Listed below are the steps that are needed for a successful egg donation/retrieval. Some Reproductive Endocrinologists may change this protocol to fit their objectives and your individualized needs. Please note that you must ask your personal physician about his or her own methods. It may be different then below.
The Medical Procedure of Egg Donation
The egg donation process consists of two phases. In the first phase, ovarian hyperstimulation, donors receive a series of hormonal drugs which cause the ovaries to produce multiple mature eggs during one menstrual cycle. During the second phase, egg retrieval, mature eggs are removed from the donor through a surgical procedure called transvaginal ultrasound aspiration. Egg donors should expect to spend around 60 hours for screening, testing, and medical appointments throughout the course of the procedure.
Women generally receive three classes of drugs during the ovarian hyperstimulation phase of donation. Prior to beginning the three-drug regimen, some donors may also take birth control pills in order to regulate their menstrual cycles.
Gonadotropin-Releasing Hormone Agonist Analogues
These first stage of the hormonal drug regimen utilizes a class of drugs termed gonadotropin-releasing hormone agonist analogues. These drugs are used to suppress the release of luteinizing hormone (LH) by the pituitary gland, which normally triggers eggs to mature within the body. This creates an "artificial menopause" in donors. Physicians can then control the timing of egg maturation and ovulation through the administration of other medications.
These drugs are generally administered through daily subcutaneous injections over the span of the stimulation cycle, and donors are encouraged to rotate injection sites to limit bruising. As an alternative to multiple injections, some clinics may prescribe a daily nasal spray or administer a single injection of Depot Lupron at the beginning of treatment.
Commercial forms of Gonadotropin-Releasing Hormone Agonist Analogues include:
Follicle Stimulating Hormone or Human Menopausal Gonadotropin
After hormone levels have been suppressed by the first class of drugs, donors then begin a daily injections of either follicle stimulating hormone (FSH) or human menopausal gonadotropin (hMG). This will encourage the development of multiple egg follicles, allowing the physician to retrieve several mature eggs at one time.
Because of elevated fertility at this point, donors in many programs are required to abstain from sexual intercourse to protect against unwanted pregnancy. While donors are taking these medications, physicians will periodically measure for the maturation of eggs through pelvic ultrasounds and blood tests. Dosage levels of FSH or hMG may be adjusted to minimize side effects and optimize the number of eggs available for harvest. During the last days of hyperstimulation, donors will undergo daily ultrasounds and blood tests.
Commerical forms of FSH or hMG include:
Human Chorionic Gonadotropin
Once tests indicate that eggs have matured, ovulation is triggered through a single injection of human chorionic gonadotropin. Egg retrieval occurs 34-36 hours after this injection.
Commercial forms of Human Chorionic Gonadotropin include:
Side Effects of Ovarian Hyperstimulation
While allergic reactions to fertility medications are unlikely, donors commonly experience abdominal swelling, tension and pressure in the ovarian area, mood swings, and bruising at injection sites as a result of fertility drugs. Temporary menopause-like symptoms, including vaginal dryness and hot flashes, may result. In treatment centers not requiring donors to abstain from sexual intercourse, unintentional pregnancy is another common complication. In one study of 110 donors, 7 percent experienced accidential pregnancy between donation cycles due to enhanced ovulation.
A less frequently occuring risk is ovarian hyperstimulation syndrome (OHSS), a serious complication marked by chest and abdominal fluid buildup and cystic enlargement of the ovaries that can cause permanent injury and even death. According to one study, severe OHSS affects between 1 and 10 percent of donors depending on the drug regimen used, although other studies show a lower incidence of the condition. Patients with OHSS may experience dehydration, blood clotting disorders, and kidney damage.
Less than one percent of the time, drugs can also cause adnexal torsion, a condition that results when a stimulated ovary twists on itself and cuts off its blood supply. Surgery is required to untwist and in some cases to remove the ovary. Additionally, some studies suggest that clomiphene, a drug sometimes used during hyperstimulation, may increase a woman's chance of developing ovarian cancer. However, this risk applies mostly to women who take the drug for a year or more. A few case reports have shown that the drug Lupron can aggravate existing tumors of the pituitary gland and cause strokes.
While serious complications are rare, a majority of donors will report pain and mild side effects from the procedure. In a recent survey of 61 egg donors, 64 percent responded that the physical side effects of fertility drugs, injections, and retrieval were a negative aspect of donation.
Eggs are retrieved from the donor through transvaginal ultrasound aspiration, a surgical procedure performed under conscious sedation. (See figure below). Using a tube attached to an ultrasound probe, a physician guides a suctioning needle into each ovary and removes mature oocytes from the follicles. A medication such as oral promethazine may be used to prevent nausea during the procedure. Following egg retrieval, donors generally remain in the clinic for 1-2 hours and then return home for further recovery. An antibiotic such as oral doxycycline will be prescribed to prevent infection, and donors should undergo a follow-up exam and ultrasound one week after the retrieval.
Fig.1 Egg retrieval through transvaginal ultrasound aspiration.
Courtesy of ASRM.
Side Effects of Egg Retrieval
Because egg retrieval involves surgery, donors may occasionally suffer structural damage to organs in close proximity to the ovaries. Major injury to the bladder, bowel, uterus, blood vessels or other pelvic structures occurs in approximately 1 in 500 to 1000 surgeries. Though the procedure is performed under sedation or mild anesthesia, egg retrieval can cause mild to moderate discomfort. Surgical risks include acute ovarian trauma, infection, infertility, vaginal bleeding, and lacerations. Additionally, anesthetic complications may occur, although they are rare in healthy women. In one study of 674 women who underwent egg retrieval, 1.5 percent required hospitalization due to complications occuring during or after surgery.