Cohort Reservation and Suitability Matching Webinar: Everything You Didn’t Know But Want To Ask!

Donor Egg Cohort Reservation & Suitability Matching Webinar: Ask a Genetic Counselor.

Recently, Fairfax EggBank hosted a webinar to dive into the cohort reservation process and further explain our suitability matching services. Brenda Amaya, our Client Relations Manager, and Rawan Awwad, MS, CGC, our Director of Genetic Counseling led a conversation for our affiliate clinics about this topic. Our goal is to clarify to our affiliate clinics the cohort reservation process from the perspective of the intended parent, as well as to better understand some of the discrepancies that exist between carrier screening panels and how our team can assist.

Here’s what you missed!

Donor Egg Cohort Reservation

To begin a cohort reservation, there are several steps that Brenda Amaya, our Client Relations Manager, recommends that our intended parents take.

1. Create an Intended Parent Profile

Creating a profile is a “simple process”. Intended parents can register on the website by providing their basic information such as name, email, and phone number. Following through the profile, they can find and sign our photo consent form which will give them access to each donor’s adult photos. All donors on the Fairfax EggBank website have completed their cycle and have at least one cohort available.

2. Find an Egg Donor

Next, the intended parents can search through the Fairfax EggBank donor database to find our pool of frequently updated, diverse, pre-screened, and FDA compliant donors. The information that’s presented in our egg donor database includes physical characteristics, a person summaries, donor essays, childhood photos and adult photos, and sometimes even an audio interview.

3. Reach out a Client Relations Specialist

Once the intended parent is interested in an egg donor, they can reach out via phone or email to their designated Client Relations Specialist or any member of our team to place a hold. Our client relations team will discuss with them the number of cohorts available for their selected donor, and if they decide to move forward, they’ll receive a complimentary 2 business day hold on a cohort.

During these two days, we send the intended parent some documents to get them started. These documents include our Terms of Use, genetic testing summary, and a genetic acknowledgment form.

Many questions arise for our intended parents regarding sperm source genetic testing and the options we provide.

If the sperm source had genetic testing:

• A suitability match would be possible. Our genetics team is available to help.
• If there are discrepant panels, additional testing on the donor or sperm source may be possible.

If the sperm source did not have genetic testing:

• The sperm source will have 60 days to complete testing and notify their client relations specialist of the results.
• If he is a carrier for the same condition(s) as the donor, the intended parent can get a free exchange or full refund.
• If he is not a carrier for the same condition(s) as the donor, shipment can be scheduled.

4. Receive the Donor Egg Cohort

Lastly, after the intended parent submits all necessary documents and the genetic testing is approved, our lab will contact their clinic and coordinate their shipment.

For more information about cohort reservation, check out our How to Secure Your Dream Egg Donor blog.

Suitability Matching and Genetic Testing:

Rawan Awwad, MS, CGC, our Director of Genetic Counseling, led us in a conversation about the suitability matching process, genetic counseling services, and professional guidelines and recommendations on carrier screening.
At Fairfax EggBank, we provide donor-recipient suitability matching, which assesses reproductive risks based on carrier screening results. If the match is unsuitable, there are multiple options that the intended parent(s) can consider including:

1. Choosing a different donor
2. Considering additional testing on the relevant gamete source
3. Declining additional testing and using the donor anyway

“The last option would require genetic counseling and informed consent as well as a discussion with the fertility clinic to learn their policies in these scenarios.”

Rawan Awwad, MS, CGC, Director of Genetic Counseling

Fairfax EggBank donors are screened by a gene panel that takes into account the recommendations and guidelines set by professional societies including the American Society of Reproductive Medicine (ASRM), American College of Medical Genetics & Genomics (ACMG), and the American College of Obstetrics and Gynecology (ACOG).

The current carrier screening recommendations and guidelines are:

• American Society of Reproductive Medicine (ASRM), 2021
  • At minimum check for the carrier status for cystic fibrosis, spinal muscular atrophy, hemoglobin disorders, and fragile X syndrome (for oocyte donors).
  • Additional expanded carrier screening “may be appropriate.”
• American College of Obstetrics and Gynecology (ACOG), 2023
  • Cystic fibrosis, spinal muscular atrophy, hemoglobin disorders, fragile X syndrome (select indications).
  • Ethnicity-specific panels (e.g. Ashkenazi Jewish panel).
  • Panethnic carrier screening is an “acceptable form of screening.”
• American College of Medical Genetics & Genomics (ACMG), 2021
  • Panethnic is more equitable for care than ethnicity based.
  • Individuals considering pregnancy or are currently pregnant should consider a Tier 3 panel (113 genes), which includes conditions with a population carrier rate ≥ 1/200.
  • A larger panel with lower carrier rates may be considered for consanguineous couples or certain family histories.

