Ep 304: Eggs, Ethics & Empathy: Unpacking Transparency in Egg Donation

 Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. Today we welcome special guest Lauren Makler, Founder of Cofertility. In this episode of Fertility Docs Uncensored, the doctors sit down with Lauren Makler to explore why transparency is essential in modern egg donation. For years, donor conception carried an unnecessary layer of secrecy. Parents often felt shame discussing the use of an egg donor, and donor-conceived children sometimes internalized guilt or discomfort, feeling that the process was transactional, or that the donor was excluded from any meaningful connection. Lauren explains how the Cofertility model aims to reshape this narrative entirely. Prospective egg donors undergo extensive medical and psychological screening before being accepted. Those who qualify complete an extraordinarily detailed profile allowing families to choose a donor whose values, background, and goals align with theirs. The donor is empowered too since she keeps half of her eggs for future use. Only a limited number of families can match with each donor, and together, donors and recipient families determine their preferred level of ongoing contact. At minimum, recipients receive identifying information, but many matches opt for deeper communication, shared updates, or even in-person meetings over time. This thoughtful, relationship-centered approach helps ensure that donor-conceived children grow up with honesty, openness, and pride in their origin story. Transparency removes shame, strengthens family identity, and honors the donor’s contribution in a meaningful, human way. At its core, every child’s conception however it happens, should be embraced with joy, not secrecy. This podcast was sponsored by Cofertility. 

Transcript

Susan Hudson (00:01)

You're listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

Carrie Bedient MD (00:22)

Hello everyone and welcome to another episode of Fertility Docs Uncensored. I am Dr. Carrie Bedient of the Fertility Center of Las Vegas and I am joined by my two kooky crafty and crazy co-hosts, Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center.

Abby Eblen MD (00:36)

Hey guys!

Susan Hudson MD (00:41)

Hello everyone.

Carrie Bedient MD (00:43)

And we are joined once again by the fabulous Lauren Mackler, who is the founder of Cofertility. So we are glad to have you back, Lauren.

Lauren Makler (00:51)

Thank you for having me. I'm excited for this.

Carrie Bedient MD (00:54)

Okay, so you said you had a surprise story for us. We want to know.

Lauren Makler (00:58)

Okay, so I live my life by a book that I read years ago. It's called Super Attractor by Gabby Bernstein. And it's a little bit woo woo, but hear me out. It it's a book about how to manifest a life beyond your wildest dreams. Okay, so I read this book at a time where I felt pretty stuck in a lot of ways. In my career, in parts of my personal life, I did not know what was ahead of me. And I read this book and then I read it again and I read it again. And it gave me a framework for how to really get unstuck. And my team knows this about me, my friends know it about me, I recommend it, I send it to everybody who's feeling stuck in their lives.

And I keep on my desk the Super Attractor tarot cards that I like to look at at any given moment. And believe it or not, I've actually manifested Gabby Bernstein, the author of the book, into my life. She's now one of my friends, I swear. Yes, you never know what's gonna happen. You just have to see it to believe it. And so, highly recommend it, check it out, and think of me when your life is.

Abby Eblen MD (02:03)

Really? How did she do that?

Carrie Bedient MD (02:04)

That was awesome.

Susan Hudson MD (02:09)

That's awesome.

Lauren Makler (02:17)

The one of your wildest imagination. Yeah, Super Attractor.

Abby Eblen MD (02:17)

Cool. I'm going to get that book now.

Susan Hudson MD (02:22)

Interesting. What are some of the premises of the book?

Lauren Makler (02:27)

It gives you ways to approach different things. So I'll give you an example. Sometimes when I find myself really wanting something, instead of like you want a new job. Or you want something to happen in your personal life. Instead of just like, really want this thing to happen and I really want it now. Instead, I look at it and I say, I want this or something better.

And by giving the possibility that like, okay, if this thing doesn't happen, something better is on its way, frees you up from the like tension of the, must get that thing right now. And so I use this mantra on repeat often and usually it works out. And so sometimes like years later, I'll be like, this was the something better.

That's just one example, but there's like lots of little things like that, that I have now worked into my daily life. And so, really recommend it.

