A World of Hope Restored

1 | P a g e Gift ov life: A WORLD OF HOPE RESTORED Egg donation as a path to parenthood: www.giftovlife.com

Tips to surviving and triumphing in the world of babies via egg donation

By Tami Sussman & Dawn Blank

South Africa


Contents About the Authors

Mourning the loss of your genetic material

The Emotional challenge

Resources for Coping and Triumphing

Choosing an Egg Donor

The egg donation process & associated timing

To tell or not to tell

Egg Donation Terminologies

Helpful Resources

About Gift ov life


About the Authors

We founded Gift ov life after experiencing our own fertility challenges and (many!) AI and IVF treatments, as we longed to become mothers. Gift ov life has since grown and is now one of the largest and most reputable national egg donation agencies in the Southern Hemisphere. We also service recipients traveling to South Africa for egg donation IVF with Gift ov life Australia, Gift ov life UK and Gift ov life USA.

Co-Founder Dawn Blank is based in Johannesburg and is a mother to two IVF miracles. Co-Founder Tami Sussman operates out of Cape Town and is still undergoing IVF to receive her gift ov life. Together we have the experience, empathy, understanding and compassion to assist you in what we sincerely hope is an end to your infertility path.

Gift ov life offers its recipient parents choice, with one of the largest online egg donor databases; accessibility with donors being available without any waiting period; anonymity, confidentiality and reputability as we work with, and are referred by, the leading fertility clinics; as well as empathy and an understanding of your need for a quick and seamless egg donation process.

If your hope is to build your family through IVF with donor egg treatment, we at Gift ov life will personally guide and support you in this often-daunting process. Both prospective parents and our egg donor angels are treated with the highest ethical standards, warm, prompt and professional, experienced and individualised service.

Gift ov Life does not discriminate assures you absolute confidentiality and we will always be personally available to you as we assist you through this process.

According to the World Health Organisation, infertility affects one in seven couples worldwide. The incidence of woman needing an egg donor to conceive is increasing.

This book, Hope Restored, is a culmination of our experience working with woman, with couples, that have been faced with needing an egg donor in order to conceive. We wanted to share what so many woman have shared with us, in the hope that as you read this book you will feel more informed, less alone, more supported and possibly, less devastated. Knowledge, support and comfort are available to you.

Gift ov life Co-Founders: Tami Sussman & Dawn Blank


Mourning the Loss of your Genetic Material 2QHUHFLSLHQWRIGRQRUHJJVVKDUHG,UHPHPEHUZKHQP\GRFWRUILUVWVWDUWHGWDONLQJDERXWGRQRUHJJV,ZDVdevastated. It felt as though someone had WROGPH , KDG D WHUPLQDO LOOQHVV , FRXOGQW LQP\ZLOGHVW GUHDPVimagine anything worse- LWZDVP\ZRUVWQLJKWPDUH,WLVDQHQRUPRXVVKRFNWRILQGRXWWKDW\RXKDYHWRVD\goodbye to seeing your DNA in your child, and to mourn the loss of your genetic material. 7KHGHVLUH WR UHSURGXFHDQGKDYHRQHVRZQFKLOGUHQ LVa primary human instinct. For many women it is an experience that drives our very existence. Even when a woman is not desperately wanting a child, when she is advised that she is unable to produce offspring using her own genetic material, the shock and fear can feel like a death, in fact, at some level it is just that. Also of course is the influence and pressure of a male partner, families, friends and society in general DOOH[SHFWLQJWKDWFRQFHLYLQJLVDQLQWHJUDOSDUWRIDZRPDQVOLIHDQGan expected result. It is important to understand that there is a steady decline in DZRPDQVfertility with increasing age, particularly

from the age of 35, but for some woman earlier and for others later. A female is born with all the eggs she will ever have, around 4 million. By the time she reaches puberty and starts ovulating, the number of eggs has already reduced to about 300,000. Whilst only one egg is usually released every month, hundreds of eggs are lost at the initiation of the ovulation process. Besides the decline in the quantity of eggs with advancing age, there is also deterioration in the quality of eggs available. In addition to these factors there is also an increased incidence of chromosomal abnormalities with age. Furthermore, embryos are less likely to implant in the endometrium after fertilisation and/or may be unable to maintain their implantation. This means that with increased female age there exists a higher risk for babies born with conditions such as Downs Syndrome, a higher rate of unsuccessful attempts to conceive and a higher risk of miscarriage. These factors often mean that the older woman will have a lower chance of successful pregnancy following in vitro fertilisation. Egg

quantity and quality may be compromised and for woman facing this fact, the recommendation to consider donor eggs will almost always be an unbearable truth. Our experience has been that most women are under the false impression that, provided they are having regular menstrual cycles, their fertility status is good. The teUPV )6+ DQG $+02YDULDQ UHVHUYH DUH IRUHLJQ WRmost woman until they are confronted with what seems like a freiJKW WUDLQ KLWWLQJ WKHP KHDG RQ DV RQHrecipient put it. So, how DO you come to terms with needing donor eggs in order to conceive? The absolute reality is that infertility and the need for donor eggs wrenches your heart, tests your relationships, questions your faith and overall is a life altering experience. $V ZLWK DOO OLIHV H[SHULHQFHV HDFK SHUVRQV UHDFWLRQ LV GLIIHUHQW $V we are all unique, so our coping mechanisms are all so different. There is no right or wrong reaction to this devastating news. The time that each woman takes to mourn and sit with the pain is ok. Some women are almost immediately ready to move past the heartache to find a solution and move forward. Other woman, and/or their partners take weeks, months or years to move onto acceptance and even excitement at the prospect of having a baby. Most women will however identify with one or more of the stages, emotions and reactions we discuss below.


