Undergrads and recent grads—young, healthy, and debt burdened—are being offered five figures to donate their eggs to other women undergoing IVF. Cofertility has a more grown-up model.
By Emma Whitford, Forbes Staff
“The best time to freeze your eggs is when you are young and can least afford to pay for it,” says Lauren Makler, founder and CEO of Cofertility, a Los Angeles startup with a novel model that addresses three weaknesses in the fertility business, which plays a part in about 100,000 (2.5%) of U.S. births a year. The first two problems, as she suggests, are timing and cost: Women traditionally haven’t sought pricey fertility services until they’ve tried, unsuccessfully, to get pregnant and are well past 30, by which time each cycle of egg retrieval produces fewer eggs healthy enough to use. That’s why more women who want children—eventually—are freezing their eggs years in advance. But the retrieval procedure and the hormones it requires can cost $10,000 or more, plus another $500 or $1,000 a year to store frozen eggs, making it unaffordable for most young women—particularly when few employers cover the cost of egg freezing before a woman experiences infertility.
The third issue addressed by Cofertility’s new model: the supply of donor eggs. Some women—including those rendered infertile by cancer or other medical conditions—need donor eggs. For women 40 or older, using a donor dramatically increases the chance an implanted embryo will lead to a baby, tripling it by age 45, according to the Centers for Disease Control and Prevention’s latest annual report on assisted reproductive technology. Cofertility tackles all these issues by allowing young women to freeze their eggs and store them for up to 10 years for free if they agree to donate half of the eggs retrieved. “All we’re saying is let’s leave out the cash compensation part and enable this woman to keep half of the eggs for her own future,’’ says Makler.
By the CDC’s count, 28,252 in vitro fertilization (IVF) cycles in 2021 (that’s 13% of all cycles aimed at producing live births) used donor eggs or embryos. Most European nations bar paying for egg donations and ethics rules in the U.S. discourage it. But donations in the U.S. are driven by money—payments start around $10,000 and can be multiples of that for donors with sought-after qualities, say, an Ivy League college degree.
Noel Rockwell, a 2024 Yale graduate with a major in history of health, science and medicine, first came across an ad for egg donation while scrolling her TikTok For You page. “It was just a woman swinging on this swing in this idyllic nature setting. And the caption was: ‘When you donate your eggs, get $10,000 and a free vacation to Florida,’” Rockwell says. “Then I clicked on the user and it was actually a clinic or a fertility agency, even though it seemed like [the video] was posted by the donor themselves.”
Fascinated, Rockwell studied egg donation advertising for her senior thesis. For historical context, she looked at ads published in the Yale Daily News from 1992 to 2015 (before print ads collapsed). Her conclusion: There was then and is now a high demand for the eggs of Ivy League students and grads, with families willing to pay tens of thousands for them. “I am a tall, white, slim woman. Those things, unsurprisingly, are very, very requested for. I have blue eyes, I go to Yale University and I have a high GPA and SAT score,” Rockwell says. For her research, she asked a clinic representative how much she might earn for her own eggs. “She said, ‘Baseline, I’d probably start you at $25,000, but it could go way, way higher.’ And I’ve seen ads myself—online especially—that are 150 grand if you go to an Ivy League school.”
When Diane Tober, an associate professor and medical anthropologist at the University of Alabama, surveyed more than 700 U.S. donors, 36% cited educational expenses—including student debt payments and tuition bills—as the primary reason they donated their eggs. “Very few are taking the money for what we would consider to be frivolous items. Most are using the money on the costs of being a student, including student loan debt,” says Tober, whose book, “Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them,” was published last week.
Egg donation is just a small part of what IBISWorld estimates to be a nearly $8 billion (annual sales) U.S. fertility industry, with an 11% profit margin. The business has been growing steadily as more women postpone childbearing and IVF has become an effective, go-to move. By the CDC’s count, 413,776 assisted reproduction technology (ART) cycles were conducted in 2021, with 41% of them done solely to freeze eggs or embryos for future use. (It’s no coincidence that even as the U.S. birth rate has steadily declined since the Great Recession, it has risen for women who are 35 or older.) The growth and healthy profits are attracting investors—according to numbers calculated for Forbes by PitchBook, private equity firms invested $7.5 billion in the U.S. fertility sector from 2018 to October 2024. The egg donation business has been consolidating too, as the growing use of frozen, versus fresh eggs, gives a boost to national egg banks.
