Posted on March 18th, 2021by RMANY

Ep 54: Ovum Donation and Third Party with Dara Berg and Melissa Brisman, Esq.

Fertility Forward Episode 54:

Becoming an egg donor, or looking for one, can feel like a daunting task. Our guests on today’s show, Dara Berg and Melissa Brisman are here to provide some clarity around several common questions and concerns and hopefully quell your fears and give you the courage to embark on this journey. Dara explains the rigorous process involved in becoming an egg donor. While it is impossible to verify all of the information outside of their office, Dara has the utmost faith in her team’s ability to identify whether a potential donor is trustworthy or not. Melissa highlights the importance of lawyers and psychologists in the donor process; they are there to help, not to make things difficult. We also discuss the reasons that people choose to donate eggs, why some people are rejected as donors, the available options for choosing an egg donor, shared cycles versus non-shared cycles, the potential difficulties that can arise when receiving eggs from family members, and more! There is no one-size-fits-all approach to third-party reproduction, and RMA offers the support that you need to make this journey as smooth and fulfilling as possible.

Transcript of Episode 54

Rena: Hi Everyone! We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our fertility forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Rena: We are so excited to welcome to Fertility Forward today, Dara Berg and Melissa Brisman to talk about ovum donation and third party. Dara Berg is a part of RMAs third party department and she's a women's health nurse practitioner who has worked in infertility. specifically in third party reproduction for 20 years. She helps care for patients who are going through egg donation cycles, co-IVF cycles and gestational surrogate cycles in collaboration with their physicians. She considers the best part of her job to be just being there for her patients throughout their individual journeys. When she's not working, she loves spending time with family and friends and during the pandemic has spent most of her non-working hours volunteering to try and secure COVID vaccine appointments for the elderly people in her town. Super excited to have you on today and joining you as well we have a recurring guest, Melissa Brisman who specializes in reproductive law who can speak to the legalities surrounding third party and ovum donation. So really excited to have you guys both on. This is a topic so many people have questions about and I'm really excited to have this platform to present accurate information and answer questions for people cause I know it can seem super overwhelming and daunting. So Dara, I would like to open it up to you and sort of tell us what is third party? What does that mean?
Dara Berg: Well, first thank you for having me. Third party reproduction is when an individual or couple is using a third party in order to conceive. So that could be using an egg donor, that could be using a sperm donor, that could be using a gestational surrogate.
Rena: Okay. So that kind of is an umbrella term?
Dara Berg: Yes.
Rena: Okay. And so for this podcast specifically, I'd love to talk about ovum donation and what that means. So say I come to you and I say, okay, you know, my doctor just told me that I'm going to have to use an egg donor. What do I do? I have no idea what that means. I'm, my mind is reeling, you know, from sort of just processing that. And I have no idea what I'm supposed to do. Help!
Dara Berg: Right. So that means that there will be a young, healthy woman, hopefully who is volunteering to donate her eggs. She will be determined to be healthy after much screening is done. And the patient who needs the egg donor will be able to receive those donated eggs and fertilize those eggs with her partner’s sperm or donor sperm, and, and then make embryos. And then an embryo can go back into the recipient's uterus and hopefully help her conceive.
Rena: Okay. So let's maybe first talk about the screening process. What kind of a screening process does someone have to go through to become an egg donor?
Dara Berg: First of all, if it's an anonymous donor, there are usually age guidelines for various infertility centers. So if it's an anonymous donor, our center screens women between the ages of 21 to 32. They fill out an application so that we can review their personal medical history, their family medical history, other things, such as hobbies and interests, and academic backgrounds, occupation. So they'll answer some open-ended questions about why they're donating and if after review their application looks okay, we move them on to invite them in for a personal interview where we go through much of the same information but try to gain more detail about what they've already submitted in their application and ask just a lot of questions to get a feeling from them that they're motivated to donate, that they're going to be responsible, try to get more details about family history information. And if we feel very comfortable with them and we haven't learned anything about them during that interview process that would exclude them, we would move them on for an assessment of their fertility hormones and their ovaries via ultrasound. If their hormone levels and their ovaries look good and healthy, we would then move them on for a psychological test to rule out mental pathology and also a meeting with our psychologist who will also interview them and ask them, you know, many, many different things. If they pass that they're invited back again for a physical exam that includes blood work and vaginal cultures, a urine drug screen. The blood work includes testing for infectious disease to make sure they're negative and healthy. And if they pass that last step of screening, they're then accepted into our program as a donor.
