Egg Donation in the U.S.A.
Contents
Summary of Egg Donation in the USA
Is Egg Donation Legal in the USA?
Availability of Donor Eggs, Sperm, and Embryos in the USA
Egg Donor Compensation in the USA
Anonymous, Open, and Known Donation in the USA
Surrogacy in the USA
Can LGBTQIA+ Couples Pursue Egg Donation, Sperm Donation, or Surrogacy in the USA?
Can Single Men and Women Pursue Egg Donation, Sperm Donation, or Surrogacy in the USA?
Choosing an IVF Clinic in the USA
Average Costs of IVF with Donor Eggs or Sperm in the USA
Legal Advice for Egg Donation, Sperm Donation or Surrogacy in the USA
Counseling for Intended Parents in the USA
Summary of Egg Donation in the U.S.A.
The USA is a country of choice for many Asian intended parents seeking third-party reproduction. This is because egg donation, sperm donation, embryo donation, and surrogacy are all legal in the USA for U.S. citizens as well as non-citizens who wish to travel to the USA for treatment. In the USA, third-party reproduction is available for single and married people, as well as same-sex couples. Another major benefit is that the racial and ethnic diversity of the USA, the strength of donor medical screening processes, and the ability to learn about donor family medical history offer a higher chance that Asian intended parents will find a donor match that meets their needs. The last census showed 22 million people of Asian descent living in the USA, with the largest ethnic origin groups including Chinese (5.4 million), Indian (4.6 million), Filipino (4.2 million), Vietnamese (2.2 million), Korean (1.9 million), and Japanese (1.5 million).
In 2021, the U.S. Centers for Disease Control and Prevention (CDC) reported that there were around 500 fertility clinics in the USA. The use of third-party reproduction is increasingly common. Annually, it is estimated that around 25,000 people in the USA use donor eggs, while up to 150,000 people may use donor or mixed sperm, and over 9,000 people use a surrogate.
However, intended parents seeking care in the USA should be aware of significant differences in access to assisted reproductive technology (ART) and third-party reproduction throughout the 50 states. This is due to the system of governance in the USA and the absence of national legislation on ART. There are no national licensing requirements, standards, or certifications for clinics operating in the USA, and intended parents must familiarize themselves with the requirements in the state where they plan to seek care. In addition, each state may have different regulations regarding the anonymity or disclosure of the identity of gamete donors.
Lastly, the high costs of medical care in the USA, including doctors' fees, operating expenses, and medications, need to be considered by intended parents. For American intended parents, some states mandate that health insurance must cover ART, though there are also important exemptions to be aware of. Non-American intended parents who wish to seek treatment in the USA will need to consider the time and process of applying for a U.S. visa to enter the country.
Is Egg Donation Legal in the U.S.A.?
Yes, egg donation, sperm donation, and surrogacy are all legal in the USA. There may be important differences between states that intended parents must consider.
In the USA, the only national legislation surrounding ART is the Fertility Clinic Success Rate and Certification Act of 1992. This act mandates that clinics performing ART annually provide data for all procedures performed to the Centers for Disease Control and Prevention (CDC) and sets forth definitions and reporting requirements to aid in standardization. The CDC is a center under the Department of Health and Human Services in the U.S. government. The CDC is required to use these data to report and publish clinic-specific success rates and certification of embryo laboratories, which can be found on their website. This act does not regulate third-party reproduction. More about the act is provided in the section below, "Choosing an IVF Clinic."
In the USA, the Food and Drug Administration (FDA) and the American Society for Reproductive Medicine (ASRM) have developed guidance for the screening of donor tissue and recipients.
The FDA is an agency of the Department of Health and Human Services. It has the legal mandate to regulate and maintain a federal registry of establishments that perform any steps of egg, sperm, and embryo donation, under Title 21 Code of Federal Regulations (CFR) Part 1271, and makes this information publicly available through the FDA website. The FDA also mandates that such establishments must carry out a medical screening of donors. This involves reviewing the donor's relevant medical records for risk factors for, and clinical evidence of, relevant communicable disease agents and diseases. In addition, donors must be tested for HIV, Hepatitis B and C, syphilis, chlamydia, gonorrhea, human T-lymphotropic virus, and cytomegalovirus. The FDA requires that records pertaining to each donor be maintained for at least 10 years. The FDA has an enforcement mandate and can carry out inspections; however, in practice, the frequency of inspections varies.
