Embryo donation is a unique and novel disposition option and family-building choice for patients. While there are an estimated one million surplus embryos cryopreserved around the world, embryo donation cases remain low. At the same time, interest in embryo donation is on the rise, as an increasing number of patients consider alternative methods of family creation. The heightened interest in embryo donation necessitates skilled fertility counselors to provide education and counseling to patients on both the donor and recipient side. Potential embryo donors often struggle with decision making around the disposition of their remaining embryos, while potential recipients may grapple with the notion of nongenetic parenting and their relationship to their donors and their donor-conceived children. The fertility counselor can play an integral role in helping patients navigate their decision making and their new relationships and family structure. This chapter explores the historical, logistical, psychosocial and relational considerations of embryo donation. The chapter highlights the important role of the fertility counselor throughout an embryo donation journey, and offers frameworks, best practices, and therapeutic tools that counselors can utilize as they work to support their patients.