Abby Eblen MD (03:16)

It’s a way to kind of reshape what's going on. I'm going to start using that because if you do get stressed out about something, that's all you can think about. You're giving yourself the, well, maybe something better is going to happen even.

Lauren Makler (03:27)

Yeah, yeah, so it's given me... Yeah, I really believe that high vibes yield high vibes. And so if I go into something thinking, I'm gonna go in, I'm gonna have a good time, and hopefully something good will come from it and we'll see. And yeah, I have not always been this way. And so it really took work to kind of become this version of myself, but this book really helped me do that.

Susan Hudson MD (03:28)

Definitely the power of positive thinking.

Carrie Bedient MD (03:53)

So when you're thinking this, you go into it with a big life plan or is this just not spur of the moment, but relatively spur of the moment.

Lauren Makler (04:04)

Something that she talks about in the book is that you have to co-create your reality with the universe a little bit. Things aren't just gonna happen to you. You have to take some steps in the right direction to make them happen. But it is a combination of this greater plan plus the steps that I'm putting into action or creating. I don't know that it's like the parking spot at the grocery store, but,

I do often think about, what is it that I want for Cofertility or what is it that I want for my family? And I try to think as big as possible because if I don't, who will? I have to imagine the biggest, best possible thing and be comfortable with the fact that I don't know what the timeline is and I don't know how we'll get there. I'm flexible on the how, but really focused on that end goal.

Susan Hudson MD (04:50)

I think book might be very good for almost every single person who's listening to this episode.

Lauren Makler (04:57)

Yes, yes, yes, yes.

Abby Eblen MD (04:57)

Absolutely. Thank you.

Carrie Bedient MD (04:58)

Yes. 

Lauren Makler (05:03)

It certainly helped me get through two very long winding roads to having children. I talked to my team about it a lot. It's whether you're giving someone advice in business or in life or on a fertility journey. Let's be focused on that outcome, which is that beautiful baby in our arms and be flexible on how we get there. It's kind of just generally good advice, I think.

Abby Eblen MD (05:27)

Yeah, it's great advice.

Susan Hudson MD (05:32)

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Carrie Bedient MD (06:54)

All right, so before we dive into that further in the world of egg donation and how that plays into both the Super Attractor and everything that goes into egg donation and building a family. Susan, do you have a question for us today?

Susan Hudson MD (07:08)

I I do. am a 34 year old otherwise healthy non-smoker diagnosed with tubal infertility after two HSG's due to likely silent endometriosis. My first egg retrieval cycle was done during the follicular phase and yielded nine eggs. After PGT I had one low-grade euploid blastocyst. My REI started me on CoQ10 and inositol.

Six weeks later, I underwent a luteal phase egg retrieval that yielded 16 eggs and from that, six euploid high grade blastocysts. My question, why do you think there was such drastic improvement in blastocysts quantity and quality? Thank you for all you do. I love your podcast.

Carrie Bedient MD (07:49)

Aw, thanks. All right, what you girls think?

Susan Hudson MD (07:52)

As much as we love CoQ10 and inositol, I actually don't necessarily think that that made a huge difference in six weeks. We all know that whatever eggs were going to be present right now started their process somewhere in the three to six months prior. And so as much as I think that...those supplements are fantastic and they can help improve outcomes. I'm not sure if that's actually what was the cause.

Abby Eblen MD (08:22)

I would agree. I was just about to say, I think it was just luck of the draw. It was just a different group of eggs potentially that you were pulling from or just luck. I had a patient this week who had a not so great outcome and stimulated pretty similarly, but we didn't get nearly as many eggs and it's just, you just never know how it's gonna turn out.

Carrie Bedient MD (08:40)

I think some of it might be the difference in luteal start versus follicular start, because even though she's 34 and odds are that her eggs are pretty decent just based on age alone, it's possible that if she's got an increased FSH that some of those follicles had already been recruited when she went into the follicular phase cycle. And so some of them had already started the process of atresia where they die off.