The ASRM is a professional association and issues guidelines for its members, which are not legally binding. The ASRM makes additional recommendations for egg, sperm, and embryo donors and recipients to complement the health-based assessment of donors mandated by the FDA. The recommendations include counseling, genetic screening, medical history, psychological assessment, and legal consultation. See the full guidelines on their website.
Another consideration for intended parents seeking care in the USA is that each state has its own regulations surrounding important issues in third-party reproduction. Different states may have different legal requirements for:
Licensure or regulation of facilities that carry out ART
Disclosure of donor identity (see section below on anonymous, open, or known donors)
Surrogacy
Providing insurance that covers certain ART treatments
For example, some states have adopted the Uniform Parentage Act (2017), a law that includes stipulation that the intended parents and not the donor are the legal parents of the child born through third-party reproduction. The law also updates surrogacy statutes to reflect current surrogacy practices and state laws, and includes an article to "require that [gamete] donors be asked whether they would like their identity disclosed," and that there be "a good faith effort to disclose non-identifying medical history information regarding the gamete donor upon request." The law has been enacted in California, Colorado, Connecticut, Maine, Rhode Island, Vermont, and Washington, and enactment is being considered in other states.
Because of these state-to-state differences, legal advice is strongly recommended for the whole process of third-party reproduction in the USA. Sometimes, clinics or agencies will direct intended parents to lawyers who specialize in third-party reproduction contracts.
Lastly, there is another consideration for intended parents who will give birth to the baby abroad after conceiving in the USA through egg or sperm donation, or seek surrogacy arrangements abroad. In 2021, the U.S. Citizenship and Immigration Services changed its regulations to recognize non-gestational, non-genetic parents and allow them to transmit citizenship to their children. While this removes a barrier for these parents, seeking legal advice early in the process is essential to ensure that you are eligible, which may include assessing the laws in the country where your child will be born.
Availability of Donor Eggs, Sperm, and Embryos in the USA
Donor eggs, donor sperm, and donated embryos are widely available in the USA, depending on the state. Asian intended parents will have multiple ways of finding a match for their needs.
First, some ART clinics have their own donation programs. These programs are often convenient and less expensive than other ways of obtaining donated eggs or sperm, with higher trust in ‘your’ doctor or clinic. However, the number of donors may be small for each clinic. This is of particular concern for Asian intended parents, because the low number of donors may mean less racial and ethnic diversity, and fewer opportunities to find a suitable match for the health and genetic history of the intended parents.
Second, many independent egg and sperm banks operate in the USA, offering greater diversity of donors. These gamete banks oversee and manage the process of gamete collection at affiliated medical clinics, thereby offering some quality assurance. Some specialize in donors with Asian ethnicities, and most will ship across the USA and even internationally where the law permits the import of gametes. The American Association of Tissue Banks offers accreditation to these gamete banks; however, very few have sought accreditation. Intended parents will need to find their donor directly through the donor bank and then coordinate with their IVF clinic to have the eggs shipped to them.
Third are donor agencies, which add value by helping intended parents with specific criteria find a suitable match. Many Asian intended parents in the USA turn to these agencies. It is important to note that these agencies are not certified and do not offer medical services. Most of the donor information provided to intended parents is self-reported and must be verified at the clinic of the intended parents. This may mean a longer, more costly process. Intended parents also run the risk that their preferred donor will not be accepted by their clinic after medical testing. In addition, these agencies charge a premium for their services, which is additional to donor compensation and all medical costs. Still, for Asian intended parents, the extra time and expense may be worthwhile to have more options for a match.
The American Society for Reproductive Medicine’s 2021 guidelines establish recommendations for gamete and embryo donors, including age, physical and mental health, maximum number of egg donations (six), and maximum number of live births from sperm donations (25).
Egg Donor Compensation in the USA
Donor compensation is allowed for egg and sperm donors in the USA. Sperm donors may be compensated a few hundred dollars for multiple donations. For intended parents, donor sperm may be obtained for around USD 500 to USD 2,000.