On the initial hearing that you will not be able to conceive with your own eggs, shock is often the first thing to hit you. Absolute disbelief that this unimaginable horror is actually happening to YOU. The numbness, tearfulness, fear and confusion that follow are all understandable and accepted as expected emotions. This is ORVV 2IWHQZRPDQZLOOVD\LIRQO\,KDGVHWWOHGGRZQHDUOLHU,ZRXOGQRWEHLQWKLVVLWXDWLRQRULIRQO\,KDGQRWSXWP\FDUHHUILUVWSelf-blame is often at the center of the loss of ones fertility, only because it could have been averted with youth, which is now hindsight. If not immediately, then certainly thereafter, anger is often an emotion that hits you, along with the frustration and irritation that having a baby is not within your control. :RPDQ KDYH EHFRPH VR HPSRZHUHG LQ WRGD\VZRUOG DQGQRZKHUH LV D SURMHFW WKDW LV RIWHQ DV D UHVXOW RIZRPDQ WDNLQJ FRQWURO of her life and delaying childbearing. For some woman anger is transitory and depression is immediate. Feeling helpless, without purpose and energy are often part of this awful path. The reality is just that reality. Moving backwards is not possible, moving forward to find a way to deal with the reality, a solution, a path that will lead to the yearning that often never leaves a woman until it is fulfilled that of having a baby. Acceptance, if not of the situation, then of the fact that you long to have a child, is the motivation that leads woman to explore the egg donor route. And so the world of hope restored, of renewed fertility, is born for so many women who find themselves facing this challenge. It is true that you will continue to struggle with questions, emotional seesawing over and over again before, during and for some even after the egg donation process. As a UHFLSLHQWV KXVEDQGVDLG WRXV7KLV LVRQHRIthose processes in life where the end justifies the means7he rewards are life changing for so many couples that choose egg donation as a means to conceive. There will be a time when you will most likely look at the positive side of the situation, that at least there is a greater chance of conception, that science has progressed to allow this treatment, that South Africa allows egg donation, that being pregnant is a possibility via egg donation7KDWDOWKRXJKRQHRIOLIHVPDMRUKXUGOHVLWLVnot the end of the world. Then there will be times when your heart will ache at the thought of never seeing your DNA created in a child. That you have been robbed. That life is not fair. Its true that, in the same way one deals with any loss, only you can find a way to process your loss and to look forward to this SRVVLEOHVHFRQGFKDQFHDWKDYLQJDEDE\ We recall so clearly DUHFLSLHQWVD\LQJRQFHDJRWWRWKHERWWRPRIP\QHHGIRUP\own genetic baby, I realised that the need came from my own ego. My view was that my genetics were superior. When I got over my own ego, I was able to move forward with egg GRQDWLRQ 6KH LV QRZ D FRQWHQW PRWKHU RI KHU EDE\ YLD HJJdonation. Those egg donor recipients that have had one baby via egg donation and return for a second or third child will tell you of the absolute love, devotion and bond that they have with their children and often how much they appreciate motherhood after all the heartache. We have worked with couples that have a child or children via natural conception and then a baby conceived via egg donation and how they feel there is no difference. They do not feel that the child is not their own. They feel no difference in love, bonding or commitment given the difference in the means of conception.


Couples share with us that they could not love their child more, even if he/she had been conceived of her own egg. The renewed hope and excitement comes once you decide to move forward and go ahead with creating your family. $VRQHUHFLSLHQWRIHJJGRQDWLRQVDLG,I$QJHOLQD-ROLHFDQORYHDGRSWHGFKLOGUHQDVVKHORYHVKHUown biological babies and keep adopting more, why canW,VHHDEHDXWLIXOVLGHWRWKLV" Whether you have arrived at the decision to use donor eggs after years of fertility treatments or within days of being advised that this may be the only option available to you to conceive a child, it may still be hard to come to terms with the idea of using somHRQHHOVHVJHQHWLFPDWHULDOWR produce a child. You and your partner, if you have one, may feel differently about the realities of donor conception. Sometimes one partner is less comfortable than the other with the idea of conceiving and raising a child with whom you have only a part, or no, genetic connection. Especially as this is a decision no one would choose to be making, these feelings can seem insurmountable. Deciding to use donor eggs to conceive involves, at its very core, letting go. Letting go RIWKHSDLQWKHHJRWKHFRQWURO2QHRIRXUUHFLSLHQWVVKDUHG,KDGWRGHFLGHZKDWZDVPRVWLPSRUWDQW being a mother or passing on my genetic material. For me being a mother was the ultimate driver in my decision to PRYHIRUZDUGZLWKWKHDVVLVWDQFHRIDQHJJGRQRU The practical advise that we can give you, dealing with recipients everyday, would be: - You are not alone. Because most couples choose not to disclose that they have used donor eggs to conceive, this reality is know by very few. - It is ok to fall apart. Not only is it ok, its expected and a part of the mourning process. - Talk about the pain and the possibilities of using donor eggs. Confide in someone you trust