I wonder if any of this is related to the luteal phase start where they were catching them at the very, very beginning of them growing, which did not line up exactly with what her period would be for a follicular start. And they just caught it a little bit early. That's not a fail safe. That doesn't work every time, but, sometimes when you see a big difference like that, that is one thing that crosses my mind of, wonder if any of those, those follicles were already atretic by the time the follicular start began and so maybe catching a few more with a luteal start because you managed to get the entire cohort all at once.

Lauren Makler (09:45)

Can I ask a follow-up question? Since I'm the only non-physician. I know it's only six weeks apart, but is there a world in which sperm quality could have an impact too or no?

Carrie Bedient MD (09:47)

Yeah.

Susan Hudson MD (09:47)

Yes.

Carrie Bedient MD (09:55)

Sure, that's always a possibility. We kind of give sperm short shrift because they're responsible for relatively little or comparatively little ⁓ with respect to the egg because the egg is not only providing half of the instruction manual, it's also providing the entire factory, all the raw materials, everything that goes with it. But yeah, there's always a possibility. Who knows if that sperm provider had a fever shortly before, and it wasn't enough to knock out his sperm completely, but it was enough to change the quality. And by the time you're six weeks later, you've got enough good sperm swimming around to balance it out that haven't had those effects that maybe it has an impact. Maybe he cleaned up smoking, drinking, bicycling every day, and then sitting in a sauna for six hours afterwards. Always a possibility. We really discount anything because I don't know about you girls, but I, every time in my head, I have thought, this will never happen. This is never gonna make it. The universe is just like, what? You are not in charge, and something comes up.

Abby Eblen MD (10:54)

And then it does.

Lauren Makler (10:54)

Yeah. Yeah.

Maybe this is just how we were raised, we just blame ourselves, good or bad, and I think it's just worth asking the question of like, what about him?

Abby Eblen MD (11:07)

That’s definitely true. Yeah.

Carrie Bedient MD (11:12)

Yeah, absolutely. Absolutely. So we were talking about manifesting your future and manifesting, in this case, probably a baby or something better. And many people, when they come into our offices, are thinking a baby with their egg. And you gave an amazing statistic earlier about women over 40. What was that stat again?

Susan Hudson MD (11:12)

Absolutely.

Lauren Makler (11:21)

Yes, the stat is that one in four women over 40 completing an IVF cycle are using donor eggs. And that stat, every time we say that to an intended parent, their jaw drops. They can't believe it. They just don't realize that they're not the only one. It doesn't change the reality, It doesn't change the fact that you're not using your own genetics in this cycle. But it does help knowing that it's a lot more common than we realize. If you were to look around the waiting room at the IVF clinic in the morning of the cycle, not everyone there is using their own egg or their own sperm.

.

Lauren Makler (12:25)

And I just think that, we say that, you know, egg donation is fertility's last taboo. And I say this because, years and years ago, it used to be taboo to talk about miscarriage and it's not anymore. And I really am so happy to see that we're honest and open about it. And we share that with one another and with the generations to come. They know they're aware of miscarriage.

Surrogacy is even becoming far more mainstream. And I thank the Kardashians for that. For being open about it. And part of it is that they have to be because their lives are so public. Their lives, they have cameras following them around. They're on social media 24/7 If they were to suddenly have a baby and you didn't see them pregnant leading up to that baby being born, everyone would know it would be obvious. And so we see celebrities being very open about using a surrogate. You don't have to share that you used an egg donor. And so people choose not to, and that's okay. I'm not saying anyone should do something they're not comfortable with, but the not having to share it means that far few people know and realize that everyone around them is also in the same.

Susan Hudson MD (13:36)

I always like to tell patients when they're considering egg donor that unless I know exactly how a baby came into this world, I never ever say, my goodness, that baby looks just like you. Because I know so many people who I would venture to say don't fit the profile of what a lot of people think that would choose to use an egg donor, a sperm donor, a donor embryo, but that is in fact how they decided to build their family. Using an egg donor is one of those things in life that you may know early on that that's something you want to do for whatever reason. But I also think that when you are faced with the inability to create a baby using your own genetics, that that's one of those things in life until you are in the middle of it yourself, you may not know exactly what path you would choose to do.