Rena: That sounds really intensive and a lot for the donor to go through. What are some of the motivating factors for someone to want to become an egg donor?
Dara Berg: There are two motivating factors. One is usually financial. The donors receive $10,000 after they've completed their donation. They're usually using it for paying back college and grad school tuition and loans. The other reason is generally altruistic. Either they know someone who suffered from infertility and that's what got them thinking about donating their eggs or they just want to do something good for somebody.
Rena: What are some reasons that you would turn someone down to be a donor?
Dara Berg: There's many reasons if they show that they're not being very responsible with their appointments. If their fertility hormones are a little bit borderline or abnormal, certainly we would not use them as a donor. We do not generally take donors unless it's a known donor, which we can talk about separately, with a BMI that would consider them to be significantly overweight. We don't take smokers. So, you know, there's a lot of different reasons. If someone obviously tested positive for an infectious disease, they would not be able to donate. So there's, there's a bunch of reasons as to why they could fail screening.
Rena: What about if someone's on medication for anxiety or depression? Like say your, your just sort of generic, you know, Zoloft or Lexapro, or just sort of generalized anxiety, would they pass the test?
Dara Berg: So that's a very common phenomenon these days especially. Our psychologist would interview her and gain a lot more insight into, I guess, how severe her issue is and how donating may affect those anxiety levels, et cetera, and how the hormones could actually also affect mood. Then at that point, the psychologist would decide whether the donor could move forward or not.
Rena: Yeah. I'm just wondering, because especially, you know, these days, you know, I know my patients more than ever are asking about medications and I see more and more people going on medications. So not sure how that would affect the donor pool, if at all.
Dara Berg: Yeah. I mean, it can affect the donor pool. It's really a case by case basis.
Rena: Sure. And what about, okay, so someone comes in and they pass the screening, they're able to donate eggs. And now how do I choose an egg donor? Is it, is there a donor bank? What does that look like?
Dara Berg: So at RMA, there's really three options in terms of finding an anonymous egg donor. You know, separately, people can have a known donor, which would be a known usually relative or friends, which if we want to discuss, we can discuss in a little bit. But as far as anonymous donors, we have three options by which a patient can find an egg donor. The first is that we're partnered with a frozen egg bank. They're not part of RMA, but they’re a bank that we've partnered with where patients can go onto their website, register with their email address, and look through photos and profiles of donors. Now the eggs of these donors have already been frozen and are being stored in various infertility centers across the country. And if a patient goes and looks through the profile and reads all about the donor and looks through the photos and likes the donor and thinks the donor matches her well, they would call the egg bank and the egg bank can actually deliver those eggs to RMA in two weeks time. So this is a very fast way to find a donor. If you log on and you see someone you like very quickly, you can also see adult photos of the donors, not all methods by which to find a donor will show you adult photos. So they show both childhood and adult photos. The second way to find a donor would be through RMA. And we have a donor pool. We recruit, we recruit and screen donors all of the time. And as donors pass through our screening process, we would then help make matches with our patients and our patients in order to be matched with an RMA donor would go on our wait list. We do have a wait list. It's about one to three months wait, in order to be matched with a donor, the patient would fill out a profile telling us exactly what they were looking for in a donor, whether that'd be, you know, a certain race or ethnicity, certain hair color, eye, color, skin tone, a height range. And then other people write down, you know, just various requirements that they have such as maybe a personality characteristic, or country of origin of their grandparents. Like they would really like their donor to be part Irish or part Italian. So they'll write down everything that's important to them and upload some photos to this profile and we would use that as a guide to then match them with a donor. And if we felt we had a great match for them physically and otherwise, we would then send the profile their way for their review. They would review it. If they like the donor and want to move forward with her, they would accept the donor. If there's something that they're not comfortable with, then they would let us know that they would like to reject the donor. And we will continue to look for another great match for them. Then the third way to find an egg donor would be through an agency. There are agencies out there that recruit and do pre-screening on girls who say they would like to be donors or it may be someone who's donated in the past and is looking to join it again. And generally not in all cases, but generally they have websites that patients could go to and they could register with an email and some personal information and look through, again, profiles and photos of egg donors. And if they feel they really like one and match with one, they would let the agency know and then the agency would contact us and we would begin the medical screening on that particular donor. And as long as the donor passes medical screening at RMA, she is available then for that couple to use as a donor.