donation. It can only help to process the emotions and thoughts that you are having.

The Emotional challenge There are many questions that recipients of egg donation ask of themselves when confronted with egg donation as a means of conception. Will I love the child as much as if it was conceived with my own egg? Mothers who have birthed their children following egg donation will tell you how the joy is overwhelming and would be no greater where your eggs part of the conception. Unfortunately, you have to go through it to know that fact and understand the hindsight of egg donation and the ambivalence that many mothers of egg donation have once they have conceived.


When you are struggling with the concept of egg donation and grieving after your own DNA, it seems that motherhood will never be yours. Hundreds of mothers via egg donation, surrogacy and adoption will however tell you that motherhood is about a love so deep it hurtsits about protecting your child to the death, about putting yourself nowhere in order to put your child -stop. Remember that attachment is not a function of genetic relatedness. Am I the biological mother of the child conceived via egg donation? The pregnant body is responsible for the growth of the fetus. The fetus takes its required fluids and "food" compounds from the blood via the placenta for the 40 or so weeks of its development. It is the flesh and blood that results in the baby's flesh and blood. She is the biological mother and the child is her biological son or daughter. for my child years later? This is often a fear that woman express to us. The fact is that many couples come to Gift ov life from Australia and the UK for IVF egg donation because of the legislation regarding egg donors in South Africa. Egg donation in South Africa is confidential and anonymous. Egg donors and recipients never know each ersonal details and never meet each other. For egg donors this is a sense of relief, as they do not donate because they want to produce a child! For recipient couples this is an unimaginable gift as there is no possibility that identities may become known at any time in the future. Couples are able to move forward with their lives and family with complete confidence. In countries like Australia and the UK, there is a central registry detailing all personal particulars, which is not acceptable for many couples or potential egg donors. How do I deal with my emotions towards egg donation? Men and women are affected by infertility in different ways. This is related to the way in which society trains and expects men and women to think, feel and act. Women are typically seen, by others as well as themselves, as the emotional caretakers or providers of the relationship. Women typically feel responsible not only for everyone's bad feelings, but also for anything bad that happens. When women try to repress feelings, their emotions can become more ominous until they finally feel out of control. Their emotions can become a monster about to swallow them whole. Our experience is that a women of an infertile couple, often protects her partner from her own pain and feelings of failure and as such takes much of the responsibility for the treatments and process upon herself. Sound familiar? When it is suggested that men accompany their wives for appointments, couples get concerned about issues like income loss, use of time, etc. While these concerns are usually relevant and important, they also serve the purpose of protecting husbands from their own responsibility in the conception process and from their own feelings,


which could easily be intensified by the repetitive contact with the medical team, which is part of the process. Men are traditionally seen as the financial providers of the relationship and are responsible for protecting the family from real or imagined dangers. Men usually feel more threatened expressing themselves since they have often been conditioned to repress their emotions. They are trained to be more instructional to take charge, to make decisions and to think without being sidetracked by emotions. Males in infertile couples often feel overwhelmed by the intensity of their partner's emotions as well as an inability to access and express their own feelings. They tend to focus their energy back into their work, a place where they feel they can have more success. As a result of taking responsibility for the emotional impact of the infertility, the woman experiences intense feelings, such as pain, anger, fear and frustration. This can be a very lonely time for a woman. Be aware of this and why you are feeling this way. Remind yourself of the facts that we have documented above and try and keep your feelings and the situation in perspective. Realise and accept that this may be one of the most challenging times in your relationship with your partner. You are in an intensely emotional state and, whether he expresses it or not, so is your partner. Interactions may be strained and affection inconsistent as you each try to come to terms with the facts, options and road ahead. It is normal to feel out of control and not know how to ask for what you need from the partner you are trying hard to protect. You may yearn for an emotional connection and interaction at one moment and in the next withdraw emotionally. For the man in this situation they may find themselves in a position where, regardless of how well they've been trained to solve problems, they are helpless to make this situation better for the woman. As a result they may give off messages that she is "too" emotional or sensitive, hoping that this will calm her down. The woman may interpret this as criticism rather than as an expression of her husband's own fears. If all you remember from this chapter is that its OK and NORMAL for infertility to challenge your relationship, you will be doing well! What about my age as a recipient of egg donation? Recipients successfully carry a baby. Unless your specialist has advised you otherwise, the fact is that just because the ovaries have failed it does not mean that your uterus is compromised. We have had a recipient to egg donation as old as 52 when she conceived (her first child!) She carried beautifully and has a

referred to, relates specifically to the viability of a eggs to conceive. Once an egg donor is used for conception the clock no longer ticks!


