Sacrifice and solicitation: an empirical ethics study of egg provider blogs

Abstract

Background

Egg providers have the right to complete and accurate information about egg donation before deciding to donate. Many seek information beyond clinics and agencies, relying on fertility clinic or agency websites and testimonials of (former) egg providers. While several studies have examined fertility clinic websites, online narratives from experienced egg providers remain largely unexplored. This study analyzes how egg providers narrate their experiences in online blogs.

Methods

A systematic online search was conducted between August 2021 and September 2023 to identify blogs written by egg providers and published independently from clinics and agencies. This resulted in 23 blogs that were analyzed using reflexive thematic analysis combined with interdisciplinary collaborative auditing.

Results

The bloggers contributed to the creation of a community where (prospective) egg providers could inform and support each other. Comparable to travel guides that provide comprehensive repositories of information, the bloggers encouraged their readers interested in egg donation to further explore and consider the option with informed awareness of the possible risks and negative outcomes and to advocate for themselves. Decisions to stop donating were detailed with extensive thought and explanation, while decisions to donate again were described as the default choice.

Conclusions

In providing information about egg donation and encouraging others to donate, the bloggers often took on the role of peer recruiters. Bloggers' lived experiences provide insights often missing from clinical sources, complementing medical facts with the everyday, embodied realities of egg donation. However, the blogs also showed patterns that reflect the notion of gendered altruism, where egg providers feel a deep, sometimes self-sacrificial, responsibility to intended parents lived experiences provide inrents. Given that the bloggers actively encouraged their readers to donate, the notion of complicity warrants further examination in this context.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-026-01452-0.

Introduction

The use of egg donation (ED) has increased to the point where the demand for egg providers exceeds the available supply [1]. Various motivations of egg providers have been identified, such as altruism, financial incentives, or the wish to pass on one’s genetic material [2, 3, 4]. Despite the complexity and diversity of egg providers’ motivations, Almeling [5] has shown how commercial egg agencies frame egg provider motivations as predominantly altruistic. She argued that this framework reinforces traditional gender norms, positioning women as “naturally selfless and generous” [6, p. 60]. Similarly, Curtis [7] suggested that this rhetoric draws on societal constructions of idealized motherhood and subtly encourages women to view donation through a lens of care and selflessness. We acknowledge that the usage of the term "egg donation" is not neutral, yet we chose to apply the term due to its widespread use in academic, policy, clinical discourse, as well as in the analyzed blogs. However, to prevent making assumptions about the motivations behind the act of providing eggs, the term “egg providers” is used instead of “egg donors” when referring to individuals who engage in this act. When directly quoting the bloggers, the usage of the term “(egg) donors” will not be altered, as this would not accurately reflect the content.

Despite the growing demand and the positive, altruistic framing of ED, several significant deterrents discourage many potential egg providers from donating. Studies have identified various reasons for this reluctance, including concerns about the drug regimen, fear of complications, time commitment, distance from the fertility clinic [8], risks associated with medication and the procedure, lack of knowledge, the invasiveness of the process, and ethical or religious concerns [9]. A Spanish study reported that 44% of egg providers experienced physical discomfort, with 14% citing pain and 8% mentioning side effects of ovarian stimulation [10]. A U.S. study found that among egg providers who reported a negative overall experience, 92% stated they experienced more pain than expected [11]. In another U.S. study with egg providers, 13% reported no ovarian hyperstimulation syndrome (OHSS) symptoms, 35% experienced mild symptoms, 39% reported moderate OHSS, 12% experienced severe OHSS, and 1.4% reported critical OHSS [12]. Although these risks and side effects do occur, many egg providers feel they were not adequately informed about them. Research showed that 66.5% of participants noted discrepancies between the information they received and their actual experience [13]. Similarly, in another study, only 2.5% of egg providers were aware of bloating as a potential side effect, yet 31.3% experienced it [4]. Tober at al. found that most egg providers rely upon the clinic or agency to provide them with complete and accurate information on ED, although some also sought (additional) information online [13]. In some cases, egg providers even felt that the information they found online, or received in their online egg provider community, was more extensive than the information they received from the agency or clinic.

Websites of fertility clinics serve as an important source of information. Multiple studies have focused on information provided there [14, 15, 16, 17, 18]. These studies show that these websites often focus heavily on medical aspects, with less emphasis on more everyday impacts like emotional implications or practical concerns and physical discomfort such as bloating [16]. Although such risks or side-effects are not medically severe, they are noteworthy in the fact that they can significantly impact day-to-day life. For example, Jacxsens et al. found that these websites focused mainly on severe OHSS [16]. Although mild or moderate OHSS is less dangerous than severe OHSS, it is more common, with its occurrence varying according to the stimulation protocol used by the clinic. For example, protocols relying on hCG are associated with a higher risk of moderate and severe OHSS, whereas protocols using GnRH agonist triggering substantially reduce this risk [19]. Nevertheless, mild OHSS can still disrupt daily activities and negatively affect quality of life [20, 13]. This relates to the broader feminist critique that medical discourse tends to prioritize clinical risks over women’s lived experiences [21, 22]. At the same time, fertility clinic websites also enforce the altruistic framework of ED [23, 14, 16, 17, 18], for example by using emotional imagery and language such as ‘‘gift of life" [24, 15].

Prospective egg providers also seek out personal stories of experienced egg providers. For instance, an egg provider in Krawiec’s study followed online advice from experienced egg providers regarding financial compensation and tax rules [25]. Less focus has been placed on such peer-to-peer information shared online by egg providers. To our knowledge, only two studies examined egg providers’ online narratives of ED. De Proost et al. analyzed narratives located within UK-based forums, while Chang analyzed Taiwanese anonymous group chats and public forums [26, 27]. They both found that egg providers use online spaces to connect to other egg providers and to share information about ED with a particular interest in advice based on personal experiences. On the UK forums, posters also conveyed the altruistic narrative of ED by using “gift language” while refuting financial motivations. However, their analysis demonstrates how egg providers’ motivations go beyond altruism or compensation and are related to an internalized drive to become an egg provider [26]. Conversely, few of the Taiwanese forums and chat discussions used altruistic language. While some egg providers did mention that donating eggs is a good deed, the primary emphasis in these online spaces was placed on financial compensation [27].

