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Past Article of the Month Originally Published 03/29/2008
The EGG DONATION Process: Information for Donors and Recipients

By Steven R Lindheim, M.D., M.M.M., Scientific Director, Fertility Specialists Medical Group, San Diego, CA
Thousands of women of childbearing age in the United States and across the world are unable to have children because they either have no ovaries or their ovaries are no longer functioning. As recently as twenty years ago, these women had no hope of ever having children. Today, however, new technology in reproductive medicine has given women the opportunity to make their dreams come true. Through the process of egg donation (ovum donation), it is possible for a young, fertile woman to donate some of her eggs to another woman. This is a precious gift to women whose only chance of conceiving is through the voluntary efforts of egg donors. <b>WHO ARE CANDIDATES FOR RECEIVING DONOR EGGS?</b> Some women are infertile because they were born without ovaries, have had their ovaries surgically removed, have ovarian dysfunction, or have gone through menopause. These women are capable of carrying a pregnancy without difficulty if they receive eggs from another woman. In addition, there are healthy couples who are carriers of serious genetic diseases that can be passed onto their children if they become pregnant through natural means. By receiving eggs from another woman who is not a carrier of this inherited disease, the risk of passing the disease onto their children is eliminated. A third category of women who require donated eggs are those who have poor egg quality. Many of these women are nearing menopause. Their chances for pregnancy are significantly improved if they receive eggs donated by a younger woman. The donated eggs are typically fertilized with the recipient partners sperm. Therefore, any children that are born as a result of this treatment carry the genetic material of the father, but not of the mother who gives birth. <b>BECOMING AN EGG DONOR</b> Healthy women who are of legal age (preferably between the ages of 21 and 32) who are interested in helping other women may participate. The donor must have no history of drug use and be free of significant medical illnesses, be willing to undergo screening for genetic diseases and tests for sexually transmitted infections including HIV, hepatitis B and C, syphilis, chlamydia, and gonorrhea. Candidates also meet with a psychologist to review the psychological aspects of egg donation and help assess if this is a process that the donor feels comfortable with. Donors generally meet with a clinic coordinator and a physician to review their medical history, discuss the donation process including its associated risks, and answer any questions. Candidates should think about what was discussed before making a final decision to become a donor. If a candidate decides to proceed, she will then be scheduled for a physical examination including a pelvic ultrasound and blood work to assess the health of her ovaries. When an appropriate match with a potential recipient is found, the next set of screening tests occurs, including a psychological evaluation to discuss the emotional aspects of being an egg donor. Some donors may be asked to participate immediately, while others may not be asked to participate for months. Not every woman that volunteers to go through the screening process is matched with a recipient couple. When a donor has been matched with a recipient couple, the physician will synchronize her treatment schedule with that of the egg recipient. The donor will be taught to how to properly give herself the necessary medications and informed about the egg collection procedure. Egg donors follow the same medication schedule as an infertile woman undergoing in vitro fertilization therapy. Typically, the egg donor may be asked to take birth control pills for one or two months prior to the start of fertility medications. She will be scheduled for an appointment for a blood estradiol (estrogen) test and a vaginal ultrasound study prior to starting. Ultrasound uses sound waves to create an image of the ovaries onto a screen. No radiation is involved and the procedure is not uncomfortable. These 2 tests are performed in order to make sure that the donors ovaries are ready for the next set of fertility drugs. The first medication involves the use of fertility drugs called gonadotropins. Eggs naturally develop in response to 2 hormones produced by the pituitary gland, FSH (follicle stimulating hormone) and LH (luteinizing hormone). Some gonadotropins contain both FSH and LH (Menopur and Repronex), whereas others contain only FSH (Follistim, Gonal-F and Bravelle). In the natural menstrual cycle, a group of eggs begin to develop around the time that menstruation takes place, but only one egg continues to develop to the point of maturity and ovulation. The remaining eggs that have begun to develop stop developing and are absorbed by the ovaries. By using gonadotropins, we are able to rescue these eggs and cause them to finish their maturation process. This allows us to collect more than one mature egg to fertilize in the laboratory. Every womans response to gonadotropins is unique. Gonadotropins are given by subcutaneous injections (just underneath the skin) using a very tiny needle (a needle the same size as that used by a diabetic taking insulin). Donors receive gonadotropins once a day for 8 to 12 days, and they are taught, along with their partner, friend, or relative how to perform the injections. The second medication is called Ganirelix or Cetrotide. This medication temporarily prevents the bodys production of LH (lutenizing hormone), the substance produced by the pituitary gland, located near the brain, which stimulates a woman to ovulate. This medication prevents the donor from ovulating allowing us to harvest the eggs when they appear to have matured. Ganirelix is given by subcutaneous injection (just underneath the skin like the gonadotropins) using a second very tiny needle. Most women are able to give themselves the shots after proper instruction. The eggs develop inside of fluid filled cysts called follicles. Each follicle produces estrogen. We are able to determine how quickly the eggs are developing in response to gonadotropins by measuring the