Lauren Makler (14:39)

Of course.

Abby Eblen MD (14:40)

I was gonna say when you were talking about celebrities, probably it's been close to 10 years ago now that Janet Jackson got pregnant. And I don't know that she used an egg donor, but I think she was about 50 when she got pregnant. So it'd be really unusual if she didn't use an egg donor. And it amazed me that the number of women that would come in in their mid-40s and they'd be like, if Janet Jackson was able to get pregnant, I should be able to get pregnant too. And...I know we've all had experiences with patients like that where we're like, no, probably she used an egg donor because beyond the age of 42 or 43, it's real difficult. And it just amazes me that so many people are unaware that I feel like the tables have turned a little bit. I feel like people are more knowledgeable about age and its impact on fertility. But still we see lots of women in their mid 40s that have no idea that they are going to have difficulty getting pregnant.

Carrie Bedient MD (15:31)

I mean, what are the odds of someone being an international superstar and able to get pregnant with their own eggs at age 50?

Abby Eblen MD (15:38)

Hahaha!

Carrie Bedient MD (15:40)

I mean, anyone can win a billion dollars in the lottery, but really?

Lauren Makler (15:44)

Great.

Susan Hudson MD (15:45)

But the odds of being that lucky twice, probably not likely.

Lauren Makler (15:46)

Right.

Abby Eblen MD (15:51)

Yes.

Carrie Bedient MD (15:51)

Yeah. So now that egg donation is so common, how are the ethics of that? How is the transparency of that working? Because things that were true when IVF started in, what, late 70s, early 80s, the world is dramatically different now. And so what are we seeing now that's different that maybe that thinking hasn't changed just in the same way that people don't realize that donation is so common. Outdated thoughts that really don't play in as much anymore.

Lauren Makler (16:21)

Right. Egg donation has changed so much. And I should mention we did do an episode a few months back, but at Cofertility, we do egg donation really differently. So just in case people weren't listeners for that episode at Cofertility, instead of the traditional model of egg donation where the donor is paid cash compensation by the intended parent, instead we do something called egg sharing where the donor gets to keep half of the eggs retrieved for her own future use instead of getting paid. And so in this scenario, both parties get to benefit and hers gets stored for up to 10 years and the intended parents get to fertilize theirs right away. And so what we've done is we've eliminated the more transactional piece of this where cash compensation is exchanged. But what we found to be true at Cofertility is that intended parents are coming to us having one done a lot of research on the topic, which is amazing. And I'm so glad that people are going into this eyes wide open and trying to think through what are the most thoughtful ways to go about growing our family through egg donation? And how are we mindful, not just of the goal, which is to have a baby, but mindful of the impact to this donor conceived child someday and what it means to be donor conceived. And so they're coming with, a lot of questions, which we love, but also a lot of research and information because there is so much of it. Thank you, internet and thank you, ChatGPT and all of those tools. But one of the biggest things that they're doing is really listening to the perspectives of donor conceived people. So we now have donor conceived people who were born 20, 30 years ago through egg donation and sperm donation that are advocating for the rights of future donor conceived people.

Susan Hudson MD (18:06)

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Susan Hudson MD (18:40)

What are some of the perspectives of donor-conceived people that may not be the most obvious to someone who's thinking about going down this route?

Lauren Makler (18:52)

The first one I would say is that when donor conception came to be, there was no DNA testing or at-home DNA testing at our fingertips. Back then, egg donation, sperm donation was billed as anonymous because we believed that was possible. Someone would give eggs or sperm and think that they would never be heard from again, or no one would reach out to them. That has changed with things like ancestry.com and 23andMe. So many donor conceived people, it's a thing that happens around the holidays when people are gifted a new at-home DNA test, they find that they have dozens and dozens of biological half siblings or they have relatives that they never knew about. And every year they have that anxiety of who am I gonna hear from this year because the sperm or egg donor's eggs were shared amongst dozens of families. A traditional egg bank will take a donor who maybe gets 30 mature eggs in a cycle. They'll divide those eggs by lots of six. So her eggs will go to five families and then they'll have her do five more cycles, and do the same thing. So her eggs could go to 25, 30 families. And that means the child will have that many biological half siblings someday.