While De Proost et al. examined online forums in the UK, and Chang in Taiwan, there remains much to explore in online spaces created by egg providers or individuals considering ED. Therefore, blogs are interesting as they reflect their writers’ personalities and perspectives, making them valuable sources of qualitative data that provide insight into the emotional and practical dimensions of ED [28, 29]. This is particularly important because personal narratives of peers have a clear potential to influence attitudes and health-related behavioral intentions [30]. A meta-analysis by Oschatz and Marker found that narrative messages have a stronger persuasive impact than non-narrative messages on participants immediately after exposure and that the greater persuasive power is persistent up to six months after reception [31]. Since such personal experience-based stories have a persuasive effect on beliefs, attitudes, and behaviors of their readers [32], understanding these personal accounts is essential. Moreover, these blogs can provide a more complete picture of the ED experience, beyond the purely medical information and altruistic perspective typically emphasized by fertility clinics.

The aim of this paper is to contribute to social science and empirical bioethics literature on the complexities of ED by exploring narrative experiences of ED within egg providers’ online blogs. The study focuses on what information egg providers discuss and share, and how they present their day-to-day experiences.

Method

Data collection

A systematic online search was conducted between August 2021 and September 2023 to identify blogs written by egg providers. The search was initially undertaken in 2021 and subsequently repeated using the same strategy following an extended period of sick leave of the first author, reproducing all previously identified blogs and identifying additional relevant material. We used two search engines: Google and Yahoo. The search strategy was designed to mimic the search strategy of potential egg providers and thus non-scholars. The search terms consisted of English keywords related to ED and included “egg donor”, “egg donation”, “oocyte donor”, “oocyte donation”. We did not use the terms “egg provision” and “egg provider” as there terms are not (yet) commonly used among non-scholars. These keywords were separately combined with the terms “blog”, “story” and “experience”. Algorithmic mediation of the search engines was treated as part of the phenomenon under study rather than as a source of bias to be eliminated. Since the data collection was conducted twice, with approximately one year between searches, following the same systematic procedure on each occasion, this helped to reduce the influence of algorithmic fluctuations and personalization. For each search, we explored results up to the tenth page. This cut-off was chosen because studies have shown that users searching for blog content focus primarily on the first few search results [33]. Extending the search to the tenth page allowed for the inclusion of a broader range of blogs beyond the most prominently ranked or popular content, supporting a reasonably consistent sampling of publicly available narratives.

There is no consensus on a single, clear definition of “blog” [34] because social media and other text-based platforms continue to evolve, blurring the distinction of what is and is not a blog [35]. Therefore, rather than providing an exhaustive definition researchers need to adopt a definition of “blog” that is consistent with their specific research question [34]. Since we aim to capture the experiences of egg providers, we adopt a broad interpretation of “blog” that includes any text written by an egg provider that relates to her experience of ED, regardless of platform or publication context. The text can be written over time or as a single post.

The inclusion criteria required that the blog was written in English and that a significant portion focused on the ED process (although it was not necessary for it to be the main focus). We only included blogs that covered aspects related to undergoing the (medical) procedure. This decision was guided by our analytic focus on the embodied experience of ED, specifically how bodily sensations, risks, side effects, and recovery are narrated and made meaningful by egg providers, and how such experiences generate informational needs and forms of experiential knowledge. Blogs that focused solely on the social or legal aspects of ED (i.e. relational and societal dimensions, such as egg provider–recipient relationships, family dynamics, and legal issues) without providing any information on the medical or physical aspects were therefore excluded. While motivations, emotions, and relational considerations were referenced in the included blogs insofar as they intersected with bodily experiences, texts in which these dimensions constituted the exclusive focus fell outside the analytic remit of this study. To ensure that we included narratives that were as authentic and original as possible, blogs that presented as responses to other blogs or news articles were excluded. Likewise, to avoid data that was influenced by an interviewer or fertility clinic, we excluded interviews and blogs published on fertility clinic websites. This way, we excluded texts that could be co-shaped by the clinics’ interests. Moreover, blogs on fertility clinic websites functioned primarily as advertisements. Therefore, the motivation for writing or editing these blogs could deviate from sharing an authentic account of personal experiences, and could (mainly) be aimed at serving commercial interests. The exclusion of blogs published on a fertility clinic website was a significant limitation to the data collection, as almost all online blogs we found were affiliated with an agency or fertility clinic. We did not use geographical location as an exclusion criterion, nor the number of times an egg provider had donated. Vlogs were not included nor were videos or photos of the included blogs because the focus of the analysis was on the textual content. Vlogs, videos and photos use a different medium with its own characteristics, such as spoken language, body language, and visual cues. We also excluded separate comment threads written by the bloggers or by readers and reader comments to the blogs, except for the latter when bloggers responded to readers’ questions directly within their blog posts.

In addition to the search described above, we also used snowball sampling; one of the most popular sampling methods in qualitative research [36]. This combined purposive and snowball sampling approach has been used in other studies where blogs were the primary data source [37, 38]. For example, the website of We Are Egg Donors, an organization of and by egg providers, operates independently of fertility clinics and egg agencies. Their website contained several blogs, which then led us to several independent blogs. Bloggers often included references to other blogs or bloggers that they followed or whose content they regularly read. This process gave the researcher access to other sources of rich data that may not have appeared in the original search.

A total of 25 blogs were found that met the inclusion criteria. They varied in content and complexity; some blogs described thoughts and feelings in depth, while others focused primarily on describing everyday events. Ten blogs were written over an extended period of time and contained multiple posts. Six blogs came from blog posts on the We Are Egg Donors website. Two of these blog posts led us to two long-term blogs, which are included in the ten blogs mentioned above. Nine blogs were published as articles on online magazine websites (Vice, Goodhousekeeping, Womanmagazine, the Guardian, the Atlantic, Allure, Minority Africa, Health line, Verily). One blog appeared in multiple posts on Twitter, and another was found as a reddit post. Two bloggers wrote about their own experiences and interviewed other egg providers. In these cases, we did not analyze the sections where the egg providers were interviewed, but only the first-hand accounts of the ED experiences.

