Egg cell donation - a brochure for the donor What is egg cell donation? Egg cell donation is the donation of unfertilized egg cells by a donor. These egg cells are given to a woman with a well-functioning uterus but who has problems with the generation of her own egg cells or who does not produce suitable egg cells. Medically speaking, egg cell donation is not as obvious a procedure as sperm donation. The egg cell donor is asked to undergo a hormonal stimulation and an ovarian puncture. The egg cells that are collected from this treatment are donated to a recipient and then fertilized with sperm cells from the recipient’s partner. The supply of egg cells is limited which means that the waiting list of recipients is long.
There are various types of donation
There are two egg cell donation formulas: anonymous and known donation. 1. Known donation (with fresh material) It is possible that there is someone in your family who is willing to donate egg cells. By obtaining a donor themselves, the pressure on the recipient couple to proceed to known donation can be great. This means that throughout their treatment only the material from the donor they obtained will be used. For the donor, it can be out of an ‘exclusive’ motivation that she does this for the couple. Often the donor is the sister of the woman or the partner of her brother. And for the couple themselves, the argument of loyalty can play a role. They have asked someone whom they trust to be a donor, some-
one with whom they have a shared history, genetic or otherwise. There are also situations in which known donation is the only option. For example, if the donor obtained is older than 35 years of age and can therefore not be accepted into the regular donor network. Or if it is a question of skin colour. Known donation always occurs using fresh egg cells. 2. Anonymous donation (via egg cell bank) Egg cell recipients can receive anonymous egg cells from the egg cell bank in three ways: Voluntary anonymous donation With this, the recipient couple does not obtain its own donor, because, for example, they do not want to involve anyone from their personal circle in the treatment. This couple will be advised to choose a voluntary donor who is undergoing fertility treatment for the sole purpose of anonymously donating her egg cells. Egg sharing With this method, the donor is a woman who is undergoing IVF treatment herself. It goes without saying that these women are capable of producing fertile egg cells themselves, a portion of which will be fertilized with sperm from their own partners as part of their own fertility treatments and another portion which will be given up for donation. This always occurs anonymously. The donor couple does not know who the recipient couple is. The recipient couple does not know the origins of the egg cells. Anonymous donation via an obtained donor In this case, the recipient couple obtain a donor who donates her egg cells to the egg cell bank. However, the recipient herself
will not receive egg cells from this donor but will receive other egg cells from the egg cell bank. This way anonymity can be guaranteed. The great advantage of this formula is that as a result of obtaining a donor herself, the recipient can more quickly be provided with a donation.
What conditions must an egg cell donor fulfil? In order to be able to donate egg cells, the following conditions must be met: The donor must be younger than 38 years of age. If the donor is older than 35, you will be informed of this fact and you are free to accept or reject these egg cells. The donor may not be a carrier of hereditary and/or infectious diseases or disorders. The donor must stop smoking during the treatment. Preferably the donor has been proven to be fertile; in other words, it is preferred that she has already been pregnant at least once.
What are the practical steps of the procedure? Before starting the procedure, you come to the Fertility Centre for a consultation with the gynaecologist and the psychologist. During your consultation with the gynaecologist, you will receive medical information about the treatment, you will be examined clinically and your personal and family medical histories will be reviewed. A standardized questionnaire must be completed. Particular attention is paid to ruling out risk factors for genetic problems and sexually transmitted diseases. Any contraindications for carrying out hormone stimulation will be evaluated. Blood tests will be performed to rule out a number of infectious diseases (hepatitis B, hepatitis C, CMV, HIV and syphilis). Genetic testing will also be performed (chromosome analysis, carrier screening for Fragile X Syndrome and for mucoviscidosis).
The blood tests for screening for infections must be repeated three weeks before the ovarian puncture and again on the day of the ovarian puncture itself. The psychologist discusses the psychological aspects of donating egg cells with you and your partner and assesses your motivation for donating. As a donor, you will also be required to undergo a standardized test that measures personality differences and pathology. Contrary to known donation, in anonymous donation, the presence of your partner, if applicable, is not mandatory.
What is discussed with the psychologist? The psychologist tries to gain insight into your motivation to act as a donor and assesses the possible expected psychological impact of your becoming a donor. The aspect of anonymity is also addressed at this time. You will be given a standardized personality test which assesses personality differences and pathology and which will be interpreted by Psypunt, a group practice of certified psychologists. Contrary to known donation, in anonymous donation, the presence of your partner, if applicable, is not mandatory. The donor must be free of distinct personality disorders, and the motivation for wanting to act as a donor must be primarily altruistic.