“Egg donation is fertility’s last taboo,’’ says Cofertility’s Makler, whose own disconcerting experience in the world of paid egg donors prompted her to start the company. In 2017, she was an Uber executive, in the process of launching Uber Health (it connects patients with non-emergency transportation to clinics and hospitals), when she was diagnosed with a disease she was told might cost her her ovaries. “I wasn’t ready to have a baby, but I am a planner,” she says. “I took a look at what the egg donation options were out there, and I was really off put by what I saw. I could not believe that if I wanted an egg donor who had the same background as me, that it meant higher cash compensation.”
Instead, she accepted her sister’s offer to freeze some of her own eggs, in case Makler needed them. She ended up keeping her ovaries and not needing her sister’s eggs—indeed, Makler, now 36, spoke to Forbes over Zoom from her Los Angeles home, while on maternity leave following the birth of her second child. In 2021, after her first child was born, Makler recruited two cofounders and in 2022 raised $5 million in an initial seed round for Cofertility. She raised more money this year but declines to say how much. Investors include Initialized Capital, Offline Ventures and tennis star Maria Sharapova.
Cofertility’s capital needs are comparatively modest because it is essentially a sophisticated matching service, a la Uber—it doesn’t own IVF clinics, but works with them. Its marketing campaign relies on social media ads (and influencers who have participated in Cofertility’s programs), subway billboards, in-person events and word of mouth. Makler says the service aims to keep a constant selection of 150 to 200 donors available in its database for would-be parents to pick from. Once a donor is picked, her profile is hidden from other families.
Pricing varies by whether fresh or frozen eggs are used and by the number of eggs received, but never by the donor’s characteristics, though 55% do have graduate degrees. For example, would-be parents who use frozen eggs are required to purchase half of the donor’s harvested eggs (the other half is kept for the donor, remember). Six eggs cost $21,000; 12 eggs $37,200. That includes everything, including legal contracts, Cofertility’s fee, the harvesting procedure, the 10 years of storage promised to the donor, and free eggs from a second donor if the first donor’s eggs don’t produce a baby.
Laurie, now 28, began worrying about the prospective decline of her own fertility last year after realizing she probably wouldn’t be ready to have her own children until her early or mid 30s—she had just started a three year part-time master’s program and didn’t have a partner. She wanted to freeze some of her eggs, “but it absolutely wasn’t possible to pay for it myself,’’ says Laurie, who asked that her last name and city not be used. In March 2023 she spotted an ad for Cofertility and by that August had matched with a couple and undergone an egg retrieval. She now receives emailed updates and photos from them about their healthy baby. Cofertility lets donors decide whether they want to remain anonymous to the intended parents. “When I first signed up, I was like, ‘It’ll probably just be easiest to just do it totally anonymously, maybe not even know if the donation was successful,” Laurie says. “But it’s very fulfilling for me now to know that I helped them with their family.”
Maiko, a 47-year-old single gay banker from Miami, is now expecting two babies born via surrogacy from a Cofertility donor’s eggs and his sperm—a boy in January and a girl in February. He too opted for an open donation even though, he says, it took longer than choosing an anonymous donor from a conventional egg bank would have. “I was able to meet her when she had her process in New York to extract the eggs. I met her and met her mom and gave them both a big hug. We’ve kept in contact ever since,” says Maiko, who asked that we not use his last name. “If I was one of my children, I would want to know who the donor is and maybe meet that donor one day to thank her because of what she did.”
Egg donors essentially go through the first half of an IVF cycle, starting with 10-12 days of hormone injections, which women can administer at home themselves, that stimulate the ovaries to develop more eggs to maturity than during a natural cycle. Then a doctor administers a “trigger shot” of hCG. A day later, a physician removes the eggs using a needle while the donor is under sedation, a procedure which carries a tiny risk.