Ethics of research using blogs

Use of online blogs without consent may be justified if it can be reasonably argued that the online data is “in the public domain”, and the blogger has no expectation of privacy [39]. The blogs in our study are publicly accessible and intended for a public audience. The latter was evident from the presence of comment sections on the websites. Although the blogs contain first-hand personal accounts, they were not produced for the purposes of this study but pre-existed the research, and are therefore considered secondary data in methodological terms. Consequently, we can consider the blogs as open access and published material (e.g. newspaper/magazine articles, opinion pieces) for which consent is not required prior to analysis [40, 35]. This approach has also been applied in similar blog studies [e.g. 28, 41, 42]. Therefore, we decided not to ask consent. However, in favor of transparency, we tried to contact the bloggers to inform them that we will use their blogs as data, leaving them with the option to opt out. Of the 25 blogs identified, one blogger could not be contacted. One journal specified in its copyright that consent was required, which we did not attain, and one blogger indicated her desire to opt out. Two bloggers responded positively, while the others did not provide any feedback. This resulted in the exclusion of two blogs from our data collection, leaving us with 23 blogs in total. A flowchart of the data collection can be found in the Supplementary Fig. 1.

Although there is no requirement for consent, the researcher is required to consider whether it is necessary to protect the blog author (e.g. if the author is a minor) [35]. Therefore, we assessed whether the authors expressed awareness of the blog’s public accessibility with the intention of excluding those who did not. All authors included in our study demonstrated an understanding of the public nature of their blogs. We interpreted this awareness based on several indicators: when bloggers enabled comments on their posts, responded to reader comments through their blog posts, or published their writing on public platforms such as magazines or general-access websites like We Are Egg Donors. In these latter contexts, it is inherently clear that their content was intended for an audience. While several blogs enabled reader comments, comment threads themselves were not included in the analysis. Our analytic focus was on self-authored blog posts as narrative texts through which egg providers construct and present their experiences. Comment sections constitute multi-authored, interactional spaces that raise distinct methodological and ethical considerations and were therefore considered beyond the scope of this study.

Since we consider the bloggers as authors, we take copyright concerns into account. Hvizdak studied blogs from women and feminists to see if and what types of copyright protection they seek [43]. She concludes that creation in the blogosphere is heavily reliant on linking and quoting information from others, with the expectation of correct referencing. Therefore, we decided to provide links to the source blogs in accordance with the norms of the blogosphere. Supplementary Table 1 presents an overview of the blogs along with their corresponding links.

The ethical approach adopted in this study is not intended to serve as a universally applicable model for all internet-based research on sensitive topics. Rather, it reflects a context-specific judgment grounded in the public, intentionally published nature of the blogs analysed.

Reflexive thematic analysis

The blogs were analyzed using reflexive thematic analysis [44] combined with interdisciplinary collaborative auditing [45]. This means that we see the practice of thematic analysis as an inherently interpretive practice, and meaning as something that is not fixed in data [44]. The main researcher receives input from collaborators but is not restricted by a consensus driven approach [45]. The first author (L.J., PhD, at the time of the analysis doctoral student) actively read, selected and annotated the data after which she focused on identifying and generating codes, using Nvivo 12. Then she provided the first auditor (i.e. the second author, M.D.P., PhD) with a first draft of the coding structure, descriptions of the codes, and a condensed selection of blog quotes per code. M.D.P. then also familiarized himself with the data (i.e., the quotes provided by L.J.) whilst memo writing. Together, L.J. and M.D.P. refined the codes and organized them into themes. After identifying initial themes, the second auditor (third author V.P., PhD) joined the auditing process. It was then noted how many bloggers choose to describe their experiences as “journeys”, a metaphor that is widespread in the world of Assisted Reproductive Technology [e.g. 46, 47]. The metaphor was then used descriptively to illustrate how bloggers narrated their experiences of ED, and to support the presentation and organisation of the findings. Thus the initial coding and theme development were conducted independently of this metaphor. The metaphor can frame ED as a process unfolding over time that allows the bloggers to situate challenges, such as medical procedures or emotional strain, as stages within a broader trajectory. This all required several team meetings, while reaching data saturation. After this, L.J. wrote out the themes, which were then reviewed and discussed by the other two authors. The authors varied in their positioning to the research topic. Two of the authors are women and one is a man. One author is a mother with lived experiences of the in vitro fertilization (IVF) process and OHSS. Another author, while lacking direct experience with ED or IVF, has closely observed a friend undergo the IVF process. Through her research, she has also come into contact and formed a bond with an egg provider who had experienced complications. She and the third author are both child-free. All three authors share a feminist perspective and approached the subject from this standpoint. Each author contributed to the analysis from their respective disciplinary backgrounds (i.e., Philosophy, Moral Sciences, Social Health Sciences, and Gender and Diversity).

Results

Many bloggers used the metaphor of a “journey” to describe their experiences with ED, seemingly taking their readers along with them. This is interesting given that multiple bloggers actually travelled for their donations, primarily within their own country, with only Blogger 8 travelling abroad. However, the majority did not expand on this aspect extensively. This journey metaphor was a common thread throughout the descriptions of several experiences. This choice of words emphasizes the transformative journey that egg providers go through. The journey parallels the demanding terrain of travel, which includes hormone injections, an egg retrieval, and periods of recovery. The journey evokes a spectrum of feelings, from initial excitement to encountering unforeseen challenges such as stress, fear and anger along the way. We used this metaphor to look at the experiences these bloggers shared with their audiences, and to present these experiences in a descriptive manner in this Results section.