What exactly is involved in the medical treatment? The most important steps in this treatment are: stimulation of the ovaries ovarian puncture
Stimulation of the ovaries The theory The chance of success of an IVF treatment is determined in part by the number of egg cells that are obtained per treatment. To bring about the development of more than one egg cell (an average of ten), the ovaries must be stimulated. This occurs with the use of hormones (gonadotrophins), which have only a temporary effect on the body and which must be administered in the form of daily injections for a period of fourteen days. Adverse effects in the long-term are unlikely and, in any case, have not yet been determined. Usually this stimulation is combined with another type of injection which ensures that the growth of the egg cells is no longer controlled by feedback mechanisms in the body. Without the uncoupling of these mechanisms, the body would initiate ovulation at a certain moment before the ovarian punctures could be performed. A (contraceptive) pill is usually taken for a period of fourteen days before the actual stimulation. The purpose of this is to ensure that the ovaries come to a basal state. The consequence of this is that a more even growth of the follicles (fluid-filled vesicles in the ovary which contain the egg cells) occurs. There is also another practical benefit to this method: the number of days that the pill is taken can be lengthened or shortened thereby shifting the estimated date of the ovarian puncture. (This can be handy, for example, to avoid family celebrations, to account for days when the lab is not open, to account for the absence of the treating gynaecologist, to avoid excessive work load in the lab etc.) The stimulation process is followed by means of ultrasonography and with blood tests, if required. This is necessary in order to be able to monitor how many egg cells develop and, more importantly, to determine the moment of their maturity and fertility. Once the follicles have reached a diameter of approximately 20
mm, the final steps of egg cell maturation are initiated by means of a final hormone injection which also serves the purpose of preparing the uterine lining for implantation. This must occur at a specific, pre-scheduled time, because the ovarian puncture must be performed between 35 and 40 hours after the injection. The injection is usually administered in the evening between 8 pm and midnight so that the ovarian puncture can be performed one day and a half later in the morning. In practical terms Before the beginning of the procedure, you will also receive a detailed stimulation schedule which includes all of the instructions you need to ensure that the stimulation goes smoothly. You will also receive all of the medication at the start of the treatment. Usually, the injections are started approximately five days after you stop taking the pill. You are free to choose who will administer the injections. You can do the injections yourself, or you can call on an independent nurse, your general practitioner or a home nursing service via the Health Insurance Funds. In case of emergency, you can also go to the emergency ward of AZ Sint-Lucas, where the injection can also be administered. It is best to have these injections in the evening. The exact time is somewhat less important (somewhere between 16:00 and 24:00). Only the final injection must be given at an exact time, since the scheduling of the ovarian puncture depends on the timing of this injection. Before the start of treatment, our nursing staff will provide you with the necessary explanation and instruction for providing yourself with subcutaneous injections. The first ultrasound examination will occur after approximately one week of injections and will be scheduled when the stimulation schedule is made up. As you probably already know, the ultrasound is a painless, vaginal examination that only takes
about five minutes to complete. On average, this examination must be performed two to three times during the two-week-long stimulation.
The ovarian puncture (follicular aspiration, pick-up) The theory The ovarian puncture is the only step in the IVF treatment that requires a short hospital admission of a half day. During this procedure, a fine needle is inserted by way of ultrasound control through the wall of the vagina and into the follicles. The follicular fluid containing the egg cell is then aspirated into the needle. As a rule, this occurs under a type of anaesthesia called ‘conscious sedation’. This means that you will receive an anaesthetic product via a drip that is a strong pain reliever and that may make you sleepy but is not a true anaesthetic (you will still be able to react when spoken to). This is combined with the injection of a local anaesthetic at the location where the needle is inserted in the vaginal wall. General anaesthesia may be necessary in exceptional cases (for example, with difficult to reach ovaries). In these cases, the anaesthesia consists of a powerful, but short-acting narcotic administered under the supervision of an anaesthetist. Regardless of the method, the patient must remain under medical supervision for several hours to rule out any acute complications. The chance of complications, however, is very small. A small amount of blood from the follicle that is punctured is released into the abdominal cavity, which, by the way, also happens during natural ovulation. This small amount of bleeding, however, almost always stops by itself after the puncture. The point where the needle was inserted through the wall of the vagina may also bleed somewhat after the procedure. It is very rare (risk of less than 1/1000) that an infection occurs due to the puncture procedure. If fever occurs in the days following the puncture, this must be reported to the doctor.