Rena: So there's a lot of different choices. Is there a big difference in terms of cost differential between the three? You know, I know with RMA, there's the wait list versus an agency may be quicker. Are there any other differences between the three that someone should consider?
Dara Berg: The RMA donor, we only do show baby photos of the donors to protect their anonymity. So that would be a difference that I didn't mention before that I wanted to mention. Agencies usually do show adult photos, but as far as the timeline and the pricing, the timeline, I think would be probably fatest if someone logged on to the frozen egg bank and found someone today, because clearly the eggs could be delivered in about two weeks. In terms of the timeline for the RMA donor versus the agency donor, I think those can be relatively similar. And then as far as price points, it really depends on if the patient has insurance that covers any of their donor cycle. Some people will save money, you know, if they have some insurance coverage for a portion of the cycle. So people with no insurance at all, their least expensive option would be the frozen egg bank. For people who do have insurance coverage for a portion of the cycle, their cheapest option would probably be using an RMA donor shared, which basically means that they're being matched to a donor. There's another couple in our office being matched to the same donor. They will never know who the other couple is and vice versa, but when a donor goes to retrieval, as long as she makes 10 eggs or more, they're split equally between both couples. And so that means that a couple doing a shared cycle would receive half of the eggs that the donor makes as long as there are 10 or more. Generally 95 plus percent of the time there are 10 eggs or more. If you have insurance coverage, that would make it actually cheaper than using the frozen egg bank.
Rena: Well, I'm so glad you brought that up. So I want to just make sure people understand that. So, so a shared donor means that your, someone else, another couple, would get part of the eggs versus an individual donor means that only one couple gets the eggs so that no one else would be able to use them.
Dara Berg: We call it a non-shared cycle. So, with an RMA donor you have a choice. You either do a non-shared cycle where you receive all of the eggs that the donor makes. Or you pick, which is the more expensive option between the two, or you would do a shared cycle where you would receive half of whatever she makes as long as there are 10 or more.
Melissa Brisman: Do you tell people? Cause when my clients come to me, I always make sure if they want to use a frozen egg bank or share a cycle that they're aware that if they want their children to have a sibling that's genetically a whole sibling, that they need to take that into consideration because a shared cycle or a frozen egg bank may only produce one baby and for lack of a better term, the eggs may go out of inventory. And...
Dara Berg: That's exactly right. We do absolutely. You know, if anyone asks, Hey, I want, you know, multiple kids and I want to maximize those chances. We do tell them, usually we recommend either doing a non-shared cycle if it's affordable or using an agency donor, which with an agency donor, it's always non-shared. So you'll get all of the eggs that way too.
Rena: Oh, so agency is always non-shared?
Dara Berg: Yes.