Egg donors are financially compensated for their time, discomfort, medical, and travel expenses. The American Society for Reproductive Medicine (ASRM) issued an opinion of its Ethics Committee in 2021 that egg donor compensation is justified and provided additional considerations for compensation, but without setting a recommended maximum compensation. This is an important update, as the ASRM previously recommended that egg donor compensation not exceed USD 10,000. In practice, donor compensation for a fresh cycle can range from USD 5,000 to USD 15,000 in the USA. However, Asian donors are often in high demand, and therefore the compensation for Asian donors may be even higher, upwards of USD 15,000 or even up to USD 50,000 in extreme cases where intended parents advertise for specific characteristics.
The ASRM recommends that embryo donations be fully altruistic and are not compensated.
Anonymous, Open, and Known Donation in the USA
Anonymous, open, and known donation are all legal in the USA. The majority of donations are anonymous, and most states do not have laws mandating disclosure of donor identity to donor-conceived persons.
Two states, Washington and Colorado, have taken the biggest steps towards mandating open donation. Washington State passed legislation in 2011 requiring sperm banks and egg donation agencies with gametes from Washington to provide the donor’s medical history and full name to donor-conceived persons when they turn 18 years old. However, donors are able to opt out of being identified.
Colorado more recently passed legislation banning anonymous sperm and egg donations, which will go into effect in 2025. Donor-conceived persons will be able to request information about their donor’s identity and medical history when they turn 18 years old. As a result, anonymous donation will no longer be possible in Colorado.
Other states have taken interim steps towards notifying donors when donor-conceived persons inquire about their identity or medical history, and providing donors with an opportunity to respond.
In the absence of federal legislation, it is likely that the laws will continue to evolve, and intended parents should clarify the law in their state of treatment.
Surrogacy in the USA
Different states in the USA have different approaches to commercial or non-commercial surrogacy. Some states ban commercial surrogacy and have specific laws on this, while others permit both commercial and altruistic surrogacy, and some have no state laws at all. Some permit surrogacy only for married, heterosexual couples, while others permit surrogacy for single people, same-sex couples, and unmarried couples.
The most favorable states in the USA for intended parents pursuing gestational surrogacy include California, Connecticut, Delaware, Oregon, New Hampshire, New York, Maine, and Nevada. These states enforce both commercial and altruistic surrogacy contracts and facilitate straightforward ways for the intended parents to be recognized as the child's legal parents. For intended parents considering surrogacy, legal advice is essential at the start of the process. For legal purposes, key factors are where the contract is completed, where the surrogate resides, and where the birth takes place.
Can LGBTQIA+ Couples Pursue Egg Donation, Sperm Donation, or Surrogacy in the USA?
Same-sex marriage is legal in the USA. Same-sex intended parents—whether single, married, or partnered but not married—have the same rights to seek IVF with third-party reproduction as other couples in the USA.
The quality of the patient experience for LGBTQIA+ intended parents may vary widely depending on the state where intended parents seek care in the USA. Intended parents may need to do additional research to choose a clinic with a track record of providing excellent care to LGBTQIA+ patients. Sometimes, referrals or a simple online search will help to identify these clinics. Many clinics will have an LGBTQIA+ section or a rainbow flag prominently featured on their website, with specific resources for these patients. Anecdotally, LGBTQIA+ clinics are more likely on the coasts and in big cities like New York, Los Angeles, San Francisco, or Chicago.
Can Single Men and Women Pursue Egg Donation, Sperm Donation, or Surrogacy in the USA?
Single men and women have the same rights to undergo fertility treatments using third-party reproduction as married individuals in the USA. Single women have the right to freeze their eggs in the USA.
Choosing an IVF Clinic in the USA
There are many clinics in the USA, and it can be difficult to know which performs better or is a better match for Asian intended parents. Check our section on “Choosing an IVF Clinic” for more information.
In the USA, it is important that your clinic is registered with the FDA. The FDA maintains a registration of all clinics performing gamete donation; these can be found through the FDA website. It is not advisable to work with a clinic that is not registered with the FDA.