Resources for coping and triumphing Once a couple have decided to attempt to conceive using donor eggs they will find themselves overwhelmed by the next step where, how and with whom do they partner and place their trust for the journey ahead? There are various resources that you need to move forward with egg donation. Some are essential requirements and others are options that you may wish to consider in support of your road ahead. Choosing your fertility clinic/Doctor and choosing your egg donor are key decisions. Choosing your clinic and specialist Choosing a fertility expert and clinic to help you get pregnant is an important decision and there are a number of variables that you should review and consider. Chemistry: We would say the most important factor is to be sure the chemistry is right between you and your doctor/clinic. Invariably you would have received the news that you need an egg donor from a specialist. You will instinctively feel that you wish to continue being under his/her care or not. You may end up working with the specialist for months or longer. Infertility treatment is emotionally difficult and physically taxing so the need for a doctor with whom you feel comfortable is imperative. Your doctor needs to be caring and empathetic, but comfortable to give you the facts, no matter how hard they may be to hear. Availability and accessibility of doctor and their support team: It is important that you have access to your doctor and/or is support in order to have your questions answered and needs addressed. Personal attention is imperative. The friendliness and helpfulness of the staff will also give you a feel for the character of the practice and the doctor. The personal recommendation of others that have been treated by a clinic or Doctor often provide a good indication. Statistics, statistics, and statistics: You want a baby, so choose a fertility clinic with good success rates. When considering a doctor and a clinic it is important to know what your specific chances for success will be as a recipient of egg donation. South African success rates at top fertility clinics are among the highest in the world. Experience: The clinics experience can be one of the most important factors when deciding which doctor/clinic to approach for fertility treatment. One should ask how long the doctors have been performing egg donation IVF and whether this is a treatment routinely performed. Also of prime importance for egg donation IVF is the laboratory facilities. Cost: For many couples it is important to establish the total cost that the treatment before commencing. Financial stress can be a huge part of the stress involved in deciding to go the egg donor route. Be informed, plan, budget and know what costs you will be expected to pay and when they become due. Your budget should take cognisance of the following costs as they apply: Recipient consultation fees and medication; egg donor agency match fee; clinics fee to assess your donor; the donors legislated compensation; donors medication; egg retrieval costs; theatre costs, laboratory costs, embryo transfer costs; recipients post embryos transfer medication; embryos freezing; embryos transport (should you


wish to move excess embryos to your home country/town.) For out of town couples, travel and accommodation costs need to be incorporated. What is important when choosing which egg donor agency / program to work with? result of more factors than an egg donor agency can take credit for? After all, the fertility clinic and doctors and their treatment protocol, the age of the donor and her fertility screening, the quality and quantity of the sperm used to fertilise, the ability of the uterus to facilitate the growth of the embryo. These are all factors that must be optimal in order to achieve a pregnancy. The fact is that all egg donor agencies in South Africa are governed by certain criteria that ensure donors are viable as fertile egg donors. These factors include egg donors being between the ages of 18 and 35, having a certain and optimal BMI and being screened before an egg donation cycle is undertaken. These factors result in all agencies being created equal as regards the actual donor. Or does it? How does one rate an agency? What after all is the role of the egg donor agency? Passport factors are standard practices that allow an egg donor agency to remain viable and attractive to recipient parents. They include: promptness in dealing with enquiries, a professional and understanding approach and first-hand knowledge and experience of the IVF process. What then differentiates one agency from the rest, if it is not the number of pregnancies achieved, the level of professionalism and first-hand experience? important to you...what would be the differentiating factors for you? Would you not want to know about the donors, whose genes you choosing, inside and out? Surely her grades at school, her tertiary education, her sexual orientation, how her grandparents may have died, whether she or anyone in her family suffers from one of 97 different conditions that may be passed on genetically, her parents hair and eye on and on. The fact that not all egg donor agencies take the interest, time or effort to make as much information available as possible to prospective parents means that all egg donor agencies are not, in fact, created informed decision? After all, as potential egg donor rin choosing an agency that gives you all the information? If you are not being provided with detailed information on a donor, ask yourself why. A summary of factors to consider when selecting an egg donor agency to work with: x Efficiency: How quickly does the agency respond to your emails or communication? Are they available 7 days a week? The process that you are about to undertake relies on efficient, prompt and after hours service. Start as you wish to continue.


