How safe is donating your eggs?

Vox reader Quentin Ampersand asks: How safe is egg donation? Are there negative long-term impacts? How well are the health impacts understood?

Egg donation occupies an unusual spot in American medicine and culture. Use of donor eggs is quite common: More than 20,000 in vitro fertilization (IVF) cycles using donor eggs took place in 2022 alone (the most recent year for which data is available). But the process also isn’t often publicly discussed. When I was researching this question, I found five media stories about people freezing their own eggs (including one by me) for every one about donating eggs to someone else.

Given the relative lack of conversation around the process, it makes sense to start with the basics: When someone is considering donating eggs, they typically reach out to a clinic and go through a screening process, both to make sure they meet eligibility requirements and to ensure they are free from STIs or any other conditions that would make donating tissue dangerous. If everything looks good, donors then take medications to stimulate their ovaries to produce many more eggs than normal (an average of 18, according to one study, compared to the usual one or two per month). Then they undergo a short surgical procedure to extract the eggs, which are typically frozen until the recipient decides to use them.

Some people donate eggs to friends or family; others donate to egg banks so that their eggs can be used by people they may never meet. People who donate to banks usually get some financial compensation for the process, which can require months of medical appointments. Payment for donor eggs has been a subject of controversy, especially since research has shown that white donors can receive more money than Black donors. Some clinics set a standard fee for all donors, often around $10,000, and the American Society for Reproductive Medicine recommends that payment should not be so high that it clouds a would-be donor’s ability to make an informed decision.

Donating eggs also has some known short-term health risks, which are usually manageable with good medical care. But you (and others) want to know about potential long-term risks. Does egg donation harm future fertility? Does it cause cancer?

Let’s break down what we know.

Medically, the process for donating eggs is essentially the same as the process for freezing your own eggs or having your eggs extracted for IVF. The most common side effects are the same, too. The injectable medications that stimulate the ovaries can cause bloating, mood swings, and pain at the injection site. The surgery to remove the eggs is very quick and usually done on an outpatient basis, but like any surgery, it carries a small risk of infection or bleeding.

Beyond these concerns, the biggest thing egg donors — like IVF and egg-freezing patients — have to watch out for is a condition called ovarian hyperstimulation syndrome, which causes fluid retention in the abdomen. In severe cases, this can cause dehydration and even short-term kidney problems. The condition is very treatable as long as the patient recognizes the signs and gets timely care, said Amanda Adeleye, the founding partner at CCRM Fertility of Chicago and a professor of obstetrics and gynecology at the University of Illinois, Chicago.

Fewer than 1 percent of people undergoing ovarian stimulation get severe hyperstimulation syndrome, but the risk is higher for patients under 35 than for older people.

These are the best-known health risks of egg donation, and if you go through with the procedure, your doctor will tell you how to spot and handle them.

But in the last few years, some patients and their families have raised concerns over possible long-term effects of the procedure.

One question donors and would-be donors have is whether the procedure can affect future fertility. So far, there’s no evidence that it does. Retrieving eggs for donation does not deplete a person’s ovarian reserve. “The eggs that are collected from an ovarian stimulation cycle are eggs that were going to die that month anyway,” Adeleye said.

However, Adeleye does tell patients that every ovarian stimulation cycle carries a tiny risk of ovarian torsion, in which an ovary twists within the body, cutting off its blood supply. This can lead to the loss of the ovary, which can harm a person’s fertility. This outcome is “extraordinarily rare,” Adeleye said.

The other big question prospective patients have is around cancer risk. Researchers and family members have reported cases of egg donors developing breast, colon, or other cancers in the years following egg donation, and though there’s no proof that the donation process was the cause, the reports caused concern — especially because egg donors are generally young and healthy.

The research available right now shows that fertility treatments in general (including egg donation, egg freezing, and IVF) are not associated with an increased risk of breast or colon cancer, according to the American Society for Reproductive Medicine. Breast cancer, in particular, is unfortunately very common, including in younger people, and reports of donors getting the disease in the years after donating may simply stem from the high prevalence of breast cancer overall, said Micah Hill, the president of the Society for Assisted Reproductive Technology.

Fertility treatments may be associated with an increased risk of ovarian cancer, as well as a type of non-cancerous ovarian tumor, but the risk of either of these conditions is very small. A woman’s overall risk of getting ovarian cancer in her lifetime is one in 87, and ovarian cancer cases and deaths are on the decline. In the case of ovarian cancer, any increase in risk may stem from underlying conditions that cause infertility, rather than fertility drugs themselves.

Overall, “the data is reassuring” on fertility drugs and cancer risk, Hill said. Patients may be concerned about the use of hormones in egg donation or IVF, since some hormonal medications have been linked with cancer, but the levels of estrogen and progesterone in the body during fertility treatment are actually much lower than those during pregnancy, Hill said. And ovarian stimulation for egg donation only lasts a couple of weeks, much less time than it takes to bring a pregnancy to term.

When it comes to risks, Adeleye tells patients “we can never fully predict the future.” Egg retrieval is still a relatively new technology; the first person born from IVF is only in her 40s today. There are uncertainties, Adeleye says, but that’s also true of any medication or procedure.

In addition to the physical safety of egg donation, experts say would-be donors should also consider the emotional impact. Egg donors could have multiple biological children in the world they may never meet. If they face fertility challenges or pregnancy complications later in life, they may feel regret or resentment around donating their eggs, even if there’s no direct connection between donation and fertility problems. For these reasons, many clinics perform a psychological screening prior to egg donation to make sure patients understand the possible emotional effects of the procedure. Some also offer shared cycles, in which patients donate some of their eggs and freeze some for their own potential use later on.

It’s worth noting that the risk-benefit calculus may be different for prospective egg donors than for IVF patients. People undergoing IVF are balancing the risks involved with the desire to build their families, but egg donors have to weigh those risks against their desire to help someone else conceive. Egg donors do receive compensation, but “it is still a gift,” Adeleye said.

“This is something that’s meant for people that are altruistic and want to give” — and people who are comfortable using their bodies to do so. “That’s not everybody, and that’s okay,” Adeleye said.

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