Ep 309: The Donor Blueprint: What to Look for in an Egg Donor

 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 with special guest Lauren Makler, Founder of Cofertility. In this episode of Fertility Docs Uncensored, the Docs welcome back Lauren Makler for a deeper dive into how to choose an egg donor—and why selecting a reputable, ethical organization matters. Lauren explains that not all donor agencies operate with the same standards, so intended parents should ensure the group they partner with strictly follows guidelines set by the American Society for Reproductive Medicine. These include essential criteria such as donor age (typically 21–34) and comprehensive medical, psychological, and lifestyle screening. Lauren also highlights a recent study showing that donors over age 25 often have better outcomes, potentially due to increased emotional maturity and readiness for the medical demands of the process. She emphasizes the importance of reviewing a donor’s anti-mullerian hormone (AMH) level to predict egg yield and notes that nicotine, marijuana, and excessive alcohol use can disqualify a donor because of their impact on fertility. Further screening, including family medical history and genetic carrier testing, ensures compatibility between donor and intended parents. The Cofertility team recognizes that families have different pathways; some prioritize speed and choose frozen donor eggs, while others prefer to wait for the ideal donor match. Cofertility enhances this process by offering donor videos, giving families a more personal connection beyond written profiles so that both parties have the best possible experience. 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.

Susan Hudson MD (00:22)

Hello everyone, this is Dr. Susan Hudson from Texas Fertility Center with another episode of Fertility Docs Uncensored. I am here with my amazing, ravishing co-host, Dr. Carrie Bedient from Fertility Center of Las Vegas and Dr. Abby Eblen from Nashville Fertility Center.

Carrie Bedient MD (00:35)

Hey!

Abby Eblen MD (00:40)

Hey everybody.

Susan Hudson MD (00:41)

And we are so, excited to have Lauren Mackler, the founder of Cofertility, joining us again.

Abby Eblen MD (00:49)

Yay!

Lauren Makler (00:50)

So happy to be here.

Susan Hudson MD (00:52)

How are you doing, Lauren?

Lauren Makler (00:54)

I'm great. was just thinking this podcast is sort of like you dropped into a group chat with three reproductive endocrinologists. How cool is that? But it's rare to be in a scenario where you have not just one, not just two, but all three of you with this brain power in one place. It's pretty cool.

Carrie Bedient MD (01:14)

Hey guys, she thinks we might be cool.

Susan Hudson MD (01:14)

You're amazing, Lauren.

Abby Eblen MD (01:15)

She thinks we're smart.

Susan Hudson MD (01:16)

I have to say that I think I have the exact same feelings because every week it's like getting together with my girlfriends and getting to chat for an hour and the whole world goes away. We just get to focus on this and us and talking about what we love.

Abby Eblen MD (01:24)

It really is.

Lauren Makler (01:35)

And that's helping people have babies, which is like, what's better than that?

Carrie Bedient MD (01:38)

And iIt's pretty fabulous. How did you end up starting Cofertility? No, not why are you in the group chat. We know full well, because I love your model. That's why you in the group chat, because you deserve to be here. How did you, who as an eight year old kid says, I wanna help women donate their eggs one day and share them so that they can preserve their own future fertility and help other women.

Lauren Makler (01:43)

You're like, why are you in this group chat? Yeah.

Abby Eblen MD (01:47)

Yeah.

Lauren Makler (01:50)

No, no, Thank you. Thank you. Thank you. Yes.

Yeah.

Certainly not me. ⁓ I will say that in another life, think perhaps I would have gone the route that you guys did. I think it would have been so cool to get to do what you guys do. Growing up, was very unsure of what I wanted to be in. So I made sure that throughout my education and throughout my career, I just was trying not to pigeonhole myself because I didn't know what I wanted. And actually watched a lot of Mad Men after I graduated college, like binge watched Mad Men. ⁓ And so good. And then I was like, gosh, I have to work in advertising. And so I applied at an ad agency, got a job in advertising, and I enjoyed it. But I got very bored making recommendations to other people about their businesses all day.

