Egg donation

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Egg donation is the process by which a woman provides one or several (usually 10-15) 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 as part of ART (Assisted Reproductive Technology). The ASRM (American Society of Reproductive Medicine) has issued guidelines for these procedures, and the FDA has a number of guidelines as well. There are boards in countries outside of the US who have the same regulations.

Contents

[edit] History

The first transfer of a fertilized egg from one human to another resulting in pregnancy was reported in July 1983 and subsequently led to the announcement of the first human birth February 3, 1984.[1] This procedure was performed at the Harbor UCLA Medical Center [2] under the direction of Dr.John Buster and the University of California at Los Angeles School of Medicine.

In the procedure, a fertilized egg that was just beginning to develop was transferred from one woman in whom it had been conceived by artificial insemination to another woman who gave birth to the infant 38 weeks later. The sperm used in the artificial insemination came from the husband of the woman who bore the baby.[3][4]

This scientific breakthrough established standards and became an agent of change for women suffering from the afflictions of infertility and for women who did not want to pass on genetic disorders to their children. Donor oocytes and embryo transfer has given women a mechanism to become pregnant and give birth to a child that will be their biological child, but not their genetic child (assuming that the recipient woman carries the baby.) In many cases, a gestational surrogate is used, and the embryos are implanted into her, per an agreement with the recipients. Oocyte and embryo donation as practiced today now accounts for approximately 5% of in vitro fertilization recorded births.

Another beneficiary of this technology is the gay parent community. Via the use of surrogates, gay men are able to experience the job of parenthood as well -- including their genetic makeup.

Prior to this, thousands of women who were infertile, single men and gay couples had adoption as the only path to parenthood. This set the stage to allow open and candid discussion of oocyte and embryo donation as a common practice. [3][5] This breakthrough has given way to the donation of human oocytes and embryos as a common practice similar to other donations such as blood and major organ donations. At the time of this announcement the event was captured by major news carriers and fueled healthy debate and discussion on this practice which impacted the future of reproductive medicine by creating a platform for further advancements in woman's health.

This work established the technical foundation and legal-ethical framework surrounding the clinical use of human oocyte and embryo donation, a mainstream clinical practice, which has evolved over the past 25 years.[3][6] Building upon this groundbreaking research and since the initial birth announcement in 1984, well over 47,000 live births resulting from donor oocyte embryo transfer have been and continue to be recorded by the Centers for Disease Control(CDC)[7][8] in the United States to infertile women, who otherwise would not have had children by any other existing method.

The process is done today in other countries as well, but many couples come to the U.S. due to laws in many other countries which severely limit or prohibit compensation given to an egg donor. Since this process is so invasive (much more so than its counterpart, sperm donation), the lack of compensation results in an extreme dearth of young women willing to go through this procedure.


[edit] 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, but not always 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. Many women have none of these issues, but continue to be unsuccessful using their own eggs.

If desired, (and if the egg donor agrees), the couple can personally get acquainted with the egg donor, her children and family members. More often, egg donations are anonymous. As stated above, Egg donation is also required for gay male couples using surrogacy (see LGBT parenting).

[edit] Procedure

 This article is in need of attention from an expert on the subject. WikiProject Medicine or the Medicine Portal may be able to help recruit one. (November 2008)

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 fertilized by the sperm of the male partner (or sperm donor) in the laboratory, and after several days, the best of the resulting embryo(s) is/are 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, but not always, the person who requested the service and then will carry and deliver the pregnancy and keep the baby.

The Egg Donor process in detail For the egg donor, the process is the following. [9] First, it will be necessary for the donor to undergo a thorough medical examination, including a pelvic exam, blood draw to check hormone levels and to test for infectious diseases, and an ultrasound to examine her ovaries, uterus and other pelvic organs. In addition, she will be referred to a psychologist who will evaluate if you are mentally prepared to undertake and complete the donation process. These evaluations are necessary to ensure that the donor is fully prepared and capable of completing the donation cycle safely and successfully. These evaluations will be done at no cost to the donor.

Once the screening is complete and the contract signed, the donor will begin the donation cycle, which typically takes between 3-6 weeks. There are two parts to a successful egg retrieval procedure: the Egg Donor’s Cycle and the Recipients’ Cycle. The Egg Donation Cycle will begin with a few weeks of birth control pills (to synchronize the donor's cycle with the Recipient’s), followed by a series of injections. There are different medical protocols currently used, but they will all include medication that makes the ovaries produce a number of eggs. At the doctor's office, the donor will be given instructions on how to properly administer the injections herself. These injections must be administered on a daily basis for one or more weeks (typically not more than 3 weeks.)

Throughout the cycle the donor is monitored often by the doctor. They will run blood tests and perform ultrasound exams to determine the donor's reaction to the hormones and the progress of follicle growth.