Intimate journeys into the digital public landscape

The bloggers engaged in intimate acts of self-expression, sharing personal, physical, and emotional details that blurred the lines between the public forum and private space. They did not simply recount their journeys; they wrote about personal and sometimes painful and "shameful" intimate experiences, such as vomiting, diarrhoea, periods, sexual urges, weight gain, vaginal examinations, and problems associated with endometriosis. Their openness extended beyond the physical, describing their emotional experiences in-depth, e.g. crying for their mother, and being terrified. These ED experiences flowed over into their daily lives, which they also discussed openly, such as their thoughts on having children, going through a divorce, religious experiences, and confrontations with body image. Some of these intimate topics were only mentioned briefly in passing, whereas others were discussed meticulously. For example, Blogger 2 described in detail how it felt to have intercourse when your ovaries are swollen.

“As for comfort, I generally don’t like having sex in the week surrounding the retrieval because your ovaries are big and it’s kind of uncomfortable. We have done it, and if it’s very slow it’s not too bad. Once things get vigorous, I feel my puffy ovaries getting banged around a lot more than I feel anything else, so we generally pass for that week.” (Blog 2)

The bloggers often delved so deeply into personal details that it was as if readers were gaining access to the bloggers’ innermost thoughts and bodily sensations. The bloggers acknowledged that they were sharing intimate and personal experiences, but also demonstrated an understanding of their audience, recognizing that their words would be read by others. Not only did the bloggers clearly express the understanding of having an audience, but some mentioned that they intentionally shared such private issues for the sake of their readers. One blogger mentioned her detailed writing about her first injecting experience, which was an emotional ordeal for her, with the aim that “if someone else is in the same situation, they know they are not alone” (Blog 6). This sentiment was echoed across the blogs, with many expressing a desire to help others, particularly women interested in or undergoing ED. Their primary motivations for blogging were to raise awareness, to offer support and information, ensuring that others would not feel alone and were well-informed about the process.

“I feel like my vagina has taken a beating with all these daily pelvic exams and a pap smear today. Sorry, were those details too intimate for you to read? Welcome to my blog. I’m open and want to share everything I have been going through so that other prospective donors can understand the whole process.” (Blog 4)

The bloggers seemed to want to create a community of egg providers, where (potential) egg providers could inform and support each other. They expressed a willingness to help their readers expand their understanding of ED and invited their readers to ask questions. Several bloggers mentioned that they searched for information about ED online but could not find what they wanted or needed. In effect, these bloggers actually became the people providing information to others who were in the position they had once been in.

The lonely donation planet: a guide for a solitary voyage

The blogs could be likened to travel guides, providing a comprehensive repository of knowledge and information covering every facet of the ED journey that an egg provider may encounter. Just as travel guides provide detailed accounts of various destinations, accommodations, and activities, these blogs meticulously documented the emotional, physical, and logistical dimensions of ED. For example, nearly every blogger wrote about the injections, either briefly or in considerable detail. While some saw the injections as a difficult challenge to overcome, others who were initially concerned eventually got accustomed to them after the first few times. Yet some considered the injections as an ordinary aspect of the process. However, these latter bloggers also mentioned their injection experiences, seemingly recognizing that other egg providers might experience some difficulties with their injections. The bloggers sometimes described the actual sensation of the injections (e.g. a “prick”) but also the side-effects that followed after a few minutes (e.g. a burning or cold sensation from the medication) or days (e.g. bruising). These descriptions provided readers with a clear indication of what to expect in terms of sensations and side-effects.

In addition to the challenges associated with the injections, bloggers also discussed more general side-effects and difficulties encountered throughout the ED journey. Frequently mentioned were discomfort, bloating, pain, fatigue and emotional sensitivity, as well as side-effects specific to the egg retrieval. Sometimes these issues were discussed in detail. The tone also varied between serious, stark accounts and some form of minimization about how the side effects were not that bad. When OHSS was the topic of discussion, it generally was given comprehensive attention, with most of the bloggers who mentioned experiencing it providing detailed descriptions. OHSS seemed to have a significant physical, mental and practical impact on them. Some accounts revealed intense fears, with one blogger (Blog 2) describing not being able to breathe and thinking she might die. She described intensely crying and experiencing a feeling of losing control over her body. This latter sentiment was echoed by multiple bloggers. One blogger (Blog 1) vividly described enduring intense pain during the egg retrieval as well as the subsequent paracentesis (the removal of fluid from the abdomen) which was needed to treat her OHSS. Detailing feelings of trauma, she revealed that several months later, she found herself unable to undergo a dental procedure because being in the dentist’s chair, under the bright light, triggered memories of the egg retrieval and paracentesis.

In sharing their knowledge and lived experiences and describing their treatment protocols, the bloggers frequently employed medical jargon and referred to specific medication. For example, “My drugs are – Suprecur 0.3 ml subcutaneous injections daily (from Fri 4th) and for Stimulation, 150 iu of Puregon daily by subcutaneous injection pen” (Blog 6). Thereby, bloggers offered readers insight into the clinical aspects of ED and familiarized them with key medical concepts and terminology, sometimes. making deliberate efforts to unpack the jargon. For example, Blogger 1 offered a lay-friendly rationale for her medications: how Cetrotride prevents premature ovulation and why this prevention is important. Blogger 9 provided an elaborate and detailed explanation of the hormonal regulation of the ovarian cycle, even drawing on visual aids: “I’m going to do my best to follow in the footsteps of my health class teacher to explain the ovarian cycle and how it relates to egg donation. The chart above is a great illustration of what really goes on with respect to hormones.” Blogger 2 explicitly acknowledged this educational purpose of her blog, stating that her initial posts “were designed to be informational for people who really wanted to know step by step what is involved,” and referred readers back to those entries for “the helpful yet boring stuff” such as “shots and pills and morals.” This statement underscores the intentional inclusion of medical explanations, revealing bloggers’ awareness of their informational role and their efforts to balance clinical accuracy with personal storytelling.

Some bloggers went a step further than solely describing their journey and with that, exchanging knowledge and informing others. Intermittently, they also offered advice for others who considered participating in ED. This took the form of practical tips, for example, on how to make the injections more manageable. In doing so, they were essentially offering their readers a helping hand at every step of the way. They also addressed short tips for more general side-effects, such as “Always take your painkillers” (Blog 3), “Another big tip - stay hydrated!” (Blog 10), or how eating lots of soy sauce can help with OHSS.

