Monday, 5 August 2013

How many eggs am I donating & what are risks of being an egg donor?

Often, egg donors inquire about egg donation and expect that they will be donating just one of their eggs to an infertile couple. It just doesn’t work that way. When an egg donor is matched with a recipient, they are contracted to donate the eggs that they produce in a particular menstrual cycle. During that cycle, the physician that they are seeing intentionally increases the number of eggs that are produced. While a “normal” woman might release one or two eggs a month, those numbers would be cause to cancel an egg donor cycle prior to the retrieval. The number of eggs produced and donated in an egg donor cycle can range from about 8 to as many as 40 (although that is very, very rare). The average cycle results in a retrieval of between 15 and 20 eggs. The eggs are fertilized after retrieval, and often not all of them will successfully fertilize and develop. About 12 to 14 healthy embryos generally result from 20 eggs. Some of these embryos (possibly 2) will be transferred to the recipient or a gestational carrier, and the remainder frozen for future use.

Egg donation is generally very safe with no long-term risks.  Society in general, would not permit a young healthy woman to donate her eggs if the procedure was dangerous.  There, however, are some short-term risks associated with egg donation.   Knowing the warning signs and being educated about them will drastically help reduce these risks.

Yes, this is a real risk!  When you are in an egg donation cycle, you will be off all birth control and will be producing multiple eggs because of the stimulation medications. It sounds crazy, but pregnancy is possible. If you have unprotected intercourse during your cycle you can become pregnant.  This could occur if some of the eggs are released before your retrieval, or if not all of your mature eggs are retrieved.  You must abstain from intercourse or use effective barrier contraception. Remember - you are taking stimulation medications, the same ones a woman going through fertility treatment to get pregnant is taking.

Medication side effects
The fertility injections contain higher doses of the same hormones (follicle stimulating hormone (FSH), and luteinizing hormone (LH)) that the brain releases naturally to stimulate the ovaries to produce multiple eggs.  As the ovaries respond, it is actually a sign of a robust response if there is some bloating and cramping.  You can take Tylenol for the discomfort.  However, if the symptoms are severe you should call the office immediately.  This may be a sign of ovarian hyper-stimulation syndrome (OHSS), which is discussed later.

Both the birth control pills you are prescribed as well as the injectable medications (especially Lupron) you will be taking as an egg donor may cause you some side effects that are similar to premenstrual syndrome.  You may have hot flashes, vaginal dryness, fatigue, sleep problems, body aches, mood swings, breast tenderness, headache, slight bloating, etc.

Temporary weight gain
Donors can gain approximately 5 lb in weight due to increase in size of the ovaries and fluid retention.  This is temporary and should resolve completely with the next menses.

Does egg donation affect a donor’s future menses, fertility or when she will undergo menopause?
The simple answer is no!  When a woman starts getting her periods, there are approximately 300,000 eggs.  In her reproductive lifespan, a woman will ovulate around 400 times.  So, there are hundreds and thousands of “spare” eggs.  With each cycle, we will retrieve around 12 – 25 eggs.  Even with 6 such cycles (the maximum number permitted) the number of eggs retrieved will not affect future menses, fertility or menopause.   A recent study measured Anti-Mullerian Hormone levels (AMH) in donors who had undergone multiple cycles over a period of a couple of years.  AMH is a marker of the number of eggs that remain in the ovary.  These donors did not show any decrease in their AMH levels indicating that their fertility was not affected by the procedure.

Ovarian Hyper-stimulation Syndrome (OHSS)
Infrequently, some donors are exquisitely sensitive to regular doses of the stimulation medications.  This results in an exaggerated swelling of the ovaries and fluid collection in the abdomen and chest.  This is known as OHSS and occurs in less than 5% of all egg donors.  When mild, you may have abdominal pain, pressure, and swelling which should go away after your next period.  When moderate, you may require careful monitoring, bed rest, and pain medications.  When severe, which is rare but very serious, there is a possibility of serious medical complications such as blood clots, kidney failure, fluid build-up in the lungs, and shock.  Severe OHSS normally requires hospitalization.

If you have any abdominal discomfort, weight gain, headaches, severe nausea or vomiting etc., please contact the Clinic as soon as possible.  Egg donors are monitored very closely and it is important for us to be aware of how you are feeling.

Bleeding and Infection with Retrieval

During egg retrieval, a needle is inserted into your ovary and there may be bleeding.  Although it is very rare, it is possible to damage or puncture the bowel, bladder, or nearby blood vessels. Spotting is normal after your retrieval, but if you bleed heavily, immediately contacts the doctor. To prevent infection, donors receive an antibiotic intravenously.  A member of clinic staff will also contact the donor the morning after her retrieval to see how she is feeling.  Donors also come back to the clinic for a post-operative appointment two weeks after their retrieval for a check-up.

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