Abby Eblen MD (02:34)

I love that song, that was beautiful. Love that song. Yeah.

Lauren Makler (02:47)

And then had a mentor who said, Hey, if you're going to work this hard, should go to a startup and own some of that company and work really hard and, and be a, be a part of it from the ground up. And then I, I found myself at Uber in 2013. So I joined very early at Uber. I thought, wow, you press a button and a car comes to you. Like, how cool is that?

And got to be on a wild ride at Uber and was there from 200 employees to 20,000 employees. But you still might be wondering, how did I end up in this group chat? ⁓ It was because, while I was at Uber, I started the healthcare arm of Uber, which is called Uber Health, which does non-emergency medical transportation for low income and elderly patients. So I sort of found myself in the digital health space, but I became a patient myself while I was building Uber Health.

So one morning I woke up with a pain in my side and underwent quite a bit of testing. Turns out I was one of 154 people on the planet to ever get this super rare abdominal disease diagnosis. I had masses growing everywhere throughout my abdomen and pelvis and was told that I'd have to have a number of surgeries to remove the disease.

And I actually was lucky enough, this was before ChatGPT existed, I found every paper ever written on the disease and built a spreadsheet of every author of those papers and figured out who was still practicing and made appointments to go see them all for a consult. And figured out what my plan was gonna be for these surgeries. And of course, my first thought was like, am I still gonna be able to be a mom someday?

And they were like, ooh, you're probably gonna lose your ovaries in these surgeries. Like if we're being real. And I had to sign paperwork that said, yes, take my ovaries if you need to. And so my natural next question was well, can I freeze my eggs ahead of these surgeries? And given how rare my disease was and they didn't know how hormones played into it, they said, no, we are not going to inject your abdomen with hormones when you have disease everywhere. Like definitely not. Egg donation might be your best bet.

I was not ready to have kids. My husband and I had just started dating. I was so overwhelmed. I started to look, I'm a planner. That wasn't clear to you already. I started looking at everything I could know about egg donation in case this would have to be my path someday. Cause I like to know what all the possibilities might be. And frankly, I was really surprised by what I saw. I could not believe how transactional it was. I couldn't believe that to find a donor that reflected my background. It meant that the cash compensation was gonna be higher for that donor. I couldn't believe that these donors were built as anonymous when we know that things like Ancestry.com exist. How is that possible? And I couldn't believe that some websites have like glamour shots of donors and others would have you download a spreadsheet where every donor was a row on a spreadsheet. I just could not believe that.

I would be expected to make such an important decision with so little information. And so at the time I really wanted nothing to do with it. My incredible sister decided that she would freeze her eggs and donate them to me in case I needed them someday. She's the best. I will never forget that she said to me, I would give my left arm if it meant you could be a mom someday. She's a left-handed person. And that was a a big offer.

And she did that. It's interesting because now in retrospect, I have a lot of thoughts and feelings. I'm glad she did it. But I think that's a big thing to take eggs from a family member. I know that that's a very loaded conversation. At the time she donated her eggs. I ended up going through three very major surgeries with very long recoveries. Miraculously did not lose my ovaries, which is still a shock to all of us. ⁓

But I got to live my life with the gift of frozen eggs, I got to make decisions about my career without the pressure of my biological clock, got to make decisions about my relationship without the pressure of my biological clock. And years later, when I went on to have my first child, which I did so unassisted, I realized there was no other way I wanted to spend my time than to help people have babies, whether that's someone who wants to have a child someday through Cofertility's split program or an intended parent that needs an egg donor today. And so that's our model. Essentially, we help women freeze their eggs for free when they donate half of the eggs retrieved to intended parents that need the help of an egg donor to have a baby. So we remove cash compensation from egg donation, making it less transactional while making egg freezing more accessible at the same time. Our setbacks can be our setups, ultimately.