Sometimes the bloggers’ guidance took the form of warnings. They seemed to discourage those afraid of needles from donating. For example, Blogger 9 stated “If you are not needle-friendly, egg donation is not for you.” Additional warnings dealt with topics such as how readers should communicate with their partner about unknown side effects and about the restrictions on sexual activity during ED before officially committing to donate.

One blogger went further than providing information and advice. She responded to a reader’s question and diagnosed the reader with OHSS. She described how scared she was when she had OHSS so that her reader would not feel alone; “I know how scary this must be for you.” She then gave practical tips and information on how she overcame her OHSS. Finally, she invited the reader to email her “If you need to just talk about it or if you have questions” (Blog 2).

Online travel guides emerging as solicitation tools

Although some bloggers described painful and/or distressing experiences of side-effects, and sometimes gave warnings, they notably did not dissuade their readers from donating. Many bloggers explicitly stated that their intention was not to discourage others from donating eggs, despite sharing their negative experiences. Instead, their primary message seemed to be one of reassurance. They encouraged their readers to understand the potential risks, to proceed with an informed awareness of the possible negative outcomes and to advocate for themselves. This was demonstrated by Blogger 4 who wrote that she did not want to scare potential egg providers but advised her readers to “know the precautions before getting picked” (Blog 4).

Apart from warnings, texts mentioning side-effects were interspersed with encouraging messages for those interested in donating, such as “For potential donors: don’t be scared of the injections!” (Blog 4), as well as messages saying “it’s not bad” (Blog 2). Those who experienced hardship and generally felt bad about their ED journey often mentioned or focused on a silver lining, a hopeful or positive aspect that might have come out of their difficult or challenging experience. Despite the pain they had to bear, they still recognized the potential positive outcome of pregnancy for intended parents (IPs). One blogger explicitly described her silver lining as being “able to sacrifice to help those stand back up” (Blog 14). Bloggers often emphasized that despite the painful side effects and perceived mistreatment, the experience was ‘worth it’ because of the deep sense of having potentially made a positive difference to the lives of the IPs.

“This recovery was painful and exhausting; it was difficult even to walk up the stairs to my third-floor apartment. I began to get ovarian cysts regularly, something I started taking birth control to prevent. But I believe it was still worth it to give someone their dream of parenthood.” (Blog 15)

Conversely, a few bloggers expressed that the ED experience was not worth it, but their dissatisfaction seemed to be always linked to the financial compensation. They suggested that the payment egg providers receive does not adequately compensate for the physical and emotional investment and hardships involved. They indicated that if financial gain would be someone’s sole motivation, the effort required to donate would not be justified.

“Was it worth it money-wise? I don’t think so. I think many people consider it an easy way to make money but it isn’t. Your body is put through a rollercoaster with barely any thought and there is no adequate way to prepare yourself because people react differently to the drugs. But to give women a chance at motherhood, especially women who can’t have children, is worth it.” (Blog 19)

Some of the bloggers seemed to approach their writing as a professional endeavor, which we observed in four distinct ways. First, one blogger expressed a desire for reader involvement, encouraging readers to contribute content and participate in building a community. “As I’d like this to be a community site in a way, the more people on board, reading and sening [sic] in links, the better the directory will become” (Blog 6). She emphasized her blog as a work in progress, continuously improving and adding relevant content such as news stories and blogs related to ED. In a way, this blogger called for a collaboration that resembles teamwork among colleagues, recruiting her readers to work on an information-sharing project. Third, several bloggers expressed their appreciation for the support and praise they received from their readers. “[…] so many of you have sent me such lovely messages and shown me so much love. I am so glad to have shared this journey with you all!” (Blog 10). Although, this was never mentioned as a motivation for writing the blogs, praise and recognition may have been an additional motivation to continue writing their blogs and something they received in return from their audience. Finally, one blogger actively asked her ED agency if she could help besides donating eggs and eventually took on the role of ‘Egg donor support’ at the agency. Another blogger eventually also started working in a fertility clinic, to formally answer questions about IVF and inform women interested in the process. She compared this new job to writing her blog: “It would basically be phone calls and emails detailing the process and what to expect. This is awesome. I already do a lot of that, anyway, via this blog” (Blog 2).

In some ways, the bloggers seemed to take on the role of a solicitor or recruiter. As Blogger 2 mentioned, the professional position offered by the fertility clinic was essentially what she was already doing through her blog. One blogger even explicitly tried to recruit egg providers for the agency through which she donated.

"If you are an interested, potential donor, please email me! I'd love to share with you my agency!" (Blog 4)

Repeat tourism

Similar to how tourists return to destinations they have visited before (i.e., repeat tourism), the bloggers reflected on “returning”, i.e., whether or not to donate again. Several bloggers shared their thoughts on (not) donating again. Out of the 23 bloggers, nine donated more than once (all anonymous). Most bloggers who decided to donate more than once did not outline a clear decision-making process. Their decisions were described as something they “knew almost straight away […] there “really was no decision to be made” (Blog 10). For example, Blogger 2 described the ending of her third cycle and then mentioned that she will start her fourth cycle without providing any explanation as to why: “This is basically it for the cycle. I will go in for a sonogram on the 3rd day of my period and that will start my 4th egg donation.” Similarly Blogger 9 did not provide any reasoning: “After my donation, I was definitely eager to get back on the donor database.” The bloggers who donated to someone they knew only donated once for those specific IPs. Half of the bloggers who donated anonymously, donated multiple times. For them, a subsequent donation seemed to be the default choice. The bloggers who donated anonymously and decided not to donate again, after one or more donations, detailed their decisions with more thought and explanation with almost always an explicit reason given. These explanations were either short, rational arguments (e.g. critiques of the practice of ED) or longer, more emotionally charged texts in which they seemed to convince themselves and/or the readers that it was acceptable for them to stop. A common reason for not donating again was the toll it was taking on their mental wellbeing and/or bodies, with one Blogger (2) even talking about feelings of “burnout.”

