The donor is then required to undergo a thorough medical examination, including a pelvic exam, AMH blood test to check hormone levels and to test for infectious diseases, Rh factor, blood type, and drugs and an ultrasound to examine her ovaries, uterus and other pelvic organs. A family history of approximately the past three generations is also required, meaning that adoptees are usually not accepted because of the lack of past health knowledge. Genetic testing is also usually done on donors to ensure that they do not carry mutations (e.g., cystic fibrosis) that could harm the resulting children; however, not all clinics automatically perform such testing and thus recipients must clarify with their clinics whether such testing will be done. Once the screening is complete and a legal contract signed, the donor will begin the donation cycle, which typically takes between three and six weeks. An egg retrieval procedure comprises both the Egg Donors Cycle and the Recipients Cycle. Birth control pills are administered during the first few weeks of the egg donation process to synchronize the donors cycle with the recipients, followed by a series of injections which halt the normal functioning of the donors ovaries. These injections may be self-administered on a daily basis for a period of one to three weeks. Next, follicle-stimulating hormones (FSH) are given to the donor to stimulate egg production and increases the number of mature eggs produced by the ovaries.
The recipient also trusts that the medical history of the donor and her family is accurate. This factor of trust should not be underestimated in importance. Donors in the US are paid thousands of dollars; such compensation may attract unscrupulous individuals inclined to conceal their true motivations. However, a full psychological evaluation is required by most IVF clinics, giving an indication if the donor is trustworthy or not. In more cases than not, there is no ongoing relationship between the donor and recipient following the cycle. Both the donor and recipient agree in formal legal documents that the donation of the eggs is final at the time of retrieval, and typically both parties would like any "relationship" to conclude at that point; if they prefer continued contact, they may provide for that in the contract. Even if they prefer anonymity, however, it remains theoretically possible that in the future, some children may be able to identify their donor(s) using DNA databanks and/or registries (e.g., if the donor submits her DNA to a genealogy site and a child born from her donation later submits its DNA to the same site). Multiple birth is a common complication. Incidence of twin births is very high. At the present time, the American Society for Reproductive Medicine recommends that no more than 1 or 2 embryos be transferred in any given cycle. Remaining embryos are frozen, whether for future transfers if the first one fails, for siblings, or for eventual embryo donation.