Once the doctor decides the follicles are mature, he/she will establish the date and time for the egg retrieval. Approximately 36 hours before retrieval, the donor must administer one more injection (of the hormone HCG) to ensure that her eggs are ready to be harvested. The Egg Retrieval is a minimally invasive surgical procedure that requires a light general anesthetic and lasts about 20-30 minutes. The doctor will use a small ultrasound-guided needle inserted through the vagina to aspirate the follicles in both ovaries. Immediately following the surgery the donor will rest in the recovery room for an hour or two. Due to the administration of general anesthesia, she will need someone to drive her home. It can take one full day up to a week to fully recover, but generally Donors return to normal activities the next day.


[edit] Results

Nationwide, egg donor cycles have a success rate of upwards of 60%. (See SART statistics at http://www.sart.org.) When a "fresh cycle" is followed by a "frozen cycle", the success rate with donor eggs goes up to approximately 80%. 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.

[edit] 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. A survey of 80 American women showed that 30% were motivated by altruism alone. Others, 20%, were attracted only by monetary compensation, while 40% of donors were motivated by both reasons. The same study reported that 45% of egg donors were students the first time they donated and averaged $4,000 for each donation [10].

[edit] Risks

[edit] Egg donor

Egg donation carries risks for both donor and recipient, although it must be made clear that the procedure for the donor, and the medication given, is basically the same as the medication given for any IVF procedure (with or without a donor). 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[11]. 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</ref>. Again, these risks are the same as with someone who is doing non-donor supported IVF. The difference is that some donors attempt to do back-to-back cycles in excess of the ASRM recommendations, which may then affect their future health. [12] Kathryn Jean Lopez on Egg Selling on National Review Online.

According to Jansen and Tucker, writing in the same ART (assisted reproductive technologies) textbook referenced above [13], the risk of OHSS varies with the clinic administering the hormones, from 6.6 to 8.4% of cycles, half of them "severe." The most severe form of OHSS is life threatening. Recent studies have found that donors were at less risk of OHSS when the final maturation of oocytes was induced GnRH agonist than with recombinant hCG. Both hormones were comparable in the number of mature oocytes produced and fertilization rates [14] [15]. A larger 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. Criteria 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.

The long-term impact of egg donation on donors has not been well studied, but apparently some evidence suggests a risk of early menopause, increased risk of ovarian cancer, and affects on fertility [16] [17]. 1 in 5 women report psychological effects from donating their eggs, both good and bad. But two-thirds women were happy with the decision to donate their eggs. The same study found that 20% of women didn’t recall being aware of any physical risks [18]. This does not mean they were told the risks involved but were not concerned about them at the time. This is worrisome since some short-term effects can be severe and the long-term effects are not well studied.

Egg donation can carry some serious long term affects for the donor and the patient that is receiving the fertile egg. There are rare cases where the egg donor can acquire cancer from hormone treatment. Cancer can develop from the usage of hormones that is given to the egg donor to develop more than one fertile egg. After the eggs have mature the patient will undergo anesthesia treatment while the doctor is removing the mature eggs, complication can occur while the doctor is removing the eggs. The complications that can occur when the doctor is removing the mature eggs are puncture of bowel, bladder, and blood vessels. The patient can also undergo long lasting infection which can cause infertility or decrease fertility in the patient.


[edit] 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. However, the FDA governs this and requires full infectious disease testing no more than 30 days prior to retrieval and/or transfer. Intimate partners of both the egg donor and the recipient are also tested.

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. However, a full psychological evaluation is required by most IVF clinics, giving an indication if the donor if trustworthy or not.

In more cases than not, there is no ongoing relationship between the donor and recipient following the cycle. Both the donor and recipient agree in formal legal documents that the donation of the eggs is final at the time of retrieval, and typically both parties would like any "relationship" to conclude at that point. 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. At the present time, the ASRM clearly recommends that 1 or 2 embryos are transferred in any given cycle. (Any remaining embryos are typically frozen for future transfers.)

[edit] Custody

Generally legal documents are signed 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. Most IVF doctors will not proceed with administering medication to any donor until these documents are in place and a legal "clearance letter" -- confirming this understanding -- is provided to the doctor.

[edit] 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. Using an attorney that specializes in reproductive law is highly suggested.

The Buzzanca versus Buzzanca, 72 Cal. Rptr.2d 280 (Cal. Ct. App. 1998), established the role of the recipient, the father of the conceived child, and the child. It stated that both the recipient and the father of the child by virtue of their procreative intent, are the legal parents of the child. Therefore, the father must pay child-support even if he claims a divorce before the conception of the child [19].

The Uniform Parentage Act (updated most recently in 2002) establishes the role of the egg recipient to the conceived child. The recipient under this act, is given complete parental responsibility of the conceived child [20].

Before the retrieval of the eggs from the donor, the donor must sign the Egg Donor Contract which specifies the rights of the donor with respect to the conceived child and the recipient. In this contract the donor agrees to undergo a thorough medical and psychological screening, genetic testing, and social diseases (i.e. HIV). Also, it specifies that the egg recipient and the father of the child are the legal parents [21].