The list of potential side effects is long, though most are minor and transitory. They range from headaches, abdominal pain, mood changes and weight gain to, in very rare instances, blood clots, internal bleeding, ovarian torsion or stroke. But while IVF itself has been studied extensively, there’s little research specifically on the long-term health impact of being an egg donor, or repeat donor, at a young age and anecdotal reports from women vary widely, even from donation to donation. One potentially significant difference: The younger women donating eggs have much higher baseline fertility than the older women going through IVF. Hormones are powerful, and the impact of ramping them up dramatically in the younger women might differ.
One reason for the paucity of research specifically on donors is that their medical records are mostly in the hands of private fertility clinics, not hospitals, so academic researchers can’t easily conduct large retrospective longitudinal studies by examining patient histories (as they commonly do in other fields), points out Linda Kahn, a fertility researcher and assistant professor at NYU Grossman School of Medicine. “The industry is getting the raw material it needs, and that’s all they care about,” Khan says. “They’re just not incentivized to do [research] because to them, the patient is not the donor. The patient is the infertile person.”
Both Kahn and Tober say that studies of women who have undergone complete IVF cycles can’t be entirely applied to egg donors because the women who have been studied are usually older, less responsive to hormones, already struggling to conceive naturally and go through both egg harvesting and implantation. Donors are young with, presumably, years of fertility remaining, and are chosen specifically for their high fertility. Tober says that when she approached the infertility section in the National Institutes of Health hoping to get funding for a study of egg donors’ complications, “the response of the program director was ‘Well, what do egg donors have to do with infertility? They’re not experiencing infertility.’”
Ruby, now 27, first donated her eggs in 2018, during her junior year of college. She’d already racked up $42,000 in student debt and was broke after spending a semester in Spain, so she responded to a Craigslist ad from a San Francisco fertility clinic offering $10,000 for one donation. “It was advertised as a good way to pay off student loans and create a little savings for yourself,” recalls Ruby, who asked that her last name not be used. She recalls that first donation as uncomfortable, but not enough so as to dissuade her from donating again in 2020. This time she had bloating and pain so intense that she went to the emergency room. The pain subsided but she now has heavier and more painful periods than before.
Bri Welsh, a resident of Southwest Pennsylvania with a masters in psychology, had considered donating since she saw an ad at 19, but finally took the plunge in February 2023, when she was 27. She needed cash, having just quit a job she disliked at a state prison. She donated again 14 months later. She had mild pain after her first donation, but severe pain after her second. “My husband had to carry me to the bathroom and even at that I was screaming. It was awful,” she says. Now she and her husband are trying for a baby of their own and she’s having trouble conceiving. Her estrogen levels are heightened which can interfere with conception and she’s wondering if there’s a link to her donation cycles—though there have not been any studies on the impact of egg donation on later fertility.
Most clinics do mention the small risk of ovarian hyperstimulation syndrome, a complication caused by the hormones required to stimulate egg drop that causes the ovaries to swell, though existing risk statistics come from studies of IVF patients, not young donors. In the population of donors Tober has surveyed—which could contain some response bias—a higher 12% of donors say they experienced severe to critically severe ovarian hyperstimulation syndrome following their donation. Severe ovarian hyperstimulation syndrome was more often reported by donors who developed an unusually large number of eggs—50 or more.
NYU’s Kahn notes that with donor egg freezing now more common, clinics have a financial incentive to stimulate a woman to produce even more eggs—they can split eggs from one donation cycle into batches and sell those to multiple families. “For $10,000, it makes a lot of sense for them to stimulate [the donor] to produce 50 eggs, so they can sell 10 batches or 70 eggs, and they can sell 14 batches,” Kahn says. “The more they get out of her, the more money they make, and their baseline investment in her hasn’t changed. All the rest is profit.”
Despite the unknowns, the rewards are hard to resist, Ruby admits. She has no plans to donate again but says she would consider it if the compensation offer was big enough. One couple reached out to her directly and offered to pay $50,000, but she ultimately turned it down. “It’s this … immediate candy hanging in front of your face, where you can help some people and hugely help yourself—maybe start a new business or get a down payment,” Ruby says. “And then also just this big scary question in the background: am I jeopardizing my future health for money?”