“So, will I be donating for a third time? I don’t think so. The process, as wonderfully rewarding as it is, can be pretty hard going sometimes. My body obviously struggled more this time so maybe it was its way of telling me that it wouldn’t really be overly sensible to do it again.” (Blog 10)

But although many bloggers mentioned that their bodies could not take any more, some of them were torn between on the one hand this feeling that they/their bodies could not take another donation and on the other hand wanting to help more IPs and especially not disappointing them. They expressed feelings of guilt for not donating again. One blogger gave succinct reasons for her decision to donate multiple times but went into great detail about the reasons for her decision to stop donating (Blog 2). In these lengthy passages, she detailed the internal conflict she experienced; torn between her hesitancy to donate a fifth time and how much she cared for the IPs and did not want to disappoint them. She even wrote about a sense of “moral obligation” she felt towards the IPs.

“Every time I think about this cycle, I am seized with anxiety. A deep physical reaction. Everything in me is screaming “no, not again” except for this sense of moral obligation. The cycle is scheduled for October. I just don’t know what to do.” (Blog 2)

One blogger had initially decided not to donate again because she felt like she “couldn’t go through with it again” (Blog 14). However, she explained how the coordinating nurse convinced her to donate another time after hearing the new IP’s difficult infertility journey. Although not explicitly stated, it was clear that she felt empathy for the IP and thought she would have felt too guilty if she did not donate. Two weeks after this second donation, she was in debilitating pain through her back and legs. Her doctor informed her that “the retrieval is the only thing that could have caused such nerve damage leading what he diagnosed as “severe sciatica.” A condition that will stay with [me] my whole life, and I must constantly be aware o.” (Blog 14). Another blogger (Blog 3) who described their experiences as “terrible” still decided to donate again. She seemed to prioritized the happiness of the IPs above self-care.

Sometimes bloggers decided not to donate again because they were unsatisfied with their initial experience. These were mostly the bloggers who also experienced OHSS with severe pain as explained in the previous section. Still, some of them talked about feeling guilty for not donating again. For example, Blogger 1, who expressed feelings of trauma after her donation, still wrote about how it pained her to decide not to donate again. A few bloggers decided not to donate again because of more general criticisms they have about the practice of ED, such as concerns about commercialization and/or eugenics.

Discussion

Based on the descriptive results, we now will turn to the discussion on the possible effects of these findings and situate them within the literature.

Although the majority of the bloggers did not engage in physical travel, the majority adopted the metaphor of a “journey.” Our study found that only one blogger travelled internationally for her donation, while a few others travelled within their own country. By using this metaphor of a “journey” to describe the data and our analysis, we show how bloggers used their online spaces to share advice, to give support and try to create online communities with and for others interested in ED. This included sharing intimate information and experiences. It seems that the purpose of this knowledge sharing was to inform their readers and encourage them to donate their eggs. By encouraging their readers to donate, the bloggers acted as solicitors.

Through their blogs, these egg providers shared deeply personal accounts of their donation experiences, offering insight into their motivations and emotions. This sharing of personal stories not only serves as a means of personal expression but also meets a demand for authentic, experience-based information from other egg providers. This demand was expressed by the bloggers but was also found in a study of De Proost et al. and Chang in ED online forums [26, 27]. Other studies have also shown how health bloggers and readers have an interest in learning on online health forums “where processes of collaborative learning and knowledge construction take place” [48, p. 508]. Similarly, the blogs went beyond mere information and – knowledge sharing, showing attempts to create supportive online communities for egg providers. This need for and attempts to create a supporting community also mirrors the findings from De Proost et al. [26], and those of a study about online forums on infertility [49].

In the studied blogs, this sharing of information, knowledge, and the creation of a supportive environment seems to have been taken a step further. A significant observation is how these bloggers adopted roles akin to those of solicitors, engaging in what we could call ‘employee referrals’, referring to the practice of organizations actively involving their current employees in the recruitment of new employees [50]. This phenomenon of reproductive workers (such as egg providers or surrogates) joining agencies as recruiters is not uncommon. This was observed in a study of surrogate blogs in which one blogger actively encouraged other women to become surrogates [51], and in another study, Indian surrogacy recruiters were found to have been surrogates themselves [52]. Similarly, the bloggers in this study seemed to recruit women within their online social network. Their dedication to guiding others aligned closely with the responsibilities of a recruiter in a fertility clinic, whose role is to raise awareness on ED, provide support, and inform potential egg providers. Likewise, the bloggers aimed to inform and assist prospective or potential egg providers through the recounts of their personal experiences, gave emotional support and shared contact details for readers seeking more information. Through their use of medical jargon and explanations of procedures, they also familiarized their readers with key terminologies, medication names, and hormonal processes associated with fertility treatments, thereby making efforts to demystify the clinical aspects of ED. Additionally, the bloggers often included warnings to ensure that only those truly committed to the entire process would decide to donate. This is similar to the crucial responsibility of professional solicitors to select potential candidates by raising awareness of both the rewards and challenges of the process. By presenting the difficulties egg providers might face, these bloggers ensured that their readers would be fully informed and prepared for the demands of ED without directly discouraging them from donating. Moreover, given the level of dedication and commitment involved in maintaining a blog, fostering community and responding to questions, it is reasonable to interpret their blogging endeavors as akin to work. This is particularly evident as one blogger explicitly compared her new role at the egg agency to her blogging experience. Notably, Bromfield also reported on a blogger who intended to work as a mentor and consultant at a surrogacy agency [51]. Interestingly, just as recruiters are paid for their efforts with a salary, the bloggers received emotional rewards in the form of praise and support from their readers. While such rewards are not monetary, they fulfil similar needs for recognition and validation, which can be highly motivating. We do not want to imply that these bloggers intentionally or even consciously recruit others. Nevertheless, it is important to acknowledge the potential influence of narratives on people’s attitudes and health behavioral intentions [30]. Although bloggers may not actively seek to recruit, their outreach influences the perceptions of their audience and therefore may have that effect.