estrogen level in the donors blood and using ultrasound to determine the size of the growing follicles. Once the ultrasound study and the blood test indicate that the developing eggs are mature, the donor takes a final injection of the hormone hCG. hCG, Human Chorionic Gonadotropin, signals the eggs to undergo their final maturation process so that they can be fertilized in the laboratory. If the donor does not take hCG, the eggs will not fertilize normally. The egg collection procedure takes place 35-36 hours after the hCG injection. The eggs are inside fluid filled cysts called follicles. We are able to remove the mature eggs from the ovaries by using ultrasound to guide a needle through the vaginal wall directly into these follicles. We aspirate the fluid from the follicles to collect the eggs. Once the egg from one follicle is identified, we pass the needle into the next follicle and again apply suction to remove the fluid. We try to collect an egg from each mature follicle from both ovaries. The egg collection procedure takes approximately 30 minutes; the donor is then taken to a room to recover for approximately 1-2 hours before going home. <b>WHAT ARE THE POTENTIAL SIDE EFFECTS OF EGG DONATION?</b> A small percentage (less than 10%) of women who use gonadotropins develop temporary side effects from the medication, such as headaches, bloating and mood swings. These disappear with discontinuation of the medication. The process of in vitro fertilization is very stressful for infertile patients because of their desire to achieve a pregnancy, and stress tends to heighten these symptoms. Since donors are not be under the same type of stress while taking the medications, they are less likely to experience these side effects. The egg collection procedure is associated with the extremely remote risks of excessive bleeding and infection. It is highly unlikely that a donor will lose more than a tablespoon of blood during the egg retrieval. There is an even lesser risk of somehow damaging pelvic organs with the needle used to collect the eggs as it is guided by ultrasound. Some women experience lower abdominal bloating for a few days following the hCG injection. This can be caused by the aspiration of ovarian follicles to collect the eggs. In addition, 1 to 5% of women who use gonadotropins develop mild swelling of the ovaries and fluid collection in the abdominal cavity approximately 5 to 7 days after the egg collection. This is called Ovarian Hyperstimulation Syndrome (OHSS). Very rarely (less than 1 in 1000) this condition can require hospitalization if a large amount of fluid retention occurs. The donors response to the fertility drugs should be carefully monitored through blood tests and ultrasound studies to minimize the possibility of this problem. Lastly, one, unreliable, epidemiological study suggested that childless, infertile women who use fertility drugs may have an increased risk of developing ovarian cancer. This study has been criticized for errors in design, which significantly diminish the reliability of its conclusions. The report did not mention what the fertility drugs were and how long the patients had used the drugs. This study did not show an association between the development of this disease and the use of fertility drugs in infertile women who had at least one delivery. Other medical studies have revealed that infertile women, in general, tend to have a higher risk of developing ovarian cancer, a disease that affects 1.4% of women during their lifetime. There is no published data to suggest that fertile women, such as egg donors, who use fertility drugs, are at higher risk of developing ovarian cancer. <b>CONCLUSION</b> Donating your eggs is a caring and generous act, given in spite of some risk and discomfort. Women who receive donated eggs feel deep gratitude and respect for this gift. The gratitude is often expressed from the recipient as follows. <i>Dear Mary I doubt that Mary is your real name, but it seems more personal than Dear Donor. I am thinking about you today, and I am struck by the enormous generosity of your participation in the egg donor program. I want to tell you how much your donation means to someone like me. My husband and I have been trying to have a child for 3 years now a problem I never expected to encounter in life. The initial realization that I had this problem was quite distressful. As time went on, and infertility procedures failed, it became increasingly difficult to deal with emotionally. You dont realize it until it happens to you, but it is very debilitating to know that there is a good chance that you will be denied what seems like such a basic expectation in life the ability to have your own family. Anyway, I wanted you to know that no words could ever adequately express the depth of my gratitude and appreciation for women like you (especially you) who are willing to make such a significant contribution to helping to helping women like me overcome this problem. No matter what the outcome of this program is for me, I wanted to let you know that I am thinking about you today and that what you have done is tremendous and appreciated! Sally (Thats not my real name either but I thought it warmer than Recipient)</i> While this is an overview of the egg donation process, it is not meant to replace the discussion and question and answers session with the donors doctor. <i>STEVEN R. LINDHEIM, MD, FACOG is the Scientific Director of Fertility Specialists Medical Group in San Diego, CA and is Board Certified in Reproductive Endocrinology. Dr Lindheim comes from the University of Wisconsin School of Medicine and Public Health, where he served as the division chief and medical director for the division of Reproductive Endocrine & Infertility. He graduated from the Temple School of Medicine and was a resident at Pennsylvania Hospital in Philadelphia. Dr. Lindheim completed a fellowship in Reproductive Endocrinology and Infertility at USC, and is currently Board Certified in both Ob/Gyn and Reproductive Endocrinology and Infertility. Dr. Lindheim's areas of interest and research are in-vitro fertilization, egg donation, and gestational surrogacy.</i> <a [email protected]>[email protected]</a> <a href=http://www.ivfspecialists.com>Fertility Specialists Medical Group</a> * Back
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