And then they'll be hearing from them years and years later. And so one of the things that intended parents come to Cofertility wanting is a limit to the number of families that the eggs are distributed to. And so at Cofertility, we don't share eggs across more than three families because we think this is a really important thing. We also know that the donor herself wants to have children someday. And so she's mindful of how many families her eggs are going to.

So limiting the number of half siblings or families is number one, the top concern. I think that that can be really, really daunting for not just the donor conceived child, but for their entire family and for the donor's own children someday. Another top thing that we hear about is related to actually being able to get in touch with one's donor someday.

Donor conceived people feel that it is important to have access to one's genetics. To be able to ask questions about their family medical history or to have the opportunity if they want to, to reach out and have a relationship or ask questions. And so we believe that that access, whether or not someone chooses to use the information is something that each donor conceived person really deserves and may want some day. Yep.

Abby Eblen MD (21:26)

Hey Lauren, how does that look for you guys when, somebody chooses a donor, they conceive, they have a child. Does that look like they send Christmas cards to each other? Is it only when there's a health scare? Or how does that work for most of the couples that you work with?

Lauren Makler (21:38)

Yeah, yeah, yeah.

So at Cofertility, we offer disclosed donation can come with many different degrees of disclosure. We help intended parents and donors figure out what feels right for them. We sort feel like it can kind of be a spectrum. There are some people who really want to develop a friendship and get to know one another. And we help actually facilitate what we call a match meeting where the intended parent and donor have the to meet over Zoom. Some like to leave it at that and maybe exchange email addresses and maybe be in touch once a year. Whereas others are like, hey, like you're in our life now. We have the opportunity to know one another and see where this goes. Others may say, great, we have that information and we'll only be in touch if there's like a medical reason. So we like to put intended parents in the driver's seat, especially knowing when you are using an egg donor, probably haven't felt like you've been in the driver's seat very much.

And so we really want them to find the relationship that feels right for them. We see our role in this as making sure that we find a donor that's in alignment with what the intended parents want. We also have intended parents that prefer an undisclosed relationship and that's something we want to honor too. As long as the intended parent and the donor know, sorry, yeah, go for it. Yes, yes. So to us, I'm like entirely allergic to the word anonymous.

Susan Hudson MD (22:51)

Lauren, can you explain what an undisclosed relationship is?

Lauren Makler (23:00)

Because anonymous is not possible. So we're really clear with intent parents and donors about that. We do offer undisclosed because again, it's up to you. It's your choice. And so if you choose not to, it's basically you're not exchanging names and contact information, but you're aware that both parties could be found someday, right? And that's really important to us that everybody is signing an agreement that says, know it's possible. And so...we want to make sure that eyes are wide open. So if it happened, it would be through like a DNA test or we've heard stories of people who need a private investigator someday to help find their donor or the intended parents or whatever.

Abby Eblen MD (23:38)

Lauren, what kind of couples tend to want to have an undisclosed relationship? Is there any typical couple or is it just random?

Lauren Makler (23:45)

We find that sometimes it could be for cultural reasons. Maybe they don't feel comfortable. Maybe even just the idea of using an egg donor is so daunting in and of itself in one's culture that the idea of also knowing the donor might just feel like a little bit far too outside of their comfort zone.

Occasionally we find, and I should mention that a lot of our intended parents are single parents as well. So we have couples and single parents, but occasionally it might just be that it's been a really long emotional road. And that the idea of meeting the donor or sharing contact information could just be too much. And in that scenario, a lot of times they may say, we don't want to have the meeting and the donors are very understanding of that.

But we do want the contact information when the child turns 18 someday. And that's something that we also can help honor. And so we really work with each intended parent to figure out what feels right for them. And it's a very like no judgment kind of thing. But when we have people who come to us and say, what is the perspective of donor-conceived people? What do they feel is right? Like how am I being as thoughtful as possible of what my child might want someday? This is typically what we would share. I'll also mention that we have some intended parents and donors who not only have met and have hit it off, but to the point where like the intended mom has gotten on video to show the donor how to do her injections. Because she had been through so many herself. ⁓ Exactly. We've also had situations now where like the intended parents named the baby, her middle name is after the donor. 

