While money has helped realign these incentives in the U.S.—intended parents can legally pay donors for their frozen eggs—cash compensation for DNA that could spawn a new human is an ethically questionable practice (hence its illegality in much of Europe). The financial incentive could exploit lower-income folks in difficult situations by convincing them to do something they're otherwise not comfortable with; and variations in pricing for eggs from different donors implies that some eggs (and by proxy, some people) are more valuable than others.
And yet, it feels unrealistic and unfair to expect young people to go through a time-intensive, sometimes painful medical process and share their eggs out of sheer generosity, even if would-be parents covered their costs of doing so. But what if they could hold onto a few frozen ones themselves, free of charge, as a perk of donating the rest?
That’s the premise behind egg sharing, a hybrid model of egg freezing and egg donation that lies at the heart of new fertility platform Cofertility. Users who join Cofertility’s “Split” program can freeze their eggs and store them for free for up to 10 years, so long as they donate half to intended parents with whom they're matched (who front the bill for all medical expenses associated with freezing plus the storage).
This kind of arrangement has gained traction in the United Kingdom, where it’s the legal alternative to buying eggs, but has, until now, only cropped up in a few fertility clinics stateside, including CNY Fertility, Oma Fertility, and Freeze and Share. Cofertility—which launched in October 2022 and officially began conducting egg sharing earlier this year—coordinates matches and facilitates the logistics with clinics nationwide.
How the Cofertility Split program solves for pain points in egg freezing and egg donation
By creating an incentive structure where saving some of your eggs for yourself is the "return" for donating eggs, Cofertility’s Split program aims to lower the financial burden of egg freezing and eliminate some of the ethical murkiness of cash-compensated egg donation. Together—as the “co” in the name implies—these changes may help more people have more autonomy over their reproductive choices, regardless of certain financial or biological realities.
On the egg freezing side, “we know that the younger you are when you do it, the more likely you are to be successful down the line,” says reproductive endocrinologist Meera Shah, MD, a Cofertility medical advisor. Yet young people are the least likely to be able to afford it, says Cofertility co-founder and CEO Lauren Makler. After all, it costs, on average, $11,000 for one egg freezing cycle, $5,000 for the medication involved, and $500 per year for storage, according to FertilityIQ. Can’t front those costs? You’d typically need to speed up your pregnancy timeline or wait until you could afford to freeze eggs, when it may be less effective.
With Cofertility’s Split program, “you can preserve your fertility now, for free, while also pursuing other goals, whether you have massive career ambitions, or maybe you want to have three kids but you’re not going to start until you’re in your mid-thirties,” says Makler.
It's important to note, however, that egg freezing is not an insurance policy nor a guarantee of future fertility. Not everyone is considered a candidate for freezing, either (more on that below). The retrieval itself can also cause unpleasant side effects like bloating and cramping. And though it’s becoming increasingly common—the number of people who froze their eggs jumped by 31 percent from 2020 to 2021—there’s still not enough data to determine the potential risk for long-term complications from the egg retrieval process (which involves stimulating the ovaries with hormones to produce many mature eggs at once).
Additionally, it's possible that some young people may not see the benefit of going through with it—that is, self-administering hormone shots, attending several doctor's appointments, and doing the retrieval procedure—even for free, particularly when they have plenty of fertile years ahead of them to conceive naturally.
But for people who plan to wait until later in life to have kids or who have reason to suspect fertility issues down the line, the opportunity to freeze now at no cost (to them) may feel entirely worth it. That was the case for Cofertility member Sara A., who’s 26 and planning to delay pregnancy, and whose mom experienced early menopause at 42. “It provides some comfort and mental space knowing that my young, hopefully healthy eggs are safely stored for later,” she says.
“So much of [cash-compensated egg donation] is rooted in someone selling their eggs for a particular price versus doing something nice for someone else.” —Lauren Makler, co-founder and CEO, Cofertility
That motivation also helps broaden the pool of potential egg donors for Cofertility’s intended parents, as it could appeal to those who might’ve felt skeeved out by the typical cash incentive—much like Makler once was herself. She initially looked into getting eggs from a donor after learning that she had a rare abdominal disease at age 28 that could affect her fertility. “I couldn’t believe how icky and transactional and outdated it all felt,” she says. “So much of it is rooted in someone selling their eggs for a particular price versus doing something nice for someone else.”
To her point, egg-donation advertisements have traditionally touted high-value paychecks and all-expenses-paid vacations as the perks of donating. Rarely do these advertisements reference the medical process of egg retrieval itself or the significant commitment of sharing your DNA with strangers. Not only do these kinds of misleading ads pose the ethical problem of potentially persuading those who aren't comfortable with donating to do so for the money, but also, according to Makler, they may even dissuade those who might otherwise be keen to donate from doing so.
“One of the biggest problems in egg donation is a major lack of diversity among donors,” says Makler, which disadvantages plenty of intended parents by limiting the options they have to build their family. “We believe that’s because payment can be off-putting for a lot of women, making them feel like they’re selling their eggs,” she says, rather than getting compensated for their time and effort. There's a fear that they'll be judged by loved ones, she adds, who might wrongly assume that they're exchanging a part of their body for money, presumably out of greed or financial desperation.
Reinforcing that narrative is the fact that traditional egg donation places a monetary premium on eggs from certain kinds of donors. Typically, that's been people of a specific heritage or education level (e.g., "smart Asian women"), or even with particular talents or high SAT scores, adds Makler. “The fact that one woman could essentially cost more—rather, her eggs could cost more—feels super unethical,” she says.
In erasing cash compensation from the equation and providing the same benefit to all donors, the Cofertility model avoids commodifying the eggs of donors and gives intended parents the comfort of knowing that the eggs they’re receiving are from someone who genuinely would’ve wanted to freeze their eggs for themselves (and who isn’t just agreeing for the money).
