Egg program vs. known donor: anonymity, contact, contracts, and who pays

Agencies and clinic egg programs recruit donors, set compensation, buy complication insurance, and run the contract and escrow. A known (directed) donor gets the same medical screening, but most of that structure has to be built from scratch. The intended parents, the donor, and two separate lawyers decide on pay, contact and cost, and the clinic will not start the cycle until that work is done. This guide compares the two paths using only what named US programs and ASRM publish.

What each path actually is

In an agency or clinic program, the program recruits and pre-screens donors and lists them in a database. Intended parents choose a donor from that list. The fertility clinic does the medical cycle, and the program handles matching, compensation, escrow and paperwork; Egg Donor & Surrogate Solutions, for example, requires a SeedTrust escrow account with a $475 management fee that is "Non-refundable once paid." Egg Donor & Surrogate Solutions (ED&SS), Beverly Hills Egg Donation (BHED), Donor Nexus and Cofertility are agencies. The Idaho Center for Reproductive Medicine (ICRM) and Shady Grove Fertility (SGF) recruit donors in-house. ICRM says that because it runs its own program, "there is no agency cost if you select one of the donors on our list."

With a known (directed) donor, the intended parents bring someone they already know, usually a friend or relative, and a clinic screens her. RMA of New York says a known donor "can be a friend or relative who chooses to donate, or may be someone who was unknown prior to the donation process but chooses to participate as a known donor." Some agencies blur the line with identified tracks, where a donor recruited by the agency becomes known to the parents. For DonorIndex’s general orientation on known donation, see the site’s own /known-donor/ section. It is an editorial page, not a legal source.

Anonymity: what programs actually promise

ASRM’s 2024 donation guidance has stopped using the word "anonymous" and says "nondirected" instead. ASRM explains that the change "reflects the realization that anonymity is decreasing with the prevalence of and access to nonmedical genetic testing." Programs say much the same. Donor Nexus tells all parties that "permanent anonymity cannot be guaranteed, regardless of donation type." No program can promise that a consumer DNA test will never link a donor to a child.

Inside a program, how much identity is shared depends on the tier you choose, and each program defines its tiers differently:

• Donor Nexus (fresh matching): Nonidentified means "Only non-identifying information is shared." Identified means the parties "agree on terms." Open ID means the donor agrees to release identifying information to a donor-conceived person 18 or older on request. Its blog says open ID is available only for fresh cycles.
• Cofertility: a disclosed donation is when the donor and parents "mutually agree to exchange contact information." In an undisclosed donation the parties "communicate solely through our team." Open ID is offered as an alternative within undisclosed donation.
• Fairfax EggBank (frozen eggs): ID Option donors agree to release identity "only to the donor-conceived child, not the recipients of donor eggs," once the child is 18 and asks.
• ED&SS: in an Unidentified Cycle the agency "will never release your personal information." Its Identified program releases both parties’ full legal names after preliminary medical screening.

A known donation has no anonymity tier. Everyone knows everyone from the first conversation. What remains to decide is how much contact there will be, how often, and who will tell the child.

Contact now and later: identity release and open ID

Agencies schedule contact around milestones. ED&SS publishes the most detailed timeline of any program we reviewed. Under its Identified program, names are released before psychological screening, contact during the medical work-up goes through letters passed on by the care coordinator, and email addresses and the donor’s date of birth are released "upon confirmation of live birth." The agency says it and other professionals believe "it is in all parties’ best interest to maintain limited contact until live birth is achieved." That is ED&SS’s policy, not a rule across the industry.

1. 1

   Preliminary screening

   ED&SS runs its Identified Donor Preliminary Medical Screening before the clinic gets involved.

2. 2

   Names released

   Full legal names are exchanged after that screening and before the psychological screening.

3. 3

   Joint session

   Donor and parents meet by video in a session led by a licensed mental health professional.

4. 4

   Limited contact

   During clinic testing, the care coordinator passes letters between the parties if they want.

5. 5

   After live birth

   Agreed contact details and the donor’s date of birth are released, and registry sign-up is encouraged.

Other programs set different limits. Donor Nexus offers a Zoom meeting before a fresh match, if the donor agrees, for a non-refundable $500 that is applied to cycle fees. It says "No identifying information is shared on the call." Even in its unidentified cycles, ED&SS requires that the Donor Sibling Registry or a similar program be written into the contract as an accepted way to communicate. With a known donor, nothing is scheduled by default. ASRM recommends that counseling for directed donation cover "Expectations for communication and relationship roles between and among donor, recipient, donor-conceived persons, partners, and other family members."