Abby Eblen MD (25:08)

Aww. 

Lauren Makler (25:20)

And so we've had situations too where the donor has met the baby. We've really tried to take this to a place that if we know anonymity is impossible. if we go into this process knowing that, where does it lead us and what feels comfortable from there?

Susan Hudson MD (25:36)

Lauren, I have question. ⁓ Do you find that you have more or less diversity in your donors as a result of having a more open process?

Lauren Makler (25:38)

Yeah. The diversity that we have, which is really incredible. I'll say 50 % of our donors identify as women of color. We have over 270 ethnicities represented as of right now in our active donor pool. I think diversity first and foremost comes from our model. This idea that we're not paying the donor, but instead she gets to keep half of the eggs retrieved. But I think like, one of the biggest stigmas or the biggest thing that prevents women from being interested in egg donation is this idea that they're gonna walk down the street one day and see someone who looks like them and wonder if that's the child born from their donation. And when we tell them, hey, that's actually not what this is. Like you have the opportunity to meet the intended parent and you can decide to get a holiday card once a year. And you can have this open relationship that allows you to be up to date on the latest in this child's life, suddenly that conversation's incredibly different. I think women at that point are like, my gosh, I get to help someone else grow their family while doing something empowering for my own future at the same time? Great, sign me up. How could I not do this? I think that black box of it all not being part of it really does mean that we can attract more women to egg donation than who otherwise would be doing it.

Carrie Bedient MD (27:12)

How awesome.

Abby Eblen MD (27:12)

Have you had any of your egg donors come back and use their own eggs at this point or many of them?

Lauren Makler (27:17)

So we are only three years in at this point. I know of one scenario where an egg donor has since created embryos. And I think she might just be storing embryos because she wanted to put them away and has recently got married. But none that have come back to use them just yet. But I think that's the nature of who is interested in egg freezing. Yeah.

Carrie Bedient MD (27:40)

How often do you find that you guys facilitate, okay, we think maybe this will be a good match and they meet on Zoom and either they both go, uh-uh, no way, or one says, oh yeah, I really like them and the other one is like, nope.

Lauren Makler (27:57)

Literally less than I can count on my hands, in like four digit matches. We're pretty deep at this point and it happens really infrequently. I think what we try to do before it gets to a match meeting is actually share more information with the donor about the intended parents. So sometimes they'll write a letter.

Here's a little bit about us. That's where our team really helps facilitate it. If for some reason we feel like it won't be a match, it probably won't even get to the point of the match meeting. We don't want anyone to feel like it's a job interview. We also bring some conversation topics to this meeting, and someone from our team is on the line. And so we really help make it feel less awkward than it probably sounds.

Abby Eblen MD (28:42)

So on the front end, do you do any psychological screening? I know probably throughout the process you do, but does that play a role at all? Do you do any kind of like MMPI or anything like that that would be personality inventory so you could figure out who might fit best together?

Lauren Makler (28:51)

Absolutely as part of the process, a donor has to undergo the psyche eval. ⁓ But what's really, I think, helpful is that our donor profiles are incredibly extensive. It's like 300 data points on a donor. The section that we find intended parents spend the most time with is what we call personalities and motivation.

So it is, if you could invite any three people to dinner, who would it be and why? What are your short-term goals in life? What are your long-term goals in life? Why are you, and I'm just pulling one up right now so that I can make sure I'm not missing any of these sections, but if you could plan your perfect day, what would you do? What are your greatest strengths?

What would you share with intended parents and what's your motivation for doing Cofertility split program? And we find that that really helps to get to know who they are as a person. And we have intended parents who'll come to us and say like, my gosh, we have the same favorite book. And I just knew she was the donor for me. But I think that the what's your motivation question is something that helps sort of tie back to the ethics piece of this, Because I think intended parents feel good knowing that this is a donor who's doing this to empower her own future, to go live her life on her own terms and to help another family grow as opposed to, there are other options out there and you can find their ads on TikTok. There's like Donor Talk where their ads are literally like, wanna go to Europe this summer? Donate your eggs every three months. I'm not even making that up.