Susan Hudson MD (07:20)

That's a beautiful story. That's absolutely amazing.

Abby Eblen MD (07:21)

You were saying it was really fun to be in a meeting with three fertility doctors. I was just thinking, it's so cool that we get to meet such great women, a lot of women, that are entrepreneurs. And that is something so out of the realm of what I know how to do. I'm very impressed by that, that I know somebody that could do that by themselves and come up with such a beautiful design of your company without really having, even I would have trouble putting that together and you have no background in medicine to be able to put that together. Because one thing I was thinking as we were talking a little bit earlier. You had said something about how you thought it was just crazy that people didn't know about this and didn't tell people about where the eggs came from. Well, actually that's not really been that long ago, although it was probably a little bit before you went into this. But in 2012, I just looked this up, I think ancestry.com was started.

And I remember, I mean, the first half of my career, nobody disclosed much of anything, because you weren't gonna ever be able to find that stuff out. We had a nurse, I remember, and she did ancestry.com, and she mentioned, she goes, when you do this, it'll tell you, if your sister or brother does it, that you share 50 % of the DNA with this person. And we were just blown away. I'm like, oh my gosh. Even though I knew a little bit about genetics, I didn't know nearly as much as I do now.

And that was really the advent of when all of a sudden all these people who had donated eggs and sperm were like, wow, okay, now people are gonna start to be able to find me. And for you to normalize it so much to make it so easy for people to do it and not feel ashamed of doing it. And I think there's a lot of shame prior to that about, I don't have good eggs or my partner didn't have good sperm. And I think it's just great that you're making it part of the conversation and making it just a really easy thing for people to do.

Lauren Makler (08:53)

Yes. So, yet no path to parenthood should ever feel shameful. You are someone who wants to have children and you're going to make that happen. There's nothing about that that is taboo or shameful or we shouldn't talk about or we should feel weird about. Like, that's true. I don't condone kidnapping. Let's not.

Abby Eblen MD (09:25)

Absolutely.

Carrie Bedient MD (09:26)

Unless you're kidnapping, we don't control kidnapping or babynap.

Lauren Makler (09:32)

I just don't think that any part of it should be a hush-hush secretive thing. I don't think it's good for anybody. And I think part of it is now that I've started Cofertility, people tell me all the time, I don't tell many people this, but my two kids are donor conceived or, my dentist was like, my second child's donor conceived. I'm like, this doesn't have to be a secret. It's okay. News came out earlier this year that said, for the first time in US history, more women in their 40s had children than women in their teens. And think about that. We know that one in four IVF cycles for women over 40 is using donor eggs, right? So third party reproduction, assisted reproductive technology is absolutely responsible for this shift and this change. People are waiting to have children until later in life, sometimes by choice, sometimes not by choice, but it's our job to help enable them to have children when they want to have children and to make it happen. And there's nothing about that that is shameful.

Susan Hudson MD (10:37)

You're absolutely right about that. All right. We can. That's the important message. But we are going to have a question. We are going to talk about what to look for in an egg donor.

Lauren Makler (10:50)

Yes, And I do want to mention, you're right, I'm not a doctor as much as I wish I was. But, and actually, my now four-year-old asked me, she knows that I help people have babies. And she asked me, what else do you want to be when you grow up, mama? I was like, what else? I was like, well, if I had all the time in the world, perhaps I would love to be a reproductive endocrinologist myself.

No, I feel like I'm on that path with what we do at Cofertility is work really closely with a lot of reproductive endocrinologists. Not only do we work with the doctors at the clinics we partner with, but we also have a really amazing medical advisory board who we are in touch with all day long every day. When I talk about what to look for in an egg donor, it certainly is not my own made up.

Abby Eblen MD (11:21)

Yeah, you are.

Carrie Bedient MD (11:22)

Very nice.

Lauren Makler (11:37)

It is with the help of a lot of physicians.