x Preferred agencies: There are preferred agencies operating in South Africa. Is the agency referred by ALL leading fertility clinics or are some excluded? If there is a clinic that has selected not to work with a particular agency, call the clinic and ask them why. Our experience of the leading South African fertility clinics is listed at the back of this book. x Personal attention & experience: Do the agency owners deal with you directly? Do they have personal experience of infertility? This is a very personal journey and your agency support can often be as necessary as the support of your clinic and doctor. x Face to face agency contact: Unless you are not based in South Africa, request a personal face to face meeting with the agency. This will be valuable both in terms of establishing a rapport with the persona in the agency that will assist you in selecting your donors and will provide an opportunity to have any questions you may have answered. x Reviewing adult pictures: Will the agency be prepared to review your adult pictures against those of the donor? Will the agency share those pictures with the clinic in order to verify their comments? x Egg donor database: Do you have a wide choice of donors? Choice in selecting your donor is possibly the most important factor that an agency can provide for you. x Donor age: The age of a donor is arguably one of the most important factors as a prediction of her fertility. We suggest that a donor should not be over the age of 33 this maximises her fertility based on the age of her eggs. take.

x Cost: If an agency is charging a match and management fee way below the market norm, ask yourself why. Do not compromise on quality of donors or service for price. x Refunds & second attempts: In the event that the donor does not pass her medical and psychological screening, after you have selected her and paid the agency match fee, are you guaranteed a 100% refund as should be the case. Furthermore, if your first attempt is not successful, will the agency give you a reduced fee for a second attempt with the same or another donor?

Your personal support structure

decision to use donor eggs. You can always tell additional people about your egg donor route in the future but you Get your support team together. Plan coffee dates with whomever you feel can support you with unconditional love, understanding and confidentiality if that is important to you. It is also understandable if you and your partner do not want to tell anyone that you are going through egg donor IVF. Be sure then to be there for each other during this time.

Where to Find Additional Support

A psychologist: Choose a psychologist that has experience in dealing with recipients of egg donation as well as screening donors for egg donation. The back of this book refers to professionals in this field.


An online Support Group: Some recipients prefer the anonymity of an online forum. There are many forums and support groups online that offer a two way communication of support and interaction. Studies show that men, in particular, respond well to the support they get from these groups. Egg donor agency: If you choose the right egg donor agency, this can be an excellent source of information, support and understanding. An agency can offer you the information that you may be missing and can also offer you impartial support that is both experience based and confidential. Choosing a Donor The criteria with which recipient parents select a donor is as varied as the recipients that we meet and deal with daily. It is also completely natural to have anxiety over and during the selection process. It is important to remember that there is no rush in choosing a donor. It may take time to find the right match or it may be almost immediate there are no rules. Whatever you are looking for as intended parents; try to get as much information as possible from your egg donation agency regarding the donor, while also tryi- After consideration of race, In our experience, recipients tend to select their donor based on one or more of the following criterion: - Physical: physical match looking at eye colour, hair colour, skin tone, height, body frame and adult facial features. - Intelligence: final school year grades and tertiary education. Bear I mind that some egg donors may have the aptitude to have studied further but not the financial means. - Baby pictures: looking at the similarity of baby pictures. Given the South African legislation, only childhood, and not adult, pictures are permitted to be shared with recipients. - Personality: Some recipients are interested in the personality that comes through in a profile. - Reason for donating: Recipients may be interested in the reasons a donor wants to donate and ask whether altruistic or financial motivations have motivated her decision. - Gut feeling: Some recipients start out looking at some or all of the above factors and end up selread A note for Jewish recipients: After consultation with we have been advised that the status of a child born is based on whether or not the birth mother is Jewish. The religious orientation of the egg donor is of no consequence in determining whether the child is Jewish.


Once a donor is selected the challenge and allowing the medical team and egg donor agency to drive the process forward. There are no guarantees in life, all of us who are parents usually begrudgingly learn that a lot more of life is out of our control than we would like. Parenting is about being able to handle all the imperfections that come with a child, whether you have your child through an egg donor or not. When couples do have difficulty containing their anxiety during this process therapy can help. Your Donors Screening In South Africa, donors are medically and psychologically screened once they are selected to donate for a recipient. Pre-screening is all good and well but blood tests should be taken just before your donation as factors can otherwise have changed between when she was last screened and when you have selected her. The psychological screening, by a psychologist or a social worker, will review the donor versus the information she has recorded in her profile, and explore any potential psychological problems. The psychologist will also discuss her decision to donate and try and predict her reliability and commitment to the egg donation process. The medical screening is two fold. Firstly the ovaries will be checked via an internal scan. Secondly blood tests will be performed. The blood tests check infectious diseases as well as fertility indicators, including FSH and AMH tests. The agency is required to screen the donor based on age, BMI and the completion of personal and social history, as well as their and their immediate families medical and health history. The recipient is responsible for the medical and psychological screening costs. There are various questions that Recipient parents often ask us as they go through the selection process. We would like to share some of these with you.

What is the ideal age for an egg donor? Donor age is an obvious and important factor to consider in choosing an egg donor. The age of the donor will indicate the age of her eggs. Statistically, women in their mid-20s are considered ideal candidates for egg donation. The law in most countries allows for egg donors between the ages of 18 and 35. However, our suggestion would be to select a donor over 21, to ensure the emotional maturity of the donor, and no older than 33. How do I find a d The reality is that there is no such thing as a donor that will match you 100%. You are you! What you can do is look for ethnic origin, features, eye colour, hair colour and hair type, height, body type, personality similarities and intelligence similarities.


