, four of the five women
who said they did not expect the physical complications that
resulted from the donation process reported being aware of
only limited risks before beginning the donation process,
such as hyperstimulation, unintended pregnancy, or moodiness due to hormone treatment. More comprehensive training
on potential risks might eliminate such discrepancies in expectations.
Despite the majority of donors reporting that egg donation
was a positive experience for them, some reported dissatisFertility and Sterility

faction with some aspects of their clinical experience, with

the physical discomforts of egg donation, and with the financial compensation that they received (see also Kafloglou and
Gittelsohn [19]). The problems with the clinical interactions
may be the easiest to ameliorate. Efforts should be increased
to treat egg donors in keeping with their importance as a critical link in the infertility treatment process. Attention should
be paid to clinic entrances and waiting and recovery areas
used for egg donors. The desire to keep donors and recipients
separate in anonymous donation situations is clear and understandable; but facilities assigned to donors should not project
the idea that the donors are of only secondary importance or
that, like others who deliver clinic supplies, they are to use the
back entrance.
In terms of the long-term physical sequelae, a significant
minority of surveyed donors reported serious physical conditions, including their own impaired fertility, ovarian cysts, fibroids, and chronic pelvic pain, which they attributed to
having donated eggs. Of course, there is no way to determine
the causality of their present symptoms with any certainty,
but their reports do suggest the need to maintain contact
with donors over a longer period. Such contact would allow
for the needed accurate assessment of the longer-term health
risks of ovarian stimulation in healthy young women. Although there has been speculation on links between egg donation and long-term health risks like ovarian, endometrial,
and breast cancers, ovarian cysts, fibroids, thyroid disorders,
and pelvic pain, the results of existing medical research has
been inconsistent in drawing causal links between egg donation and these health risks (3437). To our knowledge, no
studies have systematically analyzed whether there is a causal
link between ovarian stimulation for egg donation and impaired fertility. The few studies that have tracked the linkages
between fertility drugs used in IVF and egg donation and the
development of health problems have been limited by small
sample sizes and short time frames of analysis, and they have
mainly tracked IVF patients rather than egg donors longterm health (34, 36, 38). Additional research is indicated in
this area, and careful tracking of donors postdonation health
over a period of many years would provide important insight
into the relationship between potential risks of egg donation
and physical manifestations of those health risks.
In conclusion, this research provides a comprehensive look
at the motivations, expectations and experiences of 80 egg
donors across the U.S. Although this is a relatively smallscale study that is limited by the incalculable influence of donor recall bias, it is the first to query donors from a variety of
clinics nationwide long after their first donation experience.
These data can inform both clinical practice and future
large-scale and longitudinal studies of egg donors in the
U.S. The results suggest that the current systems for recruiting and educating egg donors are working well for most
women but that there are arenas in which improvements
can be made. Education and counseling for women initiating
the donation process can be improved to ensure that they truly
understand both the potential side effects of the treatment and
465

the possible long-term consequences. Procedural changes

can be implemented to assure that donors sense that they
are important and respected contributors to the treatment procedures and efforts made to track and assess their well-being
once egg harvesting is completed. These data suggest that donors curiosity and concern about any offspring that might
have resulted from their donation might increase over time.
Clinics and agencies working with egg donors might work toward developing a system through which nonidentifiable information regarding the outcomes of anonymous egg
donation might be made available to the donors, particularly
if a donation resulted in a pregnancy and/or live birth. Keeping anonymous donors better informed could alleviate some
of the anxiety and curiosity that egg donors reported feeling
years after having first donated. Longitudinal analysis is
needed to more accurately assess many of the issues raised
by this research. Such work could assess the motivations
and importance of financial compensation to single-time
and repeat egg donors and evaluate the role of altruistic and
financial motivations in repeat donation. Longer-term follow-up of donor health is necessary to determine whether
the long-term physical consequences that a small number
of participants in this study attribute to their past donation
are truly related to the donation. Clear understanding of the
risks and benefits of exposing healthy young women to hormonal ovarian stimulation and egg harvesting procedures requires the development of procedures that track donors
physical and mental health over a period of many years after
donation.
Acknowledgements: The authors thank Dr. Judith A. Howard, Dr. David G.
Allen, and two anonymous reviewers for their comments and advice on earlier versions of this article.

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