Susan Hudson (11:45)

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Susan Hudson MD (12:48)

Our question is, hi ladies, thank you so much for all the invaluable information you provide to us. Thank you for listening. My question is after two FETs with one embryo each time, one biological and one from a donor, should I be pushing my clinic to do more testing like a hysteroscopy? I am 44, I've been trying with this clinic for four years doing many tests, many stimulation rounds, and ultimately with insurance funding running out was guided to use donor eggs. I had four day five embryos created with my husband's DNA and now have three left. We were not allowed to do PGT testing on the donor eggs, but told that they look great. I also have Hashimoto's thyroid disease. So could there be more my clinic is missing to help with implantation issues? Thank you for your help.

Abby Eblen MD (13:38)

So she's had just one transfer that has failed, correct? Two.

Carrie Bedient MD (13:41)

Two.

Susan Hudson MD (13:41)

She's had two transfers, one from her own eggs and one from donor eggs.

Abby Eblen MD (13:48)

But none genetically tested. Even in the donor, there's a 50 % chance the egg could have been genetically abnormal and there's no way that you would know that. But to your point about hysteroscopy, absolutely. I if you've not had an assessment like that, I think now would definitely be the time to do that. That's definitely something that can make a difference if they were to find suggestive endometriotis, polyps, things like that. I think that's a great idea.

And I would assume having gone through all those other things, you would have already done other assessments, sperm assessment, that kind of stuff. And if you have Hashimoto's, I'm sure you've had a TSH and you've thyroid antibodies, but definitely now would be a good time to look at everything and maybe regroup. And there's also some other endometrial biopsy testing that you may want to consider too.

Carrie Bedient MD (14:30)

Another thing to consider is whether or not you want recurrent pregnancy loss labs done, in particular the antiphospholipid antibody or anticaridolipin antibody panels. And some of this will depend, usually we wait for two euploid failures before we do this. There's some gray area in your case with that. One, because there was no PGT done. And two, because for the one that was done with your egg, your age, influences how likely we think this is to work. For example, if you were 43, earlier 44 doing this, the likelihood of no implantation is incredibly high. That's disappointing, but not necessarily a surprise. That may shape what your docs want to do. I don't think there's a lot of harm in doing them other than they may not be covered by insurance and they sure can be expensive labs, but that's another thing to consider.

Susan Hudson MD (15:23)

Absolutely. I'm assuming that likely you are from outside of the United States since it said you were not allowed to do PGT testing and just because I'm assuming that wasn't a clinic policy. When we're looking at some of the endometrial receptivity assays that Abby was talking about, I'm not sure internationally what's available, but really the one that I think we put the most faith in at this point is the testing that's looking for a chemical called BCL6 within the lining of the uterus. And even if you don't have that accessible, talking to your physician about potentially doing some sort of suppression either with leuprolide or whatever your local version of that medication is for a couple of months prior to your next transfer, potentially might have impact in a positive direction.

Today we are going to talk about what to look for in a donor. Lauren, what are some of the things that should be at the top of somebody's list?

Lauren Makler (16:31)

One, you certainly want to trust the group you're working with. Some people will go the off book route and will maybe find a donor on their own through Facebook or through different channels like that. In those scenarios, you don't know that the donor has been clinically cleared and things like that might be questionable.

Definitely want to make sure that before you get your heart set on working with a donor that you do have your physician review every detail involved. That's an important piece of it. But if you're working with a company like ours or another egg donation company out there, certainly want to make sure that they're following the ASRM or American Society of Reproductive Medicine guideline that the donor should be between the ages of 21 and 34. Egg donor age is really an important piece of this. We know that someone's age impacts egg quality, like we mentioned before. We see that being a good age, of course, for egg quality, but also for emotional readiness. You want to make sure that someone is old enough to make a decision as big as donating eggs for their own future. What's interesting is that there was a study done a few years ago that said that younger isn't always better. ⁓ This study showed that for women that were under 25, their outcomes were actually 13 % lower in the donor cycles between the age of 21 and 25 than 26 and up. When I think about that, I'm like, hmm, why is that the case? And then if you've ever gone through an egg retrieval, you can probably guess. You literally are your own chemist.