It appears somewhat counterintuitive that these bloggers serve as peer recruiters, given that some of them have disclosed distressing experiences. As previously stated, these accounts did not actually try to dissuade others from donating. Some bloggers, in fact, encouraged others to donate despite having experienced physical or emotional distress themselves. This prompts the question of why an individual would recommend a process that caused them personal hardship. Additionally, their own multiple donations indicate a sense of obligation to continue supporting the process despite the personal pain they experienced. A potential explanation for this apparent inconsistency could be the sacrifice that these bloggers displayed. As Mongoven notes, within the context of organ donation, bioethicists frequently overlook the cultural ideals of sacrifice [53]. Therefore, we want to zoom in on Curtis’ study where she posits that the framework surrounding ED is based on the gendered rhetoric of altruism, whereby egg providers are expected to be emotionally invested in their recipients and the outcomes of the donations [7]. She shows that this investment is based on ideals of motherhood and femininity, encouraging sacrifice and risk-taking. She states that “Altruism encourages donors to care about, and be concerned for, the struggles and feelings of their recipient parents, the recipient women, sometimes to the detriment of their own health” [7, p.95]. This aligns with Mongoven’s warning that we should be cautious of any (potential) injustice generated by expectations of altruism [53]. Similarly, we observed that our bloggers tended to prioritize the IPs and a potential pregnancy over their own health concerns. For several bloggers, their motivation to donate was found to outweigh such concerns. This aligns with the findings of a study on ED forums where some posters viewed ED as an act that “required a direct cost or some form of self-sacrifice and risk-taking for the sake of others.” [26, p.9], pointing directly at how ED entails sacrifices and risk-taking. Curtis further asserts that providers may be so invested in the IPs that they are willing to donate (multiple times) to their own detriment, even if they initially had no intention of doing so [7]. We saw this with Blogger 14 who had to be persuaded to donate a second time, which, according to her doctor, resulted in a lifelong condition. Curtis’ additionally posits that since egg providers view the remuneration they receive as compensation for their time and suffering, “pain becomes a way for egg donors to demonstrate altruism unequivocally” [7, p. 95]. Moreover, she suggests it is possible that egg providers are more accepting of suffering because they are being remunerated for it. Also in our study, we may wonder whether compensation acts as a legitimization of ED and the pain involved in the process. Fernández-Alles and Valle-Cabrera show that compensation systems often serve a symbolic function, helping organizations demonstrate alignment with institutionalized norms and thereby bolstering their legitimacy in the eyes of stakeholders [54]. Applying this logic to ED, the very fact that egg providers receive compensation can operate as a normalizing and legitimizing signal: payment suggests that the practice is formally recognized and regulated. As a result, recipients may be less inclined to question the legitimacy of the process itself, even when experiencing pain or discomfort, because the act of being compensated frames their participation as part of a legitimate and normatively accepted exchange rather than an exploitative one. The combination of emotional investment in the recipients and acceptance of pain or suffering may then further explain why the bloggers prioritized the needs of the IPs above their own well-being. In line with this, Kroløkke found that egg providers’ considered their hormonal treatments as “small acts in comparison to the trauma and grief associated with infertility” [55, p.20], often despite their own fear of injections. The bloggers in our study often reflected this perspective, viewing their suffering as “worth it” because of the potential benefits for the IPs. They acknowledged the personal costs and sacrifices involved in the process while they simultaneously emphasized the joy and fulfilment that comes from helping IPs. This also relates to the finding of De Proost et al. that egg providers” intense internalized drive to become an egg provider may override other concerns [26]. The only time the bloggers expressed that the ED experience might not have been not worth it, it was linked to the financial compensation. They suggested that the payment egg providers receive does not adequately compensate for the physical and emotional investment and hardships involved, implying that if financial gain would be someone’s sole motivation, the effort required to donate would not be justified. In another study, egg providers echoed the same sentiment [4].

Recommendations

We propose that fertility clinics should adopt a more transparent, detailed, and experience-informed approach to information provision where egg providers are actively involved in co-producing the informational content. This collaborative approach would ensure that information is both medically accurate and experientially grounded, addressing the dual need for clinical clarity and experiential transparency. Firstly, the bloggers in this study demonstrated a high level of both technical and experiential knowledge about ED. Their detailed discussions of medications, procedures, and use of medical jargon reflected a clear familiarity with the medical aspects of the process. However, what is unique about their accounts is their grounding in embodied, lived experience. Rather than merely repeating medical facts, the bloggers contextualised biomedical information through the lens of everyday life. Egg providers’ experiences with the physical, emotional, and social aspects of ED grant them critical insights often overlooked in discourses dominated by IPs and fertility specialists [56, 57]. Secondly, although bloggers occupy a different epistemic position than medical professionals, their goals often align with those of fertility clinics and agencies: to raise awareness about the need for egg providers and to ensure prospective donors are well-informed. However, research has shown that fertility clinic websites often fall short of this aim. There is a tendency to minimise risks or obscure key information behind vague, commercial, or overly positive language [16, 18]. These platforms rarely address the more everyday impacts of ED, such as emotional burdens, practical challenges, or minor physical side effects [16]. The bloggers implicitly critiqued this gap, as many expressed being motivated to blog precisely because they could not find experiential accounts that reflected the full reality of ED online. Through their blogs, they offered what formal sources omit: the daily, sometimes uncomfortable or emotionally taxing aspects of ED. This shows that what (prospective) egg providers seek is not necessarily reassurance or the promise of financial gain, but realism. They want detailed, honest accounts of physical discomfort, emotional uncertainty, and potential risks to make genuinely informed decisions. The act of disclosing difficult experiences may actually increase the credibility of the bloggers rather than discouraging potential egg providers. Readers may feel more confident in proceeding with ED precisely because they feel adequately warned and emotionally prepared. Finally, the value of experience-based knowledge (co-)production has been acknowledged by others. For example, medical experts on an online cardiology forum acknowledged patients’ unique access to experiential knowledge, viewed patients’ knowledge as complementary to biomedical expertise, and recognised the value of integrating both forms of knowledge without hierarchy [58]. Brandsen et al. similarly argue that when patients as ‘experts by experience’ can contribute and co-produce valuable insights, ideas and knowledge, both at an individual level as well as at a collective level [59]. They conclude their analysis saying “scholarship thus far on co-production in healthcare has highlighted the benefits that this can bring to improving the care that patients receive” [59, p. 158]. This line of reasoning also aligns with Scully’s distinctive features of feminist empirical bioethics: relationality, embodiment, and listening to marginalised voices as sources of situated and epistemically significant knowledge to achieve equality and justice [60]. While co-production is the principle, structural reforms may be necessary to address entrenched conflicts of interest in online information provision. Even when egg providers are included in co-design, if information platforms remain tied to fertility clinics, imbalanced power dynamics and commercial incentives might continue to shape what is disclosed and how it is framed in favour of the fertility clinics. A more robust solution would be the creation of independent information platforms spearheaded by patients organisations, and supported by national health authorities (e.g., the National Health Service or Human Fertilisation and Embryology Authority in the UK, equivalents elsewhere). Such platforms could substantially reduce conflicts of interest by removing commercial pressures. They would additionally centralise accurate, accessible, and transparent information for prospective egg providers. Fertility clinic websites would then not provide their own information but refer to the online platform of the national health authority. By shifting the responsibility for information provision away from clinics and into the hands of a neutral public authority, this model addresses the systemic imbalance that arises when commercial actors both recruit egg providers and profit from their participation.