That is a real ad. And then there's another one that's like, do you want to go to lunch and not look at the bill? And it's like a visual of someone like paying a check at lunch, like donate your eggs every three months. It shouldn't be like that, so we're really just trying to show up in a different way. There was a study that was done at Harvard med school in 2021 that said, a majority of the donor conceived people that they surveyed were disturbed by the idea that their parents paid their donor cash for their genetics. We don't do this for blood donation. We don't do this for organ donation. This idea that you might pay more because a donor reflects your heritage than your neighbor who has a different heritage is just unreal that this is allowed. ⁓

And so we try to show up in a way that really is mindful of how this person born from this donation might feel someday instead of just focused on how do we get an intended parent a baby the fastest?

Susan Hudson MD (31:33)

Do you, since you're talking about time, how long does this process take? Because honestly, most of the time people are needing egg donation. They've been at this process for years. And the last thing they want is something that's going to delay the process.

Lauren Makler (31:43)

Totally, I always say intended parents who need an egg donor wanted a baby yesterday. They are not looking for something that's gonna take a while. And that's part of why at Cofertility, we now offer both fresh and frozen donation. So our frozen offering intended parents can come to us, they can see a donor, they can see how many eggs she has available today, and they can play some match with her today.

We can ship eggs and we have intended parents who have embryos created within two to four weeks. And in that process, if they want to, we do give them the opportunity to meet the donor as part of that process. So our donors are aware that if they are undergoing part of the frozen program that even after their retrieval, they may be contacted to get to know the intended parents. And that's part of what they're signing up for. On the fresh side, this is where the donor hasn't yet gone through the retrieval. And so it does take a little bit longer. We see on average a fresh cycle with Cofertility taking between three to five months. Really just depends on the clinic that we're working with, where the donor's located, things like that. But we do our best to move as quickly as we can because we know how important time is in this whole process.

Abby Eblen MD (33:00)

For the donors that are interested in this, what would you say is the biggest reason why they may be apprehensive about doing it? And what would you think is the most common reason why most of them really want to do it?

Lauren Makler (33:12)

Well, I think that certainly that topic we talked about before, this idea of will I know who this child is? I think that the fear of not knowing where your eggs are going is really daunting to women who are interested in egg donation. And so when we're clear that even if someone enters into an undisclosed relationship, we're able to share some detail about the intended parents that they're comfortable with, that really helps.

I really believe that that has changed a lot of the openness around egg donation for the women who come through our program. And then I think the why they're most excited, I was just thinking of this story that someone on our team shared the other day. We meet with every donor, obviously, before she signs onto the platform. It's really important to us. And after she...told her about the different types of intended parents that come to us and what they face before they need an egg donor, this now donor said, gosh, I can't, there's no way I couldn't do this after hearing this. And that to me was so moving. She sees this as really a win-win. Or she is planning for her own future and gets to help someone who's really struggled on the other side. And so we know that, there was a recent study that was done that said 72 % of Gen Z is already worried about their fertility. And, I certainly don't want it to be like fear mongery, but I really attribute that to how much millennials and Gen X have done to be open about our fertility challenges and how this was unexpectedly harder than we thought it would be. You you spend so much of your life trying not to get pregnant that by the time it's time to get pregnant, you're like, my God, this is so much harder than I realized it would be. And Gen Z knows that. We actually don't have to do much education on why they should consider egg freezing. The education awareness part of my job is so much easier than I thought it was going to be. They're smart. They know their stuff. They are well-educated, now it's just about access. The best time to freeze your eggs is when we could least afford it. And so our ability to provide them with a way to do it at no cost and help someone else at the same time is pretty cool. And I think intended parents too are feeling like, wow, this donor is, going through this process, wanting the same outcome that the intended parent wants. Which is great ad quality and great ad quantity.

And she is going through this, she's asking us, what should I eat? What supplement should I take? It's a very different conversation than a donor who's like, yeah, I'm going to get paid at the end of this. And so I think that that helps from a values alignment standpoint.