Melissa Brisman: There are a few egg donation agencies that will allow you to do a shared cycle, but they have to find a recipient who also wants those eggs, which is much harder when they don't have the same market base that a fertility clinic has. So it's unlikely that you'll be able to do, because you have to be using the same fertility clinic, but some of the egg donation agencies that like might specialize in certain ethnicities, like if you're going to a Jewish donor agency, they may be willing to help you with a shared cycle because, for instance, there's one that comes to mind that there's a lot of work at RMA of New York that does a lot of shared cycles because there's a lot of Jewish clients waiting for those eggs.
Dara Berg: We’re only set up for that one agency that you're referring to, which is the Jewish agency, we're only set up to work with them for a shared cycle.
Melissa Brisman: Yeah. So it's more unusual in the agency. The other thing I also find interesting is that I personally believe that there's no such thing as an anonymous cycle anymore. And although RMA is showing baby pictures, with at-home DNA kits, especially from a legal perspective, you're going to see that your donor does not need to be registered. If a child born from an egg donation registers themselves, any relative of that donor that's on that site will pop up as a genetic relative. That makes egg donation, the initial purpose that RMA is only showing baby pictures for, to protect anonymity isn't really a protection that we can guarantee donors. So whenever I tell a donor and she thinks that she's going to be anonymous for her whole life and I say if that is so important to you, you can't be a donor. If you a hundred percent will go insane if somebody finds you, then that's something that you need to be really careful about because there may be an eventuality where the child may be able to find the donor and vice versa.
Rena: Well so let’s talk more about that because I want people to know, is it even an option when you're using an egg donor, can you choose to have an open donor where you know who it is and you have a relationship with them or across the board, it's supposed to be anonymous? Obviously the advent of that from testing, you know, and DNA kits is making it a lot harder for that.
Melissa Brisman: Well, if you go to a clinic program like RMA to get your they're going to provide you, I call them currently unidentified donor, right? So we're currently unknown donor. One where it's gonna take genetic work to find out who she is, or you gonna have to be a sleuth. Many baby pictures look very similar. So you're not really going to be able to find her off a baby picture. And she's going to have no idea who you are unless I suppose she commits a HIPAA violation and breaks into the facility, right? So those people are anonymous, but there are sisters and friends that are going to be donors so they could be known and you can go through an agency and do a known donation as well. Known donations are very tricky, especially with relatives. People think that they want to use their sister and I'm sure Dara could talk a lot about this and it's going to be the greatest thing ever. They're going to have some genetic connection to their family because they're going to use their sister or their cousin or, and normally those are the hardest because number one, a relative could be doing it out of guilt and then that becomes a very hard thing. Also, people are attached to their relatives who maybe had a baby at 38, right? But when you're paying anywhere from $5,000 to $50,000, depending on if you're going through agencies and testing and whatever you're doing to find and have a baby, do you really want to use your 38 old sister who has an FSH that's through the roof? Right? And so there's like a lot of issues that come up, not to mention all the illegal issues that I could take up the whole hour if you wanted me to, to tell you why it's more complicated to use your friend or relative.
Rena: Well, I think those are all great points. As the sort of resident mental health person on this podcast and who sort of, you know, then speaks with patients going through this I will say, it's interesting and I'm, this is why we do the podcast, right, to have these different perspectives, you know? And I think I see firsthand in my patients how difficult it is, right, these choices. So I just want anyone listening to know, this is not something to think that you need to figure out in a day and it's complicated and complex. And as you know, both Dara and Melissa are pointing out, there's a lot of considerations here. And I certainly see people struggle with, should I use a friend or family? Because I think initially it feels more comfortable. You know, already it feels super foreign to think that I can't use my own eggs. I'm going to now try and carry a child, but with someone else's eggs and to, to really compute that and process that is daunting and something that really should be worked on with a professional in therapy to, to unpack that. And then it almost feels, I think at least a little safer to know, well, okay, I know the person whose eggs I'm using. So now to put that in my body at least feels more comfortable than a stranger I'm choosing on the internet. And I think, you know, again, the whole purpose of this podcast is to present reputable information and all of these points are so important to take into account. You know, it's not, it's not one dimensional any of this. You know, it's complex and multifaceted and that's why, you know, I'm so grateful to have both of you on today to present this because I know Melissa, how she presents, Melissa thinks ahead, right? You think what's going to happen not now, you know, when you're making a choice, maybe from an emotional arena, but, but what happens five years down the road, right? What happens 10 years down the road? And I think that's really important. I think all of this is so important and that's why we're discussing it. And it's certainly not a one size fits all approach for anybody. So I'm so glad that you brought all of that up.