Another central feature of empirical feminist bioethics is the importance of paying attention to power, meaning it requires that we look at ‘the dominance of some voices and exclusion of others’ (60, p. 203). This feature links to Monteverde’s notion of complicity, which she defines as “the broad notion of participation in a practice, belief, behaviour, or understanding that can lead to oppression, discrimination, or exploitation of your own or another group” [61, p. 63]. The concept can be used to examine how people contribute to the preservation of dominant norms through narratives and how they thereby enforce existing power structures. In this light, the majority of the bloggers could be seen as reinforcing the dominant narrative of ED as an altruistic “gift” between women, in the name of “sisterhood,” by downplaying negative experiences or pointing to purposes that are so important that they override these experiences, and emphasizing the positive aspects of their donations. Although some bloggers mentioned very painful or even traumatic experiences, they continued to encourage readers to consider ED, which inadvertently promotes the risks of ED. By endorsing a process that demands or is inextricably tied to personal sacrifice and suffering, these bloggers might reinforce norms (linked to gendered expectations of altruism and motherhood) that celebrate their own pain and downplay their own needs. It is necessary to further study the influence such peer-based narratives and online reviews might have on the reader, as these bloggers might be inadvertently complicit in promoting a practice that causes harm.

Limitations

This study had several limitations. Since not all egg providers write blogs, it is possible that egg providers with lower levels of satisfaction or higher incidence of complications were more inclined to write about their experiences. In contrast, some bloggers were actively trying to inform others about infertility struggles, and that might also skew the population to those who feel passionate about promoting ED. For example, bloggers who are motivated to promote egg donation may also be more inclined to donate multiple times, which could contribute to an overrepresentation of repeat donation in our sample and make continued donation appear as a “default” choice. While we excluded blogs hosted on fertility clinic or agency websites to avoid an institutional bias, some selected blogs published in online magazines may still reflect editorial influence. However, these sources do not have a direct interest in promoting EP or the agenda of fertility clinics or agencies. We observed that our dataset consists of a quite homogeneous group of bloggers, with little variation in aspects such as sexual identity. Additionally, the majority of the blogs were written by American egg providers. Since ED is a context-sensitive practice, this may have influenced our findings. Further research on a broader and more diverse range of bloggers, considering different cultural, social, and personal contexts. This includes research on non-English blogs. For example, since Spain is the European ‘hot spot’ for ED, exploring Spanish blogs on the topic could provide valuable insights. Finally, by concentrating on the medical and physical aspects of ED and on informational needs and sharing among egg provider bloggers, this analysis may have overlooked other important dimensions. Future research could extend this work by examining how social, relational, and legal considerations are articulated in online narratives of ED.

Conclusion

This analysis of egg provider blogs reveals that egg providers’ personal stories extend beyond self-expression, wishing to form supportive online communities and wanting to inform and support other (prospective) egg providers. The bloggers shared realistic accounts that both educate and warn others, promoted ED and guided future egg providers, often acting (not necessarily intentionally) as informal peer-recruiters. At the same time, the bloggers’ accounts underscore the value of experience-based knowledge in supporting adequate information provision. Their knowledge based on lived experiences offer valuable information that is often absent from clinical sources, balancing medical facts with the daily and embodied realities of ED. We propose that fertility clinics adopt a more transparent and participatory approach to information provision that includes egg providers as co-producers of content.

We recommend further research into the ways in which bloggers, despite recounting personal sacrifice and distress, continue to promote and engage in repeated ED. Such research should explore how this behaviour may reflect and reinforce notions of gendered altruism, and whether bloggers who encourage ED among readers could be seen as morally complicit in sustaining these dynamics. Despite sharing experiences of sacrifice and personal distress, the bloggers remained committed to donating multiple times and encouraging ED. This pattern confirms earlier reports on the notions of gendered altruism, where egg providers feel a deep, sometimes self-sacrificial, responsibility to IPs. We encourage further research that explores the concept of complicity of egg providers in reinforcing and perpetuating this gendered altruism.

Abbreviations

ED

Egg Donation

IPs

Intended Parents

IVF

in vitro fertilization

OHSS

Ovarian Hyperstimulation Syndrome

Authors’ contributions

L.J. and V.P. contributed to the conception and design of the study. L.J performed data collection. All authors contributed to the analysis. L.J wrote the first draft of the manuscript. All authors contributed to the writing, reviewing, and editing of the manuscript. V.P. supervised the overall project. All authors read and approved the final manuscript. The authors declare no competing interests.

Funding

This study is funded by the Special Research Fund, Bijzonder Onderzoeksfonds of Ghent University (BOFSTG2020000901).

Data availability

All blog links used as data in this study are included in Supplementary Table 1.

Declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the Faculty of Arts and Philosophy, Ghent University. Reference number of the approval letter: 2021-44.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.