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Egg cell donation for lesbian couples

May we call your attention here to a heartfelt appeal? As a result of an unlucky twist of nature or due to a medical problem, some women enter menopause prematurely. Unfortunately, for these women, making use of donor egg cells is the only option for becoming pregnant at that point. The demand for donor egg cells is much greater than the supply, and the waiting list for these egg cells is long, even several years long. Some women find a solution by actively looking for candidate donors themselves, but this is not an obvious solution. Not only must the woman then come ‘out of the closet’ herself about this delicate problem, but egg cell donors must also fulfil various conditions, and they must be prepared to undergo a hormone stimulation and an ovarian puncture.

create an egg cell bank and to help women who do not have any other alternative for becoming pregnant.

As a lesbian couple who would like to have children, you must also make an appeal to a donor; in your case, a donor of sperm cells instead of egg cells. It is relatively easy for you to go to a sperm bank, where you will be provided with the cells you need via a relatively simple procedure.

From there, our heartfelt appeal to you to consider this in the hope that in this way the ultimate wish of others less fortunate can also be realized. Could this be something for you? If you think it might be, then please do not hesitate to contact us for more information, completely without obligation.

Recently, it has also become possible to freeze egg cells, just like sperm can be frozen. This development has made it possible to

Thank you in advance for your consideration! Drs. Tom Coetsier, Isabelle Meire and Nele Van Renterghem

In light of this new development, we would like to make as many people as possible aware of this problem. In this vein, we thought especially of you, the lesbian couples who come to us for donor insemination. You, of all people, understand what it means to be dependent on a donor for the fulfilment of your wish to become parents. We also dare to hope that a number of you will be able to transform your thankfulness for your anonymous donor into a willingness to donate egg cells yourselves.


What is entailed in donating egg cells to a bank? Unfertilized egg cells can be donated anonymously by a donor to an egg cell bank. These egg cells are stored in a frozen state and are then later provided to a recipient. The recipient is a woman with a well-functioning uterus but who has problems with the generation of her own egg cells (premature menopause) or who does not produce suitable egg cells. After thawing, these egg cells are fertilized with the sperm of the recipient’s partner, and a fertilized egg cell is then transferred back to her so that she can become pregnant in this way.

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 should ideally be younger than 35 years of age, but must be younger than 38.  The donor may not be a carrier of hereditary and/or infectious diseases or disorders.  The donor must stop smoