Egg donation

Egg donation is the process by which a woman provides one or several eggs (ova, oocytes) for purposes of assisted reproduction or biomedical research. For assisted reproduction purposes, egg donation involves the process of in vitro fertilization as the eggs are fertilized in the laboratory. After the eggs have been obtained, the role of the egg donor is complete. Egg donation is part of the process of third party reproduction.

Indication

A need for egg donation may arise for a number of reasons. Infertile couples may resort to acquiring eggs through egg donation when the female partner cannot have genetic children because she may not have eggs that can be successfully fertilized. This situation is often based on advanced reproductive age. Early onset of menopause which can occur in women as early as their 20’s can require a woman to use donor eggs to grow her family. Some women are born without ovaries or other reproductive organs. Sometimes a woman's reproductive organs have been damaged due to disease or have been forced to have them surgically removed. Another indication would be a genetic disorder on part of the woman that can be circumvented by using eggs from another person. The couple can personally get acquainted with the egg donor, her children and family members. Or a couple can request an anonymous egg donor. Egg donation is also required for gay couples using surrogacy (see LGBT parenting).

* Congenital absence of eggs
o Turner syndrome [1]
o Gonadal dysgenesis/agenesis [1]

* Acquired reduced egg quantity / quality
o Oophorectomy[1]
o Premature menopause[1]
o Chemotherapy [1]
o Radiation therapy[1]
o Autoimmunity[1]
o Advanced maternal age [1]
o Compromised ovarian reserve [1]

* Other
o Diseases of X-Sex linkage[1]
o Repetitive fertilization or pregnancy failure [1]
o Ovaries inaccessible for egg retrieval [1]

Procedure
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Egg donors are recruited, screened, and give consent prior to participation in the IVF process. Some patients bring their own, designated donors, while other patients rely on the services of often anonymous donors typically recruited by egg donor agencies or, sometimes, IVF programs. Once the egg donor is recruited, she undergoes the IVF stimulation therapy, followed by the egg retrieval procedure. After retrieval, the ova are handed over to the recipient couple, fertilized by the sperm of the male partner in the laboratory, and after several days, the resulting embryo(s) is placed in the uterus of the recipient. For the embryo transfer the lining of the recipient has been appropriately prepared in a synchronous fashion. The recipient is usually the person who requested the service and then will carry and deliver the pregnancy and keep the baby.

Results

Results in treatments with the use of egg from donors often have a better than 50% chance of success. With egg donation, women who are past their reproductive years or menopause can become pregnant. The oldest woman thus to give birth is Adriana Iliescu, age 66. Babies born after egg donation are not genetically related to the recipient.

Donor motivation

An egg donor may be motivated by a number of reasons to provide eggs. Some egg donors may be altruistic and feel that participation in the reproductive process provides a benefit for another person, sometimes a person they know or are related to. Others may be attracted to the monetary compensation.

Risks

Egg donor

Egg donation carries risks for both donor and recipient. The egg donor may suffer complications from IVF, such as bleeding from the oocyte recovery procedure and reaction to the hormones used to induce hyperovulation (producing more than one egg), including ovarian hyperstimulation syndrome (OHSS) and, rarely, liver failure[2]. The long-term impact of egg donation on donors has not been well studied, but apparently some evidence suggests a risk of early menopause and increased risk of ovarian cancer[3].

According to Jansen and Tucker, writing in the same ART (assisted reproductive technologies) textbook referenced above[4], the risk of OHSS varies with the clinic administering the hormones, from 6.6 to 8.4% of cycles,half of them "severe." Patients treated with GnRH agonists appear to be at increased risk compared to those treated with GnRH antagonists. The most severe form of OHSS is life threatening. One study in the Netherlands found 10 documented cases of deaths from IVF, with a rate of 1:10,000. "All of these patients were treated with GnRH agonists and none of these cases have been published in the scientific literature." Hormone treatments that can be dangerous in the short-term may have long-term health effects.

Daniel Navot, writing in the same collection of reports states that mild OHSS is a sign that treatment is working and describes the symptoms of moderate OHSS as "includes significant ovarian englargement (5-12 cm)...abdominal pain, significant bloating,nausea, and diarrhea," symptoms attributable to ovarian enlargement and elevate estrogen levels. Signs that upgrade moderate OHSS to the severe form include liver dysfunction and anasarca. Criteia for severe OHSS include enlarge ovary, ascites, hemotacrit > 45%, WBC > 15,000, oliguria, creatinine 1.0-1.5 mg/dl, creatinine clearance > 50 ml/min, liver dysfunction, anasarca. Critical OHSS includes enlarged ovary, tense ascites with hydrothorax and pericardial effusion, hematocrit > 55%, WBC > 25,000, oligoanuria, creatinine > 1.6 mg/dl, creatinine clearance > 50 ml/min, renal failure, thromboembolic phenomena,ARDS.

Recipient

The recipient has the risk of contracting a transmittable disease. While the donor may test negative for HIV, such testing does not exclude the possibility that the donor has contracted HIV very recently, so the recipient faces a residual risk of exposure.

The recipient also trusts that the genetic and medical history of the donor is accurate. This factor of trust should not be underestimated in importance. Donors are paid thousands of dollars; monetary compensation may attract unscrupulous individuals inclined to conceal their true motivations. Moreover, recipients will have a de facto relationship to the biological parent of their offspring for life. Half of the child's genetic makeup, and related traits, capabilities, tendencies, etc. will come from the donor.

Multiple birth is a common complication if the physician transfers too many embryos. Incidence of twin births is very high.

Custody

Generally legal documents are signed to hand oocytes over to the recipient and renounce rights of ownership and custody on part of the donor, so that there will be no claims on part of the donor concerning the offspring.

Legality

Egg donation is regulated and /or prohibited in many countries. In the United States, having an attorney draft a contract is often necessary to establish and confirm the parental rights over any child.

Donor registries

A donor registry is a registry to facilitate donor conceived people, sperm donors and egg donors to establish contact with genetic kindred. They are mostly used by donor conceived people to find genetic half-siblings from the same egg- or sperm donor.

Some donors are non-anonymous, but most are anonymous, i.e. the donor conceived person doesn't know the true identity of the donor. Still, he/she may get the donor number from the fertility clinic. If that donor had donated before, then other donor conceived people with the same donor number are thus genetic half-siblings. In short, donor registries match people who type in the same donor number.

Alternatively, if the donor number isn't available, then known donor characteristics, e.g. hair, eye and skin color may be used in matching.

Donors may also register, and therefore, donor registries may also match donors with their genetic children.

References

1. ^ a b c d e f g h i j k l Womensinstiture
2. ^ Textbook of Assisted Reproductive Techniques, Laboratory and Clinical Perspectives, edited by David K. Gardner, 2001
3. ^ Kathryn Jean Lopez on Egg Selling on National Review Online
4. ^ Textbook of Assisted Reproductive Techniques, Laboratory and Clinical Perspectives, edited by David K. Gardner, 2001

ASRM Practice Committee Reports, Fertility Sterility 82, Suppl. 1, Sept. 2004.

See also

* Sperm donation
* Donor conceived people

External links

* Egg Donor Medications
* For Donors - Human Fertilisation and Embryology Authority UK
* Fertility Stories - Stories of couples using egg donation and of women who have chosen to become egg donors
* Parents Via Egg Donation Organization was created to provide an informational and supportive environment where parents and parents-to-be can come together to exchange information about all facets of the egg donation process with respect to growing their families.