Fertility – What is egg donation and why is it needed?

Fertility – Egg Donation

Egg donation is when a woman donates some of her eggs to help another couple have a child via infertility treatments such as IVF (in-vitro fertilisation, or “test-tube babies”). Donated eggs are used by some couples who cannot have children because the woman is unable to produce any eggs, perhaps because she is sterile as a result of cancer treatment or because she started the menopause at a very early age. In some other cases, the women may carry a severe genetic (inherited) disease that she doesn’t want to risk passing on to her children if she conceives naturally. In addition, donated eggs are invaluable for helping research into the causes of miscarriages and certain birth handicaps, as well as improving fertility treatment techniques, which obviously helps other couples in the future.

Who can donate eggs?
Any woman between the ages of 18 and 35 who is healthy and does not have any inherited disease or disorders in her family that she is aware of can donate eggs. Eggs are not collected from women aged over 35 because of the increasing rate of chromosomal handicaps, such as Down’s syndrome. All donors are tested for HIV infection (AIDS), as well as for hepatitis B infection, and additional tests may be carried out depending on the fertility clinic.

How does it work?
Unfortunately, egg donation is much more complex than sperm donation, and requires a fairly high degree of medical intervention. Human eggs are smaller than the full stop at the end of this sentence and usually only one is shed per month, so the eggs need to be collected directly from the ovaries (see below). In addition, while it is possible to donate just one egg, most clinics tend to give drugs to stimulate the ovaries to produce more than one egg at a time (see below), which makes the donation much more worthwhile.

Egg development –
To stimulate your ovaries to produce several mature eggs at the same time, you will be given a combination of drugs, all of which contain hormones. These will usually be given in three ways at different times over the course of a month:
1. A nasal spray is used or an injection is given every day for 28 days. These contain hormones that suppress your normal hormone production, and so give greater control over when your eggs are produced.

2. An injection is given, or a tablet taken, every day over the second half of this month (for 14 days). These drugs are known as superovulatory drugs because they contain hormones that stimulate the ovaries to produce eggs, but in much higher amounts than you would normally produce so that many eggs mature at once.

3. A final injection is given 34-38 hours before collection. These hormones trigger the ripening of the eggs.

Egg collection –
This has to be done between 34-38 hours after the final injection, so that the eggs are mature but have not left the ovaries. You will be given a general anaesthetic, and once you are asleep, the gynaecologist will collect your eggs using a thin hollow needle, or probe, usually via your vagina or bladder, but sometimes through the wall of your abdomen. The collection probe may be attached to a laparoscope (a thin flexible viewing tube) or ultrasound may be used to guide the probe to the ovaries. The eggs are gently suctioned from the follicles (where they matured inside the ovaries) in to the probe, and then probe is withdrawn and the eggs are transferred in to a test tube.

What are the possible side effects?
Some women experience side effects from the drugs used to stimulate egg production, and these may include hot flushes, feelings of depression, and irritability, headaches and sleeplessness. Side effects are more common with the first drug that is given (the one you take every day for a month), and the symptoms are often relieved once you start taking the second drug.

You might experience some painful cramps for a short time immediately following the collection procedure and your abdomen may be sore for a few days afterwards. You may also notice some blood spotting from your vagina or clouding your urine, but this is nothing to worry about.

In a very few cases, a woman may over-react to the drugs and develop ovarian hyperstimulation syndrome (OHS). This happens following egg collection, and is when the empty follicles that contained the eggs become filled with fluid and may develop cysts. The symptoms of OHS include abdominal discomfort, nausea, and breathlessness, and can usually be easily treated by drinking lots of water, taking pain killers, and taking it easy for a couple of days. The symptoms should go within two to five days. However, in very rare cases, OHS can cause diarrhoea, vomiting, abdominal pain and swelling, and problems with your kidneys (you may notice that you are urinating much less than normal). If this happens, or the symptoms of mild OHS get worse or have not gone within a week, you should contact your clinic or hospital (your clinic will advise you about the procedure), as you will probably need to be put on a drip in order to stabilise the fluid in your body. OHS is not a lasting condition, not will it affect your future fertility.

Can I donate eggs just for research or solely for the use of a particular woman or couple?
Yes, you can specify how you would like your eggs to be used, and by whom. In addition, if you change your mind you can withdraw permission for your eggs to be used, although obviously this can not be applied to eggs that have already been used.

Will I have any contact with any child born as a result of my donation?
No. In law, any child born as a result of fertility treatment is considered to be the legal child of the woman receiving fertility treatment and her husband and male partner, even though you are one of the child’s genetic parents. All donors are anonymous, and your details will not be given to the couple or the resulting child. You may be told whether a pregnancy has been achieved using your eggs, but you will not be given any on-going information about the pregnancy or child, or about the couple involved.

What information about me will be held on file?
By law, your name and date of birth must be held as confidential information by the Human Fertilisation & Embryology Authority. This is because the Authority has a legal duty to help adults who were born as a result of treatment using donated eggs or sperm and who ask whether they might be related to a person they wish to marry. The Authority needs your name and age so that this check can be made, but they will not pass on any information about you to the people involved.

In addition, non-identifying personal information is usually held, and can be given to an adult born as a result of your donation who asks for further information. This includes details about your appearance, occupation, interests, and may include any details that you think may be useful or interesting for a person seeking background information about themselves, such as are twins in your family or you are left-handed.

What else should I be aware of?
You will be offered counselling so that you can make an informed decision and are clear in your own mind about the emotional issues surrounding egg donation. While everyone is different, these issues may include not knowing for sure that a child has been born as a result of your donation, not knowing that child or what she or he is like and whether he or she is happy and healthy, and the knowledge that your children may have a half sibling living somewhere else in the world.

Most clinics will do a full chromosomal analysis before you donate your eggs so that they can be sure that you do not carry any of the known inherited diseases, such as sickle cell anaemia or cystic fibrosis. However, not all genetic diseases can be checked for yet, and so if you are aware, or suspect, that there is an inherited disease in your family, you must tell the clinic. In addition, if a previously unsuspected inherited disease is discovered to run in your family some time (even if it is years) after your donation, you should contact the clinic and let them know.

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