Melissa Brisman: And you also want to make sure when you use a friend, let's say you're using a friend. Everything may be great now. What frequently comes in is we don't need a contract. I know her. She's been my best friend since kindergarten. Right? Well, people have falling out with their friends. People get married and then they get divorced, right? The contract is there to think of worst case scenario. So whenever you go through an agency, whether it's an anonymous or a known donor, or whether you have a friend or a family member, you're going to want to have a contract because if something should happen. So for example, if I'm the sister and I'm donating eggs to my sister, I’m going to have to realize that in this contract, those are going to be embryos that are made within that marriage and if they get divorced, it's possible that the ex-husband may have custody of those embryos, which now have eggs that I meant to give to my sister only. And do I really want her ex-husband to use them to have a child if a) my sister is no longer in the marriage or like all of these things that you would never think about have to be fleshed out and discussed. Like, okay, so I'm giving you my eggs, but there's are there conditions with that? Can you donate them to a third party for research if you're done with them? Can you give them to a third party to have a baby if you're finished. All these things that you might not think about, have to be in there. I once had a sister donate eggs to her sister and psychologically after the twins were born, she didn't not talk to her sister or see the kids for five years because she said that she wasn't properly prepared for how she would feel when she saw those kids and that she loved her sister, but every time she saw them, she thought they were hers. And that you want to make sure from a psychological perspective that any relative or friend is not going to be damaged like that they're giving you a gift and that it's not something that they feel that they have to do.
Rena: Well, I think again, I think that that's an important point and that's what I want to encourage anyone listening to not get scared by this, but to just, you know, knowledge is power. And to not think that you should or have to go through this alone, you know, that's why there are supports in place. That's why, you know, you should go through this with a counselor. That's what, you know, third party department at RMA is here for. You know, that's what a wonderful attorney like Melissa is here for. You know, it takes a village and it is super important to collect facts and info and really think about all of these things and not feel, you know, like you're making a choice under pressure and really think through.
Melissa Brisman: Yeah. I think it's really important also not to skimp on the screening because a lot of times when it's family, you think, Oh, I don't need psych. And you give a very hard time to people like Dara about going to see the psychologist at RMA. And you say, Oh, I don't need that. She's my sister. But those are the times that we really do need the social worker is those family situations. Because if you get a donor, if Dara presents you with a donor and you don't like her, and she's a paid donor from the system, you can pick another one. Right? But we can't, we can't exchange your sister. She's there. So the psychological support is probably more important than me because we don't want to damage the family by doing this. We want it and a lot of times the psychologist can help the situation and make it work rather than pull it apart. I think that a lot of people think that the lawyers and psychologists are really useless and we’re really here to make your life easier, not harder.
Dara Berg: And we do mandate that our patients see our psychologist for this reason. Exactly it is mandatory.
Melissa Brisman: But I bet you get a hard time, right? With the family members?
Dara Berg:Sometimes not always. Once they know it's a requirement, they don't often complain
Rena: Well let’s go back a little bit more to the logistics too. So say you're a donor and you you're a successful donor. You've passed the screening. You did a cycle. Can you donate more than once?
Dara Berg: Yes. You're allowed to donate up to six times in your life. And that's just the ethical guidelines set forth by the American Society for Reproductive Medicine. It is very common for a donor to donate again, maybe not up to six times, but you know, a couple of times is pretty typical. They're supposed to wait sometime in between donations, but usually if they're going to repeat, they do it, you know, within a six month or nine month period, it's not often that donors come back two years later and say, I want to do it again. It's often fairly quickly.