I'm not saying it's impossible to do if you're 25 and younger, but it is, it's a big undertaking to make sure you get it right and that you are really compliant with the protocol. Doing it at the same time every day and following instructions and going in for all of the appointments and for the monitoring and taking that really seriously is something that, I think women that are in their late twenties are probably better at than women in their early twenties.

Abby Eblen MD (18:09)

Yeah, it's pretty daunting.

Lauren Makler (18:31)

We have intended parents that'll come to us and they'll say, oh, I need a donor who's under 24. And we're like, But why though? That just doesn't actually improve the outcomes. I also think about it, someone who's a little bit older in their later 20s is probably making a more thoughtful decision about their future. I would say as long as they squarely fit into that ASRM requirement, you're probably in good shape. And we actually have data that shows women in their early 30s, as long as their AMH is above a certain number, that their outcomes are excellent. We feel really strongly and we share that data with intended parents who want to see it because data is everything. Age is certainly super important, but there are course factors beyond age.

Someone's overall health, of course, but their lifestyle and behavioral factors matter quite a bit. Nicotine can impact egg quality. So Certainly want to make sure that someone isn't vaping or smoking, and that's just a big part of it. Excessive alcohol, abstaining from alcohol during the egg donation process is really important.

Making sure that the organization you're working with does follow those sort of base level things is super important.

Susan Hudson MD (19:45)

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Susan Hudson MD (20:22)

What do you think about marijuana use?

Lauren Makler (20:24)

We will certainly disqualify someone if they are using it on a very regular basis or aren't willing to abstain for several months leading up to the process because I think it's less studied than alcohol use. You guys probably know this better, but less studied because I think only in recent years has it been something that's been legal in certain states and even where I think now it's clear at least if you're using marijuana products, like how much of that marijuana product you're using because it is in the labeled container. Years ago it wasn't. And so I think there's a lot to come as it relates to really studying the impact that it has on conception and things like that. But until we have that data, we think it's probably best to steer clear during a process like this. How do you guys feel about that?

Abby Eblen MD (21:12)

Well, and even for things that we know, like most of us can drink alcohol socially, but we know you don't do that when you're trying to get pregnant or when you're having a baby. You're right, there's not a lot of data on marijuana, but I bet the data is gonna show it's not something you wanna do when you're either trying to get pregnant or pregnant.

Lauren Makler (21:27)

Totally, yeah, exactly,

That's certainly one of the lifestyle factors that we look at. I think the other is fertility indicators. At Cofertility, we have an AMH threshold that a donor has to be above. We want to see an AMH of at least 2.0. And if a donor comes to us and they're on hormonal birth control and their AMH is below 2.0, we have them...go off of it and wait and retest, but we're not gonna take that chance in a situation where we have intended parents that have been matched with them and are gonna go forward with the cycle.

Susan Hudson MD (22:01)

How does that compare industry-wide? I would actually think that would be a relatively low AMH compared to most of the industry.

Lauren Makler (22:10)

We set that with our medical advisors, just knowing that if you have a donor who is between the age range and is at a 2.0, that they're very likely to have a strong outcome. My understanding is that that's the same AMH that a number of other organizations use. But I think our average AMH that we see for donors is actually 4.0. But we do know that we have good outcomes with 2.0.

I think beyond those factors and of course, once the donor goes in for her first ultrasound, we want to make sure that her antral follicle count is in alignment with her AMH. Sometimes it can be a little bit off and it's really important to make sure that they're on point. But I think of course, her medical history and her family medical history play a big role.