Carrie Bedient MD (35:58)

How often do you see a donor come through and she's banking her eggs, everything seems good with her testing, but then the intended parents go to make embryos and nothing works or it's much less than what is expected and there's no obvious cause, sperm looks fine. And how much of that information gets relayed back to the donor of? All of it?

Lauren Makler (36:19)

All of it. Yeah.

Well, that's basically, I think one of the benefits of what we're doing for the donor is that usually when you're freezing eggs, you have no knowledge or information about them until you go to thaw and fertilize them yourself someday. You know how many mature, but that's all you know. With Cofertility, half the eggs are getting fertilized right away.

We love that we can share that information. Sometimes it's not great news, of course, right? If we have to share with the donor, hey, none of the eggs fertilized. We then talk to her about how she may want to undergo another cycle or what different options for that would be. So we think that's really important on the donor side. On the intended parent side, we offer what we call an embryo guarantee.

And on fresh, that embryo guarantee is two embryos. And so if the intended parents did not get two embryos, we will rematch them with either if they want the same donor to try again, they can, or if they want a new donor, we'll rematch them. And so we really want them to go home with a baby. And so we see that being a really important part of that. On frozen, the number of embryos guaranteed depends on the number of eggs in the cohort of eggs that the intended parents choose to go with.

And so we have actually a lot of intended parents will opt to get upwards of 15 or even 20 plus eggs with one of the Cofertility donors so that they can get more embryos, as you can imagine. If they get 22 plus eggs, they're guaranteed four embryos. For someone who's undergoing, who may be a same-sex male couple who wants to do a dual sperm source journey or an intended parent who's looking to work with a surrogate, many surrogacy agencies require intended parents have four embryos before they'll match them. We find that they love to work with a Cofertility donor who has more eggs available so that they're better set up for success if that's the route that they're taking. Or if they want to have a sibling journey. If you want to have two siblings that are biologically 100 % related, getting more eggs up front can offer you the opportunity to have embryos for that second journey and not have to go back to the drawing board to make embryos the second time.

Carrie Bedient MD (38:25)

That's awesome. Well, thank you for sharing so much about some of the ethics behind all of what we do and egg donation and how that plays in both for the intended parents and the donors. That is, it's an area that I think a lot of people don't really think about a whole lot as they're going through this. So it's nice to be able to bring it up and know that there are people who are paying attention to it.

Lauren Makler (38:28)

Yes!

Yes, yeah, and we actually have donor-conceived people on our team who I think feel a sense of responsibility and thoughtfulness. They want to be part of this way we think about it for the next generation. I think it's a Maya Angelou quote about, if you know better, do better. And I think that that's...where we find ourselves in this space.

Carrie Bedient MD (39:13)

That's awesome. Well, thank you so much, Lauren. We are very appreciative of your expertise and sharing it with all of us.

Lauren Makler (39:21)

Thank you guys for having me.

Carrie Bedient MD (39:23)

For our listeners who want to get a little bit more information about this, Lauren's episode that we did before was 279, and the IVF Blueprint that we just published has an entire couple of chapters actually on third-party reproduction, egg donors, sperm donors, gestational carriers, LGBTQIA+ family building. And so there's a lot of resources out there, but those are two off the top of our heads, episode 279 and The IVF Blueprint.

Susan Hudson MD (39:53)

And to learn more about Cofertility, you can visit Cofertility.com.

Carrie Bedient MD (39:57)

To our audience, thank you so much for listening. Please subscribe to Apple Podcasts to have next Tuesday's episode pop up automatically for you. Be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Susan Hudson MD (40:10)

Visit Fertilitydocsuncensored.com to submit questions and sign up for our email list. Pick up your copy at the IVF Blueprint today at Amazon, Barnes & Noble, or your favorite bookstore. Check out Instagram and TikTok for quick hits of Fertility tips between weekly episodes.

Abby Eblen MD (40:26)

As always, this podcast is intended for entertainment. It's not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we'll talk to you soon. Bye.

Susan Hudson MD (40:36)

Bye.

Carrie Bedient MD (40:36)

Bye.