[edit] Donor registries

Main article: Donor registration

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.

The largest registry is the Donor Sibling Registry- with more than 25,000 members, the DSR has matched almost 7,000 donor conceived people with their egg and sperm donors, as well as with their half siblings. Alternate methods of providing an information link between the donor and recipient (both agreeing to stay registered on the DSR) are often provided for in the legal document (referred to as the "Egg Donor Agreement".)

[edit] Religious Views

Christian leaders are concerned about all in vitro fertility therapies because they disrupt the natural act of conceiving a child. Gamete donations, both egg and sperm donations, are seen to “compromise the marital bond and family integrity” [22]. Infertile couples are instead encouraged to consider adoption.

In the Muslim Community, Sunnis are allowed fertility treatments that do not involve third parties. This rule does not allow for the donation of gametes. Shi’ite Muslims on the other hand are allowed to accept egg donations. Although there are some details that prevent egg donation in some countries and regions [23].

The permission to use an egg donor for Jewish couples is based on the decision of a rabbi. Although there is no consensus in the orthodox community as to if a child is Jewish based on the religious status of the genetic or gestational mother [24]. This distinction is important since a Jewish egg donor may be needed. This is not an issue in the reform community since only one parent, either the mother or father, must be Jewish for the child to be considered Jewish. In the orthodox community the mother must be Jewish for the child to be Jewish.

[edit] References

  1. ^ http://query.nytimes.com/gst/fullpage.html?sec=health&res=9404EEDC143BF937A35751C0A962948260
  2. ^ http://www.humc.edu/calendar/careacc.html
  3. ^ a b c http://www.time.com/time/magazine/article/0,9171,952517,00.html
  4. ^ http://www.time.com/time/magazine/article/0,9171,952514,00.html
  5. ^ http://www.time.com/time/magazine/article/0,9171,952514,00.html
  6. ^ http://www.time.com/time/magazine/article/0,9171,952517-6,00.html
  7. ^ http://www.obgmanagement.com/srm/pdf/first_live_birth_donation.pdf
  8. ^ http://www.obgmanagement.com/srm.asp?id=5030
  9. ^ https://bhed.com/pub_donor_info.php#donation
  10. ^ Kara N. Maxwell, Ina N. Cholst, Zev Rosenwaks. (2008). The incidence of both serious and minor complications in young women undergoing oocyte donation, Fertility and Sterility. 90: 2165-2171.
  11. ^ Textbook of Assisted Reproductive Techniques, Laboratory and Clinical Perspectives, edited by David K. Gardner, 2001
  12. ^ http://www.asrm.org
  13. ^ Textbook of Assisted Reproductive Techniques, Laboratory and Clinical Perspectives, edited by David K. Gardner, 2001
  14. ^ Galindo, A., Bodri, D., Guillen, J.J., Colodron, M., Vernaeve, V., & Coll, O. 2009. Triggering with HCG or GnRH agonist in GnRH antagonist treated oocyte donation cycles: a randomized clinical trial. Gynecol Endocrinol. 25(1):60-6.
  15. ^ Bodri, D., Guillen, J.J., Galindo, A., Mataro, D., Pujol, A., Coll, O. 2009. Triggering with human chorionic gonadotropin or a gonadotropin-releasing hormone agonist gonadotropin-releasing hormone antagonist-treated oocyte donor cycles:findings of large retrospective cohort study. Fertil Steril. 91(2):365-71.
  16. ^ Textbook of Assisted Reproductive Techniques, Laboratory and Clinical Perspectives, edited by David K. Gardner, 2001
  17. ^ http://health.usnews.com/articles/health/healthday/2008/12/26/risks-and-benefits-of-egg-donation-reported.html?PageNr=1
  18. ^ Kara N. Maxwell, Ina N. Cholst, Zev Rosenwaks. (2008). The incidence of both serious and minor complications in young women undergoing oocyte donation, Fertility and Sterility. 90: 2165-2171.
  19. ^ http://www.law.uh.edu/healthlaw/perspectives/Reproductive/980408Child.html
  20. ^ http://www.eggdonor.com/?section=recipient&page=legal
  21. ^ http://www.eggdonor.com/?section=recipient&page=legal
  22. ^ http://www.albertmohler.com/commentary_read.php?cdate=2006-05-10
  23. ^ Inhorn, M.C. 2005. IVF and gamete donation in the muslim world. Religion and Reproductive Technologies. 46:14. http://www.aaanet.org/press/an/0502Inhorn.htm
  24. ^ http://www.yoatzot.org/article.php?id=112

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

[edit] See also

[edit] External links


v • d • e
Charity - Donation
Organ donation
Other biologic donations
Gamete donation (Egg donation, Sperm donation) • Embryo donation • Blood donation • Body donation
Other
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