A survey will be performed to determine if you are a candidate to continue in the donor process. This survey will briefly cover your personal and medical background. This will take approximately 5 minutes.
After you complete the survey, we will mail or email a donor application to you. This application not only covers your personal and medical background, but the medical background of two generations of your family. If you have any family members with an illness you are unsure of, it would be best to investigate this promptly.
After reviewing your application, we will determine your acceptability for the program. Our office will contact you if you are deemed eligible to proceed. If provisionally accepted, you will move to the next step in the process and meet with our Nurse Coordinator.
Each provisionally accepted donor must meet with our Donor Egg Coordinator. At this visit, the coordinator will explain the process step by step, inform you of pre-testing requirements, coordinate scheduling of tests, and answer any questions you may have. A contact system will be set up so we may confidentially reach you when necessary.
A complete physical exam performed by one of our physicians or physician assistants is required for all donors. You will need to have your medical and GYN records sent to our office before your visit with our practitioner. The screening is performed at different times throughout the process. Some testing will be done during the initial screening while others will be performed within 30 days of your egg donation cycle. Required testing will include, but is not limited to:
You have made a serious decision in choosing to be an egg donor. Due to the complexity of this decision, you are required to meet with a mental health professional to discuss the emotional, psychosocial, ethical and legal issues surrounding your choice. More than one visit may be needed since this is not only an assessment of your ability to donate, but an educational session as well. We will arrange this appointment for you. If you are married, your husband will also need to be part of this process.
All donors must meet with our Reproductive Endocrinologist, Dr. Horvath. At this visit, we will review your medical and family history and discuss the donor egg process. You will have the opportunity to ask questions and will be expected to sign the consent to become an egg donor. You should receive final clearance after this visit. If you are married, your husband is required to attend this meeting.
You will be given an appointment to meet with our Billing Coordinator, Renee Bessette, so you may discuss information related to your compensation as an egg donor. In some cases a cycle must be canceled before egg retrieval due to poor follicle development or other unforeseen events. Donors will be compensated for the time committed to the point of cancellation. Details of these policies will be discussed at this visit.
The growth and ripening of multiple eggs is achieved with hormone injections. Possible risks and complications of these medications include:
1. Bruising, discomfort, or infection as a result of subcutaneous or intramuscular injections.
2. Ovarian Hyperstimulation Syndrome (OHSS): may include:
a. Cyst formation – The medications prescribed may cause large cysts on the ovaries. These cysts usually disappear spontaneously and require no intervention. In very rare instances, these cysts could create significant abdominal bloating, distention and pain, requiring hospitalization for observation purposes. Ovarian cyst rupture, while rare, could require emergency surgery to stop bleeding. This could result in a need for blood transfusions and in exceedingly rare circumstances possible loss of one or both ovaries.
b. Fluid shifts – Fluid shifts in the body may require hospitalization for observation and treatment. High estrogen levels associated with stimulating medications may alter the way the body handles fluids. The blood vessels supplying the ovaries may become "leaky," resulting in the accumulation of fluid in the abdominal cavity (ascites) or around the lungs (pleural effusion). This may cause abdominal distension and discomfort with shortness of breath due to the diaphragm being pushed upward by fluid in the abdomen. In severe cases, this fluid may need to be removed from the abdomen or from the space around the lungs through additional surgical procedures such as paracentesis, culdocentesis or thoracentecis.
The "leaky" vessels may also cause dehydration because the fluid is in the abdomen instead of the blood vessels. Intravenous fluid administration may be required to maintain adequate blood flow to vital organs such as the kidneys. There are extremely rare reports of death occurring as a result of complications of OHSS. OHSS is a risk inherent in ovulation induction therapy; prevention cannot be guaranteed. At times, when monitoring shows the risk of OHSS is unacceptably high, a cycle may be canceled. Severe OHSS will rarely occur if hCG administration is withheld.
3. Pain, infection, bleeding or injury to pelvic organs, especially the ovaries at the time of egg retrieval. Rarely, ovaries may bleed excessively after an egg retrieval procedure, requiring emergency surgery to stop the bleeding. Excessive blood loss could result in a need for blood transfusions and in exceedingly rare circumstances possible loss of one or both ovaries.
4. Negative reaction to anesthesia.
5. Ovarian tumors and cancer: Current studies suggest that women who use fertility medications are at increased risk for developing cancer of the ovaries. Unfortunately, there are shortcomings of these studies, which brings into question the validity of these findings. There is insufficient evidence to determine whether or not there is a link between fertility medications and an increased risk of ovarian cancer. We cannot guarantee that a future link will not be found.
Once you have completed all requirements to become a donor, your profile will be put into our donor registry. If your profile is chosen by a recipient, the cycling/stimulation portion of the egg donation process will begin. There are three phases egg donors must undergo:
You will be placed on oral contraceptives so we can control your cycle and synchronize it with that of the recipient. You will also be instructed to start an injectable medication (leuprolide acetate, Lupron) to suppress ovarian hormone production. Once suppression is achieved, you will begin the stimulation phase.
In a natural cycle, you would mature a single follicle – a specialized cyst that contains an egg – and ovulate a single egg. During this phase, you will take injectable medications called gonadotropins which stimulate your ovaries to produce multiple follicles. You will be monitored regularly with blood work and transvaginal ultrasound. This will enable your physician to closely monitor your blood hormone levels and the development of follicles.
You may be instructed to come to our office every day. When the monitoring shows you to be hormonally appropriate with mature follicles, you will be ready for egg retrieval. You will be instructed to take a medication called human chorionic gonadotropin or hCG. This helps in the final maturation of the follicles and is a timed injection. You will be instructed to take this injection at a very specific time.
Egg retrievals are done using transvaginal ultrasound directed needle aspiration (TVA). This is a minor surgical procedure performed under light general anesthesia or heavy intravenous sedation. A vaginal probe is placed in the vagina and a needle is inserted through a guide attached to the probe. This probe is identical to those used to perform ultrasounds in the monitoring phase of your cycle.
The ultrasound image lets the physician accurately guide the needle through the vaginal wall directly into each follicle for aspiration. The process takes about 30 minutes. After retrieval, the donor will remain in the office until medically cleared – about one hour. Pain medication may be taken for discomfort, typically Tylenol 650-1000 mg every 4-6 hours as needed. Complications of TVA are rare, but include the possibility of infection and persistent ovarian bleeding after the procedure, as well as injury to blood vessels during the procedure.
In the event of suspicion of a rare complication – severe abdominal or pelvic pain after the procedure, persistent low blood pressure or dizziness – hospitalization and possible emergency surgery may be required. Someone must accompany the donor to this appointment, as she will be restricted from driving after the procedure. The donor will be instructed to return to the office in two weeks or with their next menses, whichever comes first. At this time, she will have a post retrieval followup including a transvaginal ultrasound.
The final step will be a revisit appointment about two weeks after retrieval. A pelvic exam will be performed. You will also meet with the nurse coordinator for case closure and receive payment for your time and commitment. Any questions or concerns you may have can be addressed at that time.