Admittedly, the chance to freeze your own eggs at no cost can also reflect a major economic savings—and it’s possible that some donors may still be persuaded to donate for that reason. After all, there’s no incentive structure that doesn’t place some value on the eggs donated. But still, the setup of the Cofertility Split program ostensibly precludes any decision based solely on the monetary upside, says co-founder Halle Tecco, with its purposefully thorough process for onboarding, screening, and connecting donors with the intended parents they stand to help.
Cracking the medical and ethical logistics of egg sharing
Though people often address egg freezing rather flippantly (“Just freeze your eggs!”) and ads for egg donation would have you think it’s quick and easy, both processes involve a substantial investment of time and energy and carry significant future implications. Particularly with egg donation and sharing, you’re giving your genetic material to a stranger, which can have a life-altering impact on you, them, and (naturally) the potential future child. In order to ensure an ethical result, the process for egg sharing with Cofertility Split involves a good deal of screening.
As a baseline, only uterus-having folks who meet all the recommendations from the American Society of Reproductive Medicine (ASRM) for egg donation will qualify for Split to both ensure the safety of all people involved (including a potential future child) and help avoid the scenario where someone freezes their eggs with the intention of donating half of them and only winds up with, say, one or two eggs getting successfully retrieved.
For the sake of the former, every Split member has to complete a medical history and genetic screening to show that they have no markers of hereditary disease (which could make their way to a child) and have a psychological evaluation to demonstrate that they fully understand the gravity of the decision they're making, says Tecco.
And in terms of the latter, hopeful Split members need to be under 34 years old and undergo a test for anti-müllerian hormone, (AMH), “which helps us understand a person's egg supply or ovarian reserve, and whether they’re likely to get enough eggs that they can split and have a meaningful outcome,” says Dr. Shah. While you can’t guarantee good egg yield (even a healthy, young person might have low-quality eggs or not respond well to hormones), she adds, “I think we’ll find that the vast majority of women have outcomes that correlate well with what we've predicted.” Those who don’t qualify can still participate in Cofertility’s "Keep" program and freeze eggs just for themselves—but they’ll have to pay for it in this case (though the company has partnerships with clinics and storage facilities to lessen that price).
“So many intended parents today are really focused on finding a connection with a donor rather than just buying eggs.” —Makler
When a person does qualify and is accepted onto the platform for Cofertility Split, they’ll fill out a profile with all sorts of intel about who they are, what they do and like, and their personality—purposefully detailed to humanize the process of matching. This way, intended parents can “see more than a potential donor’s physical attributes,” says Makler. “They can learn about their values and their motivations and what their ambitions may be, and whether they’re an introvert, an extrovert, or an ambivert, and so on,” she adds. “It’s about getting to the core of who these women are because so many intended parents today are really focused on finding a connection with a donor rather than just buying eggs.”
Naturally, some intended parents might care less about personality and be more interested in connecting with a donor who looks like them, comes from their same ethnic or religious background, or has particular physical traits—which is why Cofertility Split members also share these details in their profiles.
The idea behind the platform's universal exchange is to generate a highly diverse group of donors in order to serve the interests of as many different intended parents as possible. "Choosing a donor is a deeply personal decision," says Makler, who says she's seen the full gamut, from folks eager to choose someone based on the way they write their profile answers or because they share the same favorite movie to those who make a decision based on an uncanny physical similarity. "By the time you're even coming to that decision, you've often been through so much—whether it's multiple rounds of failed IVF or pregnancy losses or illness," says Makler, "so we really try to hold space for whatever feels right."
That experience is mirrored on the donor side, too, as any donor selected by intended parents will get information about that family and can choose whether to opt into the match. “That double opt-in is pretty unique,” says Tecco, “and gives the donor the chance to consider, ‘Who is this family that I’m going to donate to, and could I envision sharing my DNA with them?’”
This matching process opens the door for some version of a relationship between donor and intended parents (and perhaps, eventually, between donor and donor-conceived child), which is quite a departure from the norm. Traditional cash-compensated egg donations function more like a one-and-done transaction, with the egg donor typically remaining anonymous—which recent research suggests isn’t in the best interest of the donor-conceived child (and eventual adult).
“A lot of donor-conceived people may have questions when they grow up about where they came from, or their medical history, or their biological relatives.” —Halle Tecco, co-founder, Cofertility
“What we've learned is that a lot of donor-conceived people may have questions when they grow up about where they came from, or their medical history, or their biological relatives,” says Tecco. Knowing the nature of their conception before those questions arise is a good thing. “That doesn’t necessarily mean that all donor-conceived people will want to have a relationship with their donor, but it means having access to that information can feel a lot less troubling or traumatic down the line,” says Tecco.
For that reason, Cofertility encourages donors and intended parents to have a disclosed relationship (aka non-anonymous), and can even set up a virtual meeting for matches to get face time before deciding whether to formally pair. “I’m grateful that I moved forward with a direct connection [with my donor],” says Lisa F., 44, a cancer survivor who began her search for an egg donor after multiple unsuccessful rounds of IVF. “A total stranger just felt familiar to me, and our connection was magical.”
Sara was a bit more apprehensive going into her own match meeting with the intended parents to which she’ll be donating, but “the more I thought about adding a layer of transparency to the process and for the potential future kid, the more I liked the idea,” she says.
Certainly, not every donor or intended parent will want to meet either the family to which their eggs will go or the person supplying them, respectively—and that’s okay. The goal is just that all parties involved can have a say in the relationship or lack thereof, says Tecco. “When we set out to build this, we really just wanted to honor the donors, the parents, and ultimately, the children that we're helping bring into this world.”
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