Long before a donor ever makes it to our platform, we are doing a thorough review of her medical history, her family medical history. We're also doing a genetic carrier screen because we know that that's really important for intended parents to be able to compare her results to the sperm source's results. But we also make her medical history known because some intended parents may feel really strongly about certain things in someone's medical history because of the sperm source's family medical history as well. If we see the sperm source has an extensive medical history of heart disease, maybe they want to make sure the donor has no history or the egg donor has no history of heart disease on her side. We really want to be able to work with the intended parents to find something that feels right for them. But we want to make sure that that is done and reviewed and very available to the intended parent before they ever make a match.

Susan Hudson MD (23:50)

Lauren, how do you counsel people about the limitations of a family history?

Lauren Makler (23:57)

We are as upfront about that as possible. Part of what we do is we make sure we're getting the family history at multiple points during the donor's process because the opportunity to share that information multiple times may show either like a lapse in memory or not getting something right the first time, but also having it done with the site provider and a genetic counselor is a way to make sure we're uncovering as much information as possible. In the US, we have a healthcare system that does not have a universal EMR. We're not able to pull the donor's pediatric records and her OBGYN records. We don't have the ability to share that way in a way that I think all of us would probably feel better about if we did.

Carrie Bedient MD (24:44)

How do you approach donors who don't know about family members? For example, let's say a parent is estranged. Let's say grandparents are estranged or a dad is not known or something like that. How do you approach those cases? Because you've got the ones where the donor says, I know everybody and nobody likes to go to the doctor so nobody's got any medical problems. Versus someone will say, I know my mom and my maternal grandparents have da-da-da-da-da-da-da.

But my dad's long gone. I don't know anything about his side of the family other than I was told he had, heart disease early and that's about it.

Lauren Makler (25:15)

Yeah. Sadly we have to disqualify donors that don't have family medical history on both sides. That is one of the requirements that we have up front. We cannot have huge gaps in understanding of one's family medical history. It's just not fair to do to the intended parent or the donor conceived child someday. That's not to say that we don't believe that person should be able to have children. It just means that in this process, we think it's really important to have all of the picture. We don't think it's fair to the intended parent to not be able to share that. We would have to disqualify that person earlier. And we do have a program, by the way, called KEEP for women who might be interested in our egg sharing program to donate, but maybe don't qualify. I should start by saying this, we have to disqualify most of the women who apply to our split program. We do because of our stringent requirements. I wish we could let them all in and we'd have so many more donors. And we always do have hundreds of donors available to match with intended parents at any given time. But if we let everybody in who wanted to be in there would be thousands and thousands more. Sadly, we have to decline way more than we're able to let in because of things like that.

Carrie Bedient MD (26:37)

What would you tell intended parents who have been through the wringer, which pretty much by the time they get to you, everybody's been through the wringer, but there's some people who've just above and beyond gone through the washer, the dryer, high spin, all of it. And what would you tell them when they say, okay, we want to do this once, we want to do it right. We need a baby the first time. And there's, there's a little bit more trauma behind that. What do you, what do you tell them about, how do you get to the most successful?

Lauren Makler (26:55)

Yeah, totally.

One of the things we do is that we will have a, we call it a matchmaking call, but we'll have a consult call with any intended parent. There's no charge to that. We want to make sure they feel comfortable working with us before moving forward. And what we try to do is learn about them and learn about what they're indexing for. Some of them may come to us just like you said, and say look, this has been a long road. We have to get there and we have to get there fast and we need to avoid as much heartbreak as possible. Then we have other people who might come and say, it doesn't matter how long it takes, it doesn't matter how many goes we have to do, we want to find the absolute most perfect donor for us. We will say no to most of them, but we're looking for that perfect person. It's important on our end that we know what you're indexing for because we will help navigate you to the path that we think is best for you. If you came to me and said, it's been a long road, it's been rough, what's the least heartbreak fastest path? I would absolutely say, let's go with frozen donation. And the reason for that is because with our frozen program, we know exactly how many eggs have been retrieved. They are already there waiting for you. She's already been through her genetic carrier screen. She's already passed a psych eval. She has already met with the lawyer, she's already gone through every step of this process and it's complete and it's ready to go. And you can move forward with those eggs and have embryos within two to four weeks if you choose frozen. There's more guaranteed less uncertainty in the process. If you were someone who said, I have more time, I'm not in a rush, which some people are in this boat, it's rarer when you need an egg donor to be in this boat, but it's possible.