In practical terms When the timing of egg cell maturation has been determined by way of ultrasound, the scheduling of the final injection is planned as is the scheduling of the ovarian puncture. The ovarian puncture is always performed in the morning, during the week starting from 8:00 and in the weekend usually a little later. The donor, with or without her partner, must report to the day clinic of the Fertility Centre in straat 7 one half hour before the scheduled time of the ovarian puncture. You may not have had anything to eat or drink since midnight of the previous night. On the day of the puncture, you must bring all of the completed and signed consent declarations with you to the Centre. The puncture procedure takes approximately one half hour. After the puncture, you must stay in the recovery ward in straat 7 of the day clinic for several hours for observation before you are released to go home. The gynaecologist will come to see you to make sure there are no problems and to confirm that you may go home. Please note: Because you have been given a form of anaesthetic, you may not drive a car for the rest of that day. You may also not be left alone for 24 hours following the procedure. You may experience some vaginal bleeding during the first few days after the ovarian puncture. This is normal and usually stops by itself. This blood is coming from the points where the needle passed through the vaginal wall. Slight to moderate abdominal pain, to a certain extent, is also a normal consequence of the puncture. You may definitely take pain relievers for this pain (preferably paracetamol: e.g., Perdolan®, Dafalgan®). The more egg cells that were collected, the greater the swelling of the ovaries and the more pain you can expect in the lower abdomen. It is normal that these pain symptoms worsen in the evening, especially on the first day, since the pain
relievers administered during the puncture will have completely worn off by then. It is important to use some type of contraception (for example, condoms or a copper IUD) during the treatment to avoid spontaneous pregnancy.
Treatment risks During the puncture, a needle must pass from the non-sterile zone (the vagina) to a sterile zone (the abdominal cavity). In doing so, it is unavoidable that bacteria end up in this sterile zone. Normally, the immune system of the woman is able to eliminate these few bacteria, but in some rare cases (risk of less than 1/1000) they may cause an infection. If you develop a fever (> 37.5째C) in the first days following the puncture, the doctor must be notified. In exceptional cases, this infection will require treatment with antibiotics or require surgery (keyhole surgery or laparoscopic surgery). If you are in doubt about whether something is normal or not, it is best that you call the Fertifoon (09/235.07.46). This is a telephone number that you can use to contact the fertility team 7 days per week 24 hours per day. In any case, your calling will never be held against you. The fact that you are concerned is sufficient reason to call, even if it is just to hear a team member give you some assurance about your condition. Hyperstimulation syndrome The number of egg cells that can be brought to maturity per cycle varies greatly from individual to individual. The optimal number of egg cells is between 10 and 20. In some cases, the ovaries react insufficiently, which can negatively influence the result of an IVF treatment. In other cases, however, the reaction of the ovaries is unexpectedly strong and 30 to 40 egg cells are developed.
As a result, after ovulation and egg cell pick-up, the ovaries can swell and produce fluid that accumulates in the abdomen. In most women this will cause only a temporary feeling of heaviness in the abdomen. In rare cases, this reaction can cause an enormous shift in the fluid balance of the body which may require treatment in a hospital. The most significant symptoms at that point are swelling and pain in the abdomen, shortness of breath (especially when lying down), dizziness, stomach pain and heart palpitations. The treatment for this consists of bed rest, intravenous administration of protein-rich fluid and, if necessary, the removal of excess fluid from the abdominal cavity. Even though a hospital admission of 1 to 2 weeks may be necessary, the hyperstimulation syndrome will have no adverse effects on the health of the woman, as long as its treatment occurs under medical supervision. A comparable, yet less severe phenomenon can result in a weight gain of 2 to 3 kilos due to the accumulation of fluid during IVF stimulation. This is normal, and since the weight gain is due to fluid as opposed to fat tissue it disappears again after treatment. In the case of donors, we can start the patient on preventive medication in order to prevent possible hyperstimulation.
Approximately two weeks after the stimulation you will begin to menstruate
We request that you definitely undergo an ultrasound of the ovaries after menstruating in order to verify whether or not their condition has been normalised.
How many pregnancies can be achieved from the same donor?
The number of pregnancies that can be engendered within one region by the same donor is not unlimited. This reduces the risk that half-brothers and half-sisters would enter into relationships
with one another in the future. In Belgium, the legally established maximum number of recipients per donor is 6.
Will you be financially compensated?
The tissue bank provides for some compensation per donation. This amount can only be paid out via bank transfer after the completion of the entire treatment. The consultations for donor intake are, of course, free of charge. The consultations with the psychologist are charged by him or her to the tissue bank as are the laboratory tests.
How can you contact us?
It is best to make an appointment with the doctor and the psychologist at +32 9 224 60 92 or + 32 9 222 99 22.
The donation of egg cells is not an obvious course of action. It demands a great deal from a woman, both physically and psychologically. However, many couples have been looking for years for someone who will go through this effort, someone who can make their long-held dream of having children come true. Could you be that someone? Director:
Dr. Tom Coetsier
Team members: Gynaecologists
Dr. Tom Coetsier
Dr. Nele Van Renterghem
Dr. Isabelle Meire
Team of psychologists Psypunt
Fertility Centre AZ Sint-Lucas Groenebriel 1 – 9000 Gent tel. +329/224.60.92 – fax. +329/22406602 e-mail : Fertiliteit@azstlucas.be
Fertility Centre AZ Sint-Lucas