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| 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.
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.
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.
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