I'm thinking of an intended parent in my mind who felt like, I'll know when I know. She was looking for a donor with very specific heritage, but also she was like, I am looking for someone who exudes a certain warmth and kindness. We know with that intended parent, she loves donor videos. And a good portion of our donors not only share their photos with us from throughout their life, some...Intended parents really love to see baby

photos, childhood photos, teenage, adult, recent photos, but also we upload a Q&A video. And we know this intended parent loves the videos. And so anytime we send her a donor, we make sure the donor uploads a video. And recently she was like, found her. She's the one. And it was, it was this video that spoke to her. And she is cool with knowing that fresh is going to be a bit of a longer road, but it was worth it for her to find this perfect donor. Now we have to go through the process of there is a chance she'll go in for her antral follicle count and maybe it won't match the AMH, or there is a chance that the donor might not pass the psych eval. But there are steps that there can be friction in the process of fresh. And my goal is that any intended parent choosing that process at least is just aware. What I tell intended parents is There is a world in which this donor on Fresh doesn't make it all the way through the retrieval. If that happens, we've got you, we'll rematch you with another donor that you may even feel more excited about the next donor. But it's important to know that we don't see this as there's only one donor out there for every intended parent. It's not your one in a billion. Typically we have two intended parents sitting together on a couch in front of us over Zoom and I tell them, The person next to you on the Zoom, the one you're gonna raise this baby with, that's your one in a billion person. Any number of amazing donors could help you grow your family. And being open to that needing to happen in the process with Fresh is a possibility.

Abby Eblen MD (30:42)

Lauren, is there any specific thing with the donor for those people who may want to be part of it or people that want to use a donor from Cofertility, is there anything outside of what you've mentioned like ASRM guidelines or the psych eval that would make you go, you're probably just not a great fit for this program.

Lauren Makler (31:01)

We definitely care very much about the FDA guidelines and ASRM guidelines and the things that, we've worked with now over 225 clinics across the US. And I don't ever want to send a clinic an intended parent and donor match where the clinic is gonna be like, what, why'd you send me this donor? That's not gonna work. We wanna make sure that it's an overwhelming obvious yes when we send this match to your clinic.

And hopefully the three of you have experienced maybe, I hope that it's an obvious. Yes, this is a good fit. We find it's really important to us, every single donor meets with my team. It acts both as an interview of the donor, but also as informed consent. We want to make sure that she understands that donating eggs is not a trivial thing. This is a decision you're making for your life. We also want to make sure she is who's in her photos. We don't accept, we won't accept filtered photos or AI generated photos. You have to be the real person that's in your photos. If someone's unwilling to come off camera, they don't make the cut. They have to be who is in their photos and they have to go into this eyes wide open.

We ask them to sign a contract with us just to say, yes, I know what I'm getting into. Yes, I want to do this. Yes, make my profile available. We give them opportunities to change their mind. We want to make sure they are absolutely all in. The motivation behind it is the thing that I would look for. But really, every intended parent is looking for a donor that's as unique as they are. Who am I to say that someone isn't a good fit or is a good fit when, an intended parent might feel they're the perfect reflection of what they're looking for. I think that's the coolest part of all this is that someone who might appeal to one intended parent as a donor may or may not be a fit for somebody else.

Susan Hudson MD (32:50)

I've always found it interesting watching intended parents pick donors because they all think that everybody's picking donors based on the same criteria that they think is important. And it varies so much person to person, couple to couple. And it's just, it's a neat thing to watch and how it unfolds and how even whether it's in a situation where they have full disclosure or whether they don't have full disclosure of who people are, that it's definitely a process, but you will know in your heart what's the right decision.