The reality, as one donor and personalities different to each other and none like their biological mother or father! We will get what After all the analysis, go with a donor choice that is your peaceful preference. Should I choose a proven donor? A proven donor means that the donor has donated before. Proven fertility, on the other hand, means that she has been pregnant before and it is therefore possible to say that she is fertile. All donors, whether proven or not, undergo medical pelvic and scan procedures and blood tests to determine the presence of ovaries, eggs and to track how the eggs mature under hormone treatment. A proven donor is therefore not always indicated. Does it matter if the donor smokes? This is often a question raised by couples choosing a donor. The facts and considerations are as follows: - The medical body governing gamete donation has allowed donors to be smokers, as detailed in the Guidelines for Gamete Donation in South Africa. - It is not true that non-smoking donors produce better or worse quality or quantity eggs than smokers. Exactly what causes one egg reserve and quality known. There are age, lifestyle and genetic factors that can be contributors. Certainly age is a definite woman in t How many embryos are considered a good number in a donor egg cycle? Since most fertility clinics transfer only two embryos or one embryo in an IVF cycle, it is not necessary to have a large number of embryos to achieve a healthy pregnancy. Nevertheless, when there are many embryos from one egg retrieval, the recipient is more likely to have extra embryos to freeze for future use. Having at least 6-8 fertilised eggs is certainly desirable, and frequently there are more than this. The fertilises, attaches and grows! How do I ensure desirable traits?

parents are analysing the egg donation route to conception. The reason it is still a debate s. In terms of factors which are often determined by genetics we provide the detailed donor profiles in order to try and match some of these traits e.g.: eye colour and height. As regards your


How important is the birth mother given a child conceived via egg donation? Genes are expressed within a given child depending on the environment and its effects. The environment is the pregnancy woman's womb and its is her genes, and not the egg donor's, that will determine how the genes received from the egg donor, are expressed. Epigenetics is a new buzzword in the field of egg donation for conception. Essentially Epigenetics refers to factors outside the gene, such as a cell's exposure to hormones or genetic variations that can modify a gene. Such factors can change what is ultimately expressed; they can change a phenotype i.e.: they can alter what an organism looks like as a consequence of the interaction of its gene AND the environment. In terms of conception via egg donation that environment begins with the womb of the birth mother. Some unrelated examples of epigenetics include hormone and reproductive factors in a woman that may influence the chances of breast and ovarian cancer. These factors are believed to be linked to a woman's exposure to estrogen and progesterone and their effects on cell differentiation in the breast that occur during pregnancy. Conventional science has historically linked cell behaviour to the genes present. Latest research suggests however that cells send out signals unique to an individual that in turn receives signals from the outside. This is specifically interesting for birth mothers where it appears our identities may be formed in the womb, linked to an exterior field of energy. World Epigenetics studies are now focusing on how donor conceived babies DNA may actually be expressed based on the woman who carries that baby. The study of Epigenetics reveals that our lives are more than the sum of our inherited genes. During growth in the womb and after birth differences begin to reveal themselves due to specific genes being active in some people and non-active in others. There are a number of reasons for certain genes to be active and others not including the way the hosts body functions, lifestyle and how we think and feel our emotions and reactions. In the world of babies conceived via egg donation, it is the woman carrying the baby at the conception of life, that starts the process of determining which genes are active and non-active. The birth mother helps shape the baby she carries from the moment that embryo is implanted in her uterus. The egg donation process and associated timing The egg donation cycle usually takes on average around 3 months from beginning to end. It may be shorter and it may be longer, depending on certain factors and your timing requirements. SELECTING A DONOR AND HER SCREENING Once you have selected and secured your donor, your agency will make contact with your treatment clinic and advise them that you have selected a donor. They will do a formal handover to the treating clinic and/or doctor and to the treating psychologist, according to the clinics specific protocol.