Legal agreements: who drafts them and when

ASRM’s table of recommendations for oocyte donors includes "Legal consultation, particularly for directed donations." ASRM’s patient booklet says that with known donors, both donors and intended parents "are advised to have separate legal counsel and sign a legal contract that defines the financial obligations and rights of the donor." ASRM’s ethics opinion on donors who are family members tells all parties to seek independent advice from attorneys "with specific expertise in third-party reproduction."

Clinics turn those recommendations into requirements in different ways. Fertility Centers of Illinois says "All known donors and recipient couples require separate legal representation, which cannot be waived," and needs an attorney’s letter on file before any medication starts. Yale Fertility Center says its in-house donors need no outside contract, but "if you choose to use a directed or agency donor, you’ll need to have an outside legal contract with the donor." SGF says that for both agency-recruited and known donors, "both parties will collaborate with reproductive attorneys to finalize a legal agreement." On the agency path the contract is usually arranged for you. ED&SS lists $2,000 to $3,000 to cover both attorneys for the Direct Donor Agreement. On the known path, you hire the lawyers and agree the terms with someone you know.

Who pays: compensation, medical costs, legal fees, insurance, travel

On the agency path, intended parents pay nearly every line, and agencies publish those lines. ASRM tells practices to make sure the donor "has medical insurance or that the practice has a policy to cover donation-related medical expenses or complications." ED&SS meets that with a $400 short-term complications policy, paid on the donor’s behalf before she starts injections, which it says "covers major medical complications the egg donor may have as a result of her egg donation cycle." At ED&SS, clinic medical charges are billed separately from agency fees: a donor who lives away from your clinic uses a "monitoring clinic" for 2 to 6 appointments, which parents pay directly by credit card, typically $1,000 to $3,500.

Travel and medical costs also go to the parents. ED&SS lists $100 to $3,000 for initial-visit travel and $1,000 to $6,000 for retrieval travel, and says "All unused funds will be refunded at the completion of the cycle." BHED lists donor travel (if she lives more than 25 miles from your clinic), donor legal expense, and clinic and medication charges as costs outside its fees. Cofertility says that if the donor travels, "you will be responsible for associated expenses." ED&SS sends parents to their IVF physician for screening, monitoring and medication costs, which "are paid directly to the clinic providing the service."

Known donors are often not paid, though this varies by program. Women & Infants Fertility Center describes a known donor as someone "who donates eggs at no cost to the recipient," and contrasts her with agency donors who are compensated. South Jersey Fertility Center’s 2020 brochure says its known-donor cycle costs less "because known donors are not given the $8,000 compensation that our anonymous egg donors receive." SIMPLIFY Egg Bank says friends and family "typically" donate altruistically. None of the clinic pages we reviewed spelled out who pays a known donor’s medications, insurance or legal fees. FCI leaves outside monitoring costs to "the egg donor or recipient couple" and tells parties to discuss supplemental insurance with their attorney. NCCRM’s known-donor package includes donor monitoring, but it lists donor screening and psychological evaluation as possible extra costs, and medications are paid directly to the pharmacy.

Screening is not a shortcut

A friend or sister does not skip any medical steps. FCI’s known-donor page lists ovarian reserve testing, an FDA physical exam, infectious disease and genetic carrier panels, a psychological evaluation that is "Required for the known donor couple," and an attorney’s letter, all before medication starts. ASRM strongly recommends separate counseling sessions for the donor and the recipients in directed donation, plus a joint session that includes the donor’s partner. Yale says it does "not accept intergenerational (i.e. daughter to mother) donations" and reviews donations by family members case by case.

There is one real difference in the rules. Under ASRM’s summary of FDA rules, a directed donor who is found "ineligible" may still donate if both parties know the risk and consent. A nondirected donor in that position cannot. Timing also differs. SGF puts the average for an agency-recruited or known donor at about three months from when the donor is identified. Agency donors have often been pre-screened already. A known donor starts the full work-up from scratch.

Sperm-bank rules that do not transfer

Many known-donor guides are written with sperm donation in mind. Several of their points do not apply to eggs, and we have left them out of this comparison: vial-based pricing and per-vial limits, sperm-bank open-ID registries, and the quarantine step. ASRM recommends a 35-day quarantine and retest for directed sperm, but says "Quarantine of oocytes is not required by the FDA for nondirected or directed donation." Egg donation always involves stimulation and retrieval at a clinic, so there is no at-home or informal version to compare.