Lauren Makler (33:19)

And that's the thing that some intended parents will read someone's profile and what resonates with one person is not what will resonate with the next.

I think, to hear and listen and to maybe pick up on something that someone wants that maybe they don't even know they wanted or to suggest a donor that maybe is outside of their original criteria that could end up being a fit. But that's part of why I think it's so important that we don't have cash compensation as part of this, because I don't ever want an intended parent to choose one donor over another because of cost between them. It's like, this is what it costs to get an egg donor through Cofertility. Whether you're choosing an Ivy League donor who is a violin prodigy or a donor who went to design school who is a fantastic artist. That shouldn't be the reason or different heritage shouldn't be the reason that cost comes up.

Carrie Bedient MD (34:27)

When your team is meeting with these potential donors, how often do you find that your spidey senses go off, where there's nothing that's necessarily wrong with anything they're presenting, saying, or doing, but you get that sense of just something's not right. That women's intuition is just like, don't know what it is, but it's not right. How often do you guys experience that?

Lauren Makler (34:30)

Not often, I think by the time someone has spent the time and energy to complete our incredibly intense and thorough, it is hundreds of questions that the donor has to answer before she ever gets to the point where she's meeting with my team that usually they sort of self-select out of the process.

Occasionally, and that's why it's in our terms of service that we have the right to decline anybody from the platform for no reason other than we want to. Because we don't want to have to work with people that we don't think are a good fit for this program or to work with an intended parent. But I find that usually people self-select out. I think our model really attracts the type of person who...is in this for the right reasons, who sees this as, this is something I can do for myself and someone else at the same time. I will also say that 55 % of our donors have a graduate degree or higher. They are incredibly educated.

The nature of the model attracts that kind of person. Really most often I'm blown away by these donors. I feel bad about my own resume when I see them. ⁓

I can barely even think of a handful of donors that we've had to be like, this is weird. I'm impressed by this generation's awareness and understanding and desire to, they see this as service in a way. I get to help someone else not face this struggle. It's pretty cool.

Susan Hudson MD (36:20)

I think you're in an amazing position to be able to give hope to two hopeful families down the road. It's a really amazing concept that came out of not an amazing situation. And you identified a problem and came up with a relatively unique way to fix the system.

Lauren Makler (36:28)

Yeah, thank you.

Thank you for that. It's really, you know, we actually, just had our 54th Cofertility baby born and we have, we have dozens of pregnant intended parents. We have a team Slack channel where we just, it's photos of, of ultrasounds and babies. And I, I just wish that more intended parents who are faced with, this prospect of sort of grieving their genetics and, it's a tough spot to be in when you are realizing, I have to deal with the feelings I have of this. I have to cope with that and time is of the essence. I have to move the ball forward at the same time. You're being asked to parallel process the feelings and the logistics. And I don't want intended parents to add shame on top of them. Let's add some possibility and some hope of there are more people than you realize who are in this boat and who are getting to the other side. And there's nothing wrong with that. And, we can hopefully help. I want people to feel hopeful more than anything.

Susan Hudson MD (37:49)

Well, I think you are bringing a lot of hope into the world and I thank you for everything you do. And for our listeners, if you're interested in Cofertility, either for building your family now or later, go to cofertility.com. And thank you so much for listening and subscribe to Apple Podcast to have next Tuesday's episode pop up automatically for you. Also be sure to subscribe to YouTube. That really helps us spread reliable information to help as many people as possible.

Abby Eblen MD (38:20)

Visit us on fertilitydocsuncensored.com to submit specific questions you have and sign up for our email list. Check out our new book, The IVF Blueprint, and it's at all major sellers, Amazon, Barnes & Noble, and bookshop.org.

Carrie Bedient MD (38:34)

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

If you want to know more about Cofertility, check out episodes 279 and 304. And if you're interested on more of the mechanics of egg donation, sperm donation, and surrogacy, check out The IVF Blueprint. Chapters 16, 17, and 18 are for you and have a ton of information that may be helpful.