The assessments by your fertility specialist and psychologist will follow. From the time you choose your donor until she has had her first consultation and you receive the results of her blood tests, usually takes approximately 3 weeks. This is a difficult waiting time for you as invariably you just want to get started! You need to be patient, as need to be taken into account when making appointments. CYCLE CO-ORDINATION Cycle co-ordination involves ensuring that when s is ready to receive an embryo (or two!) five days later. The doctor and the IVF co-ordinator of your preferred clinic will make direct contact with you to discuss your and the donors treatment plans. Your cycle and that of your cycle will be co-ordinated synchronised - and the time line for donation and embryo transfer determined. The time required for this part of the process varies from one donor/recipient to the next, depending on your cycles and whether or not the donor is on the Pill. Often the donor will be prescribed the Pill to assist with cycle co-ordination. Allow 6 to 8 weeks for cycle co-ordination. MEDICATION AND EGG RETRIEVAL -ordinated cycle she will begin her hormone treatment, designed to stimulate egg maturation. If you have ever been through an IVF cycle you will know that this involves her injecting herself with subcutaneous injections into the stomach. You will also commence your medication treatment to prepare your womb lining for receipt of the embryo/s. The donor will be seen by the doctor throughout her treatment cycle with regular scans to ensure that she is being optimally stimulated. Over stimulation can produce too many eggs (sometimes in excess of 36 eggs) and under stimulation may result in your not getting a good egg yield. The doctor will, by way of a scan, determine when the donor eggs are ready for aspiration/ removal. These scans are usually performed on day 8, day 10 and day 12 of her cycle. Usually around midnight on day 12 the donor will be given her trigger injection to assist with the release of the eggs and prepare her for her retrieval, which is usually performed 48 hours later. Egg retrieval is usually performed between day 12 and day 14 of the donors cycle but this can vary, depending on the maturation rate of the eggs. Your partner (or for some woman sperm donor) will be required to drop off a sample of his sperm on the clinic on the morning of retrieval to allow for the embryologists to perform the fertilisation. The process of medication to egg retrieval takes 2 weeks.


FERTILISATION AND EMBRYO TRANSFER On the day that the eggs are removed they will be fertilised with your partners semen by the embryology team at your fertility clinic. You will be contacted the following day with an update on how the embryos are growing! This is an anxious and exciting time so be prepared! Three to six days after fertilisation (usually 5 days) the embryo/s will be transferred to your womb in a simple, quick and pain-free procedure. ARE YOU PREGNANT? You will have to wait approximately 12 to 14 days to find out, via a blood test, whether you are pregnant! This waiting is the hardest part of the procedure!


A SAMPLE IVF DONOR CYCLE DAY DETAIL 1 2 3 stimulation injections 4 stimulation injections 5 stimulation injections 6 stimulation injections 7 stimulation injections 8 stimulation injections. SCAN 1 8 cation stimulation injections 9 stimulation injections. SCAN 2 10 stimulation injections 11 Trigger Injection 12 Donor rest day - no medication 13 Donor Egg retrieval Sperm sample to be provided - Fertilisation of the sperm & donor egg 14 Day 1 of embryo cycle 15 Day 2 of embryo cycle 16 Day 3 of embryo cycle 17 Day 4 of embryo cycle 18 Day 5 of embryo cycle embryo transfer 19 12 to 14 day wait 20 12 to 14 day wait 21 12 to 14 day wait 22 12 to 14 day wait 23 12 to 14 day wait 24 12 to 14 day wait 25 12 to 14 day wait 26 12 to 14 day wait 27 12 to 14 day wait 28 12 to 14 day wait 29 12 to 14 day wait 30 Pregnancy Test * Please note that this is a sample schedule. Medication and timing will vary from donor to donor and recipient to recipient


To tell or not to tell One of the pressing thoughts and questions that recipient parents of egg donation dwell on, is whether to tell anyone about their decision to use donor eggs. Intended parents also spend time thinking about whether they should tell their child of his/her conception. Although surveys have shown that most people approve of, and support the use of donors to help make families, this is still a very personal decision. There are the activists for childrens rights that will advise on telling the child of his/her conception. There are also the views of recipients of egg donation that have conceived and will tell you that they want to get on with beiwithout constant anxiety about how a child may react to news about his/her conception. Dealing with your own feelings and the reactions of others is not easy. Many parents face this very difficult situation. For some intended parents the answer to this question is decided long before the egg donation procedure even commences. It is based on a peaceful preference for you and your partner. If you have not conception details public or not, considers this advice from an egg recipient mother. She suggested that before you decide whether or not to give birth to your child. Often once you settle into motherhood, the answer to this question becomes clearer for you. The reality is that, despite professional recommendations and recipient advise, this is a personal decision and the answer is specific to each new family created via egg donation. It is difficult to know how you might think and feel after the child is born and the emotions of infertility are behind you. It can be wise to more people later, but you can never -