Melissa Brisman: Do you have a lot of donors that do it six times? Or what, what's the average?
Dara Berg: I would say three to four, you know, is usually where they stop, but occasionally we'll have someone go up to six and then occasionally, you know just one. So it just varies depending on their experience. But for the most part, I feel that the donors at RMA have a really good experience, they're well, very well taken care of and they often want to do it again.
Melissa Brisman: I also wanted to make clear when you call it egg donation or that they volunteer, they do get compensated right, for providing their, their eggs?
Dara Berg: Of course. Yeah, $10,000.
Melissa Brisman: Yeah. Cause sometimes I have clients who come to me and they say donation, that's great. Where do you find all these people to give me the word donation in the United States? Sometimes for people just coming into this, they think of it as free. Right? But they do it for a combination of altruistic and also the financial, a lot of times helps them with maybe school debts or just living in New York, which is expensive.
Rena: Yeah. That's what’s we talked about more at the beginning and Dara said, you know, there are really two motivating factors. One is altruism and the other is financial so both are definitely, you know, taken into account as someone who's, who's donating.
Dara Berg: Okay. Now I should just clarify the known donors don't get compensated. So it's really the anonymous donors that would get compensated.
Rena: Right,so a friend or family member does not.
Dara Berg: Correct.
Melissa Brisman: Do you want me to go over a little bit what people might expect to see in a contract?
Rena: Yeah.
Melissa Brisman: Okay. So normally people would, so if you get a donor through a bank, you're going to sign the contract that the bank gives you. Or if you get a donor that's through RMA’s pool, there's no need for a legal contract. Those eggs have been, you know, there has been legal, the legal team at RMA has prepared all of that. So that's an expense that you save. But if you have a friend or a family member that you're bringing, you're going to need a contract to make sure that that person can’t come back and claim rights or responsibilities to the child and you’re also going to need to protect the donor from child support actions. The same thing if the donor comes through an agency. You will also have a contract directly with the donor even if the signature of the donor is kept at the lawyer's office so that you don't see what her true full name is. Normally some things that we're going to put in a contract are things that you are going to think about in the future. What is going to happen if the parents die or the parents back out? Let's say, you know what, I'm sure you've seen this happen, but it's very where using an egg donor is stressful, right? So the day before the implantation or the retrieval, sometimes couples or singles could say, you know what? I want to take a step back. I need another month to think about this. I'm not going to do this right now. So how is the donor going to be paid if the cycle doesn't go through, or if she, the donor doesn't feel like this is the right match for her, or she can go forward right now? We are going to talk about what's going to happen once the embryos are made. Can those embryos be donated to science? Can they be donated to another couple? We're going to talk about complications. What happens god forbid, if something happens to the donor? I want to make sure that she has donor insurance. Very rare for a complication to happen to the donor, but we want to make sure there's some complications insurance, especially for a non-RMAdonor. An RMA donor can just come in to RMA, has hyperstimulation. RMA is going to treat her and make sure she's okay. She's going home to California. She's going to have to go to a separate facility. We've got want to make sure that that's covered for the client. We want to talk about using at-home DNA data banks and contacting people in the future and what's going to happen if there is a medical problem with the child. Are we going to want to be able to get in touch with the donor? Things like that we're going to talk about. We're also when it's a family and friends, we're going to talk about who's going to tell who, right? So if your sister goes around telling every single person she's ever met that she donated eggs to have your child, that may be uncomfortable for you. Maybe you don't want her to talk about it with other people. Maybe she knows that you're going to be the one to tell the child. What are we going to tell her kids? There's like a whole host of things that we're going to talk about that you haven't thought about. We're also going to go over the money and the travel, like who's gonna pay for what, and COVID, that's sort of a big deal, but hopefully that's going to go away soon.
Rena: Well I think that’s super helpful, and a lot for people to think about.