“Panethnic carrier screening is becoming the more suitable direction because it enables identifying more carriers and bypasses the superficial way we classify individuals’ ethnicities… As we all know here in the United States, especially, we’re a melting pot of ethnicities so it’s becoming more and more justifiable to utilize panethnic panels” said Rawan Awwad, MS, CGC, Director of Genetic Counseling speaking on the significance of using panethnic gene panels versus the previously used ethnicity-based gene panels.

At Fairfax EggBank, we are currently partnered with Natera and offer our donors a 601-gene panel that encompasses all those recommendations and guidelines including the ACMG tier 3 genes. Using a large genetic testing panel allows for more opportunity to compare donor results with those of intended parents regardless of their testing panels, to further reduce the risk for disease.

Larger screening panels have limitations such as the inclusion of rarer diseases. As such, clinicians often wonder what constitutes an ideal carrier screening panel to utilize in the third-party reproduction field. Fairfax EggBank hosted a closed round table discussion on “Carrier Screening in Third Party Reproduction” with other experts in the field to discuss this topic. We concluded that there isn’t one specific panel that is recommended, but there is a general preference for using larger panels. This can allow for a deeper comparison between the donor results and the intended parents and may capture what could have been screened in diverse patient populations.

Variability in Carrier Screening Panels

Rawan mentioned extreme differences in gene content between carrier screening panels on the market even among panels of similar sizes. This can create frequent discrepancies when gamete sources are screened through different laboratories.  

In addition, laboratories differ in their reporting practices. It is highly recommended to work with a healthcare specialist like a genetic counselor to confirm a suitability match. Comparing carrier screening results can sometimes be challenging for non-genetic professionals for several reasons including:

• Labs may use alias names to refer to the same condition, for instance “Cystic Fibrosis” and “CFTR-related conditions.”
• A gamete source may seem to be a non-carrier for a specific condition when their panel didn’t include that gene/condition to begin with.
• For specific results, a carrier-carrier match may not always increase the reproductive risk for disease.
  • Example: Two silent carriers for alpha thalassemia.
• Variability in residual carrier risk reporting and the use of detection rates.

Fairfax EggBank provides suitable matching services for our intended parents and affiliated fertility clinics. This includes a written summary of the gamete sources’ results against each other. If the donor of interest is not a suitable match based on carrier screening results, we will provide options for the intended parents to consider including additional carrier testing.

Genetic counseling is often recommended for intended parents to better understand the reproductive risks and options. A genetic counseling session with a board-certified genetic counselor may include an assessment and discussion of the carrier screening results, a suitability match, and a discussion of the donor’s family and medical histories (if needed).

At Fairfax EggBank, we currently don’t offer genetic counseling sessions; however, we do provide suitability matching services for our intended parents, so they are able to secure a cohort as soon as possible, offer them and our affiliate clinics with support, and mitigate the wait times for a genetic counseling session.

This webinar discussed Fairfax EggBank’s cohort reservation process and suitability matching services to aid affiliate clinics in better understanding our processes for the intended parents.

If you have more questions on cohort reservation or suitability matching, feel free to check out the full video or contact [email protected].

Learn more about the authors

Rawan Awwad, MS,CGC

Rawan Awwad, MS, CGC is a board certified and multi-state licensed reproductive genetic counselor with expertise in preimplantation genetic testing, carrier screening, and gamete donation. She currently serves as the Director of Genetic Counseling at Fairfax EggBank where she oversees the review and assessment of donor genetic testing, manages the investigation and dissemination of medical updates received on donors and donorconceived persons, and serves as an in-house genetic expert for clients seeking suitability matching or clarification on donor histories/results. Prior to joining Fairfax EggBank, Rawan served as a Genetic Counselor at a PGT laboratory where she managed the review and counseling on PGT cases and served as a clinic liaison to referring clinics.

Brenda Amaya

Brenda graduated from the University of Maryland with a bachelor’s degree in Communications and soon after joined Fairfax EggBank as a Client Relations Specialist. Over the years, she progressed to the role of the Client Relations Manager, driven by a passion for assisting intended parents in their family building journey. Brenda’s goal is always to provide intended parents with the support and information they need during such a sensitive time in their life.