Egg Donation Terminologies

ER relates to a movie about an extra terestrial being and that FSH is not a mis-selling for FISH es in the world of egg donation. Recipient A recipient, or recipient couple, is the would be parent/s of an egg donation IVF attempt. IVF: In vitro fertilisation IVF is a term that, for some couples, is a completely new concept. IVF is a process by which egg cells are fertilised by sperm outside the body; in vitro. IVF as a treatment for infertility and the only method by which donor eggs can be used for assisted conception. The eggs are removed from the ovaries and fertilised with the partners sperm in a fluid medium in a laboratory. The resulting embryo is then transferred to the uterus in an attempt to establish a pregnancy. The first successful birth from an IVF procedure was in 1978. ER: Egg Retrieval The eggs are retrieved from the donor via trans-vaginal ultrasound aspiration. This is a procedure performed under conscious sedation. A tube is attached to an ultrasound probe and the doctor guides a suctioning needle into each ovary. The mature eggs/oocytes are removed from the follicles, which hold the eggs. ET: EmbryoTransfer In the case of IVF, and following the fertilisation of the donor eggs and sperm, the embryos are usually allowed to grow/develop for 5 days. On the 5th day the transfer to the recipient is performed this being the embryo transfer. A speculum is inserted into the vagina for visibility of the cervix, which is prepared and cleansed. A soft transfer catheter tube is used to pick up the embryo/s and handed from the laboratory (usually via a window into the theatre room) to the doctor. The identity is confirmed and the laboratory confirms that the embryo/s have been loaded into the tube. The catheter is inserted through the cervix and guided to a specific position within the uterus. The maximal implantation potential (MIP) point, is usually identified using ultrasound. After insertion of the catheter, the laboratory confirm that the contents have been are expelled. The procedure is quick and pain free. FSH: Follicle Stimulating Hormone FSH is one of the most important hormones involved in the production of mature eggs in the ovaries and is an acronym that you may well have heard of if you have been diagnosed with premature ovarian failure. It is produced by the pituitary gland in the brain, along with LH. When a woman goes into menopause, she is running out of eggs in her ovaries. The brain senses that there are low estrogen levels and signals the pituitary to increase the levels of FSH hormone which it does and as such, a rise in the levels of FSH can be detected. Thus women in menopause have high FSH hormone levels. As women approach menopause their baseline FSH levels (day 3 of their cycle) will tend to gradually increase over the years. When they run out of follicles capable of responding, their FSH will be high and they stop having periods. FSH levels can fluctuate and in general, your ovarian reserve is as bad as your worst FSH


reading. It is suggested that waiting for a menstrual cycle with a lower FSH level is not of any proven benefit when attempting IVF. AMH: Anti-mullerian hormone AMH is a substance that is produced in ovarian follicles. AMH blood levels suggest the levels of the remaining egg supply, or "ovarian reserve" of a woman.


Helpful Resources General

Netcells Store your babies stem cells at birth and understand why its the greatest gift ov life you could ever give your child Johannesburg Tel: +27 (0) 11 697 2900 [email protected] www.netcells.co.za Fertility clinics Gift ov life works with and is referred to, by all the clinics listed below.

Medfem Fertility Clinic Johannesburg Tel: +27(0)11 463 2244 [email protected] www.medfem.co.za

Vitalab Fertility Clinic Johannesburg Tel: +27 (0)11-911-4700 [email protected] www.vitalab.co.za Cape Fertility Clinic Cape Town Tel: +27 21 674 2088 info@ capefertilityclinic.co.za www.capefertilityclinic.co.za

Sandton Fertility Clinic Johannesburg Tel: 27-(0)11-883-1776 info@[email protected] www.sandtonfertility.com

Gynomed Fertility Clinic Johannesburg Tel: 27-(0) 11 796-1100 / 27-(0) 11839-1870/1 www. gynomed.co.za

Bioart Fertility Clinic Johannesburg Tel: 27-(0) 11 484-5119 [email protected] www.bioartfertility.co.za

Pretoria East Fertility Clinic Pretoria Tel: 27 (012) 883-8854 www.netcare.co.za UCT Private Academic Hospital Cape Town Tel: +27 21 674 2088 [email protected] www.ucthospital.co.za


Care Clinic - Durban Tel: +27 031-2677920 [email protected] www.careclinic.co.za/ Psychologists Leanne van der Westhuizen Cape Town Counselling Psychologist Tel: +27 021 671 1116 Mandy Rodrigues - Johannesburg Counselling Psychologist Tel: +27 011 463 2244


About GIFT OV LIFE Gift ov life is a highly reputable national Egg Donation Agency assisting local and international couples with egg donation IVF in South Africa. Gift ov life offers a world-class egg donation program with one of the largest online databases of available egg donors, ensuring no waiting period for a chosen egg donor.

Egg Donation Program is supported by South Africa's leading Fertility Clinics ensuring the best possible chance of conception via IVF egg donation as well as confidentiality and anonymity guaranteed. We work extensively with International and Local recipients in need of egg donors in order to conceive. We are proud to have facilitated egg donation cycles for couples from around the world and notably from Australia, the UK, the US, Germany, Spain, Africa and New Zealand. Gift ov life was born as a path to parenthood for so many that face infertility. Each and every egg donation of our Egg Donation Program is personally and professionally handled by Co-Founders Tami Sussman and Dawn Blank, who each intimately understand the infertility journey. Gift ov life has Co-Founder co-ordinators based in Johannesburg and Cape Town and thus uniquely situated to meet the logistical demands of our national and international Egg Donor Recipient Parents and Egg Donors alike. Gift ov life offers an easy-to-access online Egg Donation Database, which you can access now by clicking here. We have no prejudices...our aim is to assist those that long to be parents with the potential Gift ov life. Our hope as the Authors, is that you now know a little more about egg donation as a path to parenthood. That you feel less anxious about unanswered questions and more empowered to make your own informed decisions. Should you like more information about the world of egg donation or should you wish to begin your search for a donor, please go to www.giftovlife.com, where we are ready to assist you. You may also email Dawn or Tami on [email protected].

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