Melissa Brisman: Yeah. We also want to make sure that there's an attorney on both sides, right? So I want to make sure the donor has her own independent counsel so that she doesn't feel that if I'm representing the parents we’re pushing her into signing something that she doesn't understand.
Rena: So I want to back up a little bit, cause I don't want, this was a lot of information and a super deep dive, which is great, but I don't want anyone listening to feel scared and super overwhelmed by all of the things that have to be done. So I want to just take a step back and say, okay, so say I'm a friend again and I was just told, I need to use a donor. Right? And now I'm listening to this and it's like, Oh my goodness, there's so much to do. Where do I start? What are the basics? What do I do first?
Dara Berg: I think the best thing is to have, you know, a discussion with someone from my team, you know, myself or another nurse. And there's questions that we can ask patients to get a sense for which route is best for them in terms of finding a donor. So if someone said, I'm in a hurry, I want to do this as soon as possible. I am only aiming for one child here. You know, then we may be more likely to direct them to use frozen eggs. So we'll ask a lot of questions, but also, you know, certain races and ethnicities, those donors are easier to find different ways. So we'll, we'll ask them just a little bit about what they're looking for in a donor and those types of things. And then we can really direct them. So I would say the majority of our patients after having a discussion with us, they'll pick one or two ways by which to find a donor and I'll focus on those and wherever they find a donor first that they are comfortable with, that's how they'll move forward.
Rena: And do you have any resources to suggest if someone is listening and they're not ready to pick up the phone, or maybe they're not a patient of RMA, any reputable resources to sort of start the process? Or, you know, I'm a big fan of really, I direct everyone at RMA to third party or say, come to RMA and go to third party because I trust you. And I had only, I hate people going on the internet and then reading false information.
Dara Berg: So I think a lot of patients who are not sure if they're going to pursue egg donation because of whatever's going on, whether it be psychological concerns or financial, we direct some of those patients to our psychologists before even talking to us to really just receive an overview from her about egg donation from a real psychological perspective. And she is there really to help people with any obstacles they may have in terms of moving forward. She has actually a biological mother perspective on egg donation that I'll let her share, but she's excellent. If one partner is ready and the other partner is not ready to move forward, she really helps out with that. So I would say, yeah, that's a really good start before, you know, having that more fact-finding discussion with the third party team. As far as financial, we have a whole finance team that could help figure out how to help make it happen. I know there are loan programs and things that people could also seek out.
Rena: Okay. I also direct people too since, you know, we briefly touched upon this a little bit, but then a lot of people's question is, well, how do I disclose this? You know, do I tell friends and family, do I tell the child, how do I tell the child? You know, all really important questions. So episode 21 on the Fertility Forward podcast, third-party donor with Nancy Kaufman, we answer a lot of those questions. Nancy Kaufman is a mental health professional I often refer to as well. She specializes in third-party and she's another fantastic resource. So there, you know, that episode might be helpful to listen to. Also in there are certainly so many resources out there that are reputable and you know, again, people who are listening can send us a message via Instagram or to, to our email, you know, with any questions or if they want to be connected also. So, you know, again, we're all here to help. And it really, it takes a village to, to get through this and that's what we're here for. So I think this was, I mean, a really great deep dive and hopefully left people feeling like they knew more and knew sort of where to start. Are there any other final thoughts or things you think anyone should know before we wrap up?