In addition, there are several accreditations that your clinic’s laboratory may have. The Fertility Clinic Success Rate and Certification Act of 1992 mandated the CDC to develop a ‘model program’ for the certification of embryo laboratories, to be carried out voluntarily by states. Embryo laboratories can choose one of the following nonfederal laboratory accreditation programs, which are not overseen or endorsed by the CRC:
College of American Pathologists under the American Society for Reproductive Medicine: This is common (88% of clinics in the USA are accredited). Intended parents should ensure that your clinic is accredited by searching their directory.
Joint Commission on Accreditation of Healthcare Organizations: This organization offers accreditation, certification, and verification for all kinds of healthcare facilities (it is not specific to ART). Accredited clinics display the Joint Commission’s gold seal on their website as a sign of quality.
The Society of Assisted Reproductive Technology (SART) is another important professional society for clinics in the USA and abroad; in 2018, 86% of IVF clinics in the United States were members of SART. SART assists clinics with quality assurance, and publishes detailed IVF success rate data, including cycles with donor eggs. This information is summarized and made publicly available by year in this database.
The State of New York is notable as a state with its own, more rigorous licensing standards. Any fertility clinic’s laboratory in the state should be certified, which is searchable in the state database. Note also that in 2021, the New York State Tissue Bank Program stopped providing accreditation for embryo laboratories.
The CDC publishes clinic-specific success rates and certification of embryo laboratories, which can be found on their website. It is important to note that intended parents should not rely solely on this information, but to rather ask clinics questions yourself. However, it is important to ensure that your clinic is reporting data to the CDC, and is therefore in good standing.
Doctors in the USA are required to have a medical license granted by a U.S. state or jurisdiction. In addition, look for doctors who are board certified by the American Society of Obstetrics and Gynecology in Reproductive Endocrinology and Infertility.
Average Costs of IVF with Donor Eggs or Sperm in the USA
Cost of donor gametes:
Sperm: USD 500 to USD 2,000 per vial
Donor eggs: USD 15,000 to USD 35,000, depending on whether your clinic offers an in house program, you use a donor egg bank, or you use an agency, and the amount of compensation directly to the donor. For fresh cycles, this excludes the cost of the donor’s egg retrieval treatment, including medication, which is below and needs to be added.
The costs of IVF vary based on the clinic used and the location and may range from:
Initial investigation (Semen analysis, ultrasound, blood tests): USD 1,000-2,000
Egg retrieval (including medication), IVF or ICSI, 5-6 day culture, PGT-A and egg freezing: USD 15,000-25,000
Frozen embryo transfer: USD 2,500-5,000
IUI: USD 200-1,000
Legal Advice for Egg Donation, Sperm Donation or Surrogacy in the USA
As in all countries, legal advice is imperative in the USA. It is important to find a lawyer who specializes in fertility and third party reproduction. The American Society of Reproductive Medicine maintains a Legal Professionals Group for this purpose. You can find a lawyer on their website.
Counseling for Intended Parents in the USA
Counseling is likely to be required for all intended parents seeking third party reproduction in the USA, as well as all donors and surrogates. The quality and availability of mental health professionals is generally high in the USA. Typically, clinics will have their own counselors either in-house, or will refer intended parents to an independent counselor who will provide a report so that the clinic can approve them to move forward with third party reproduction.
Intended parents may also wish to seek counseling from someone independent from their clinic, either because of a need for appointments in excess of what is provided by the clinic, or because of specific ethnic or language needs or preferences. If you are looking for a counselor yourself, the American Society of Reproductive Medicine maintains a Mental Health Professionals Group and it can be helpful to seek mental health professionals who are members of this group. That is because it is critically important that intended parents using third party reproduction seek non-judgemental mental health care. Professionals who are not familiar with third party reproduction may have their own biases and questions, and may not be able to provide suitable care to intended parents. As with all fields, it is also important that your counselor has a relevant degree, professional qualification, and membership in professional societies, and perhaps even board certification (e.g. American Board Certified Psychotherapist)
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As a reminder, this website is not a substitute for professional legal and medical advice. Please seek the advice of your doctor and lawyer to verify the information that we provide.