Dara Berg: I think one of the really common questions that we get from our patients is about how some information about the donor is verified. A lot of people want to know, how do you verify she goes to NYU or how do you verify her mother had breast cancer and things like that. So that seems to be something that our patients have as one of their very first questions. So I think it's important to just address that we do our very, very best to try to learn all the information that we can about the donor's personal medical history and family medical history by doing, you know, as I said before, the screening where they are asked multiple times about the same thing, you know, whether it be through the application or the personal interview or the interview with our psychologist. And so, you know, a) we're absolutely checking for consistency in their answers and also trying to get a gut feeling from them that they're being honest and they're being sincere. But there is no way to go outside our office walls to double check their family medical history, by speaking to relatives and getting medical reports from them. Of course, we're making sure the donor is healthy through the screening process and the physical exam and the blood work so that the patients can feel very, very comfortable that the donor is healthy. We do genetic testing also on the donors, which we didn't talk about, but they're screened for 283 different diseases on our genetic panels to see what they carry. That's really important so that when a donor is being matched with a patient that we compare, whatever the egg donor carries on her genetic panel with that of the sperm source, just to make sure there's no overlap between the two. So yeah, there's a lot of testing where we would know, you know, the donor is healthy, but, I think for other, you know, other people are really concerned about how we verify that information. And just the honest answer is there's no way to verify it outside this office, just certain things.But we do our very, very, very best to make that we just feel very comfortable with their answers. And we would reject anyone that we felt was being insincere or dishonest in their responses and in their information that they're giving us. And also just as a side note, when we're reviewing their family history information, if a donor is telling us, everyone in her family is healthy and no one has one medical problem, whether it be high cholesterol or high blood pressure or cancer, diabetes, those types of things, we really then doubt that the donor is being honest and would reject someone like that. So I just wanted to cover those points because those are really the biggest questions from the patients that are entering the program about donor screening.
Rena: Okay. I'm so glad you did, Melissa, is there anything else that you want to add?
Melissa Brisman: I usually tell people not to be scared about the lawyer part because people are usually very intimidated by the long list of things that I give them. But it's really better to think about all these things upfront then to come into a situation years down the line. So I think that it's like anything else, if you do your homework, you're going to feel comfortable and better at the end, even though it might be a little bit more painful in the beginning and that we're all doing it to help you and get you to the baby. We're not putting roadblocks. Cause a lot of people feel like most people can just have a baby, but the natural way. And I'm now forced to go to the psychologist and a lawyer and it's not fair. And we're, we're doing it to help you in the long run, not to punish you.
Rena: And I always encourage people too, to start the process before maybe they have to. Maybe they still have one of their own embryos that they want to transfer, but their doctor has said, well, look, if this doesn't work, you know, I think you need to consider egg donation. I always say, look, just talk to third party, have a conversation. There's, you know, they have a great PDF, which explains everything and then file it away. File it away. Work in parallel. It might feel like a little bit less pressure and then filling in the blank, the blanks so that you at least know what the timeline, the price, the process looks like, will at least make it not seem so scary because then you'll know what you're, what you're dealing with. I hope this podcast really served as a source of information and filled in some blanks for people. So thank you both so much for taking the time to come on. I think this is such a valuable discussion and one that, you know, I know a lot of people have so many questions about, so I so appreciate both of your time.
Melissa Brisman: Well thank you for having me. Anytime.
Rena: The way I like to wrap up is by on a positive note and going around and sharing something we are grateful for. So if either Dara or Melissa who wants to go first, just share something that you're grateful for.
Melissa Brisman:So I'm grateful that I know how to use Zoom now and I'm able to go on these podcasts because I'm sort of a dinosaur and I hate change and I have resisted the zoom for a very long time, but I think I'm there now. And I thank you for having me on this program and being patient with my technology woes.
Rena: Well thank you.
Dara Berg: I'm grateful to obviously be healthy and my family is healthy. I'm grateful to be able to work from home and it's actually allowing me to work longer hours and just contribute more of myself to RMA. So yeah. See my kids here and there at the same time, which is nice.
Rena: Love that. And yeah, I think I'll go the same grateful for zoom also. I was super resistant at first too, but I think, yeah, it's allowing us to work longer hours and now, you know, the three of us are, are doing this. My little dog has joined us. She's sitting on my lap coming in at the end which is super nice. So really grateful also, and grateful to get everyone together and you know, such smart women to share this and people who really genuinely care about their work and their jobs and really helping other people. I think that's really a beautiful thing. So thank you both so much.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself. And remember you are not alone. Find us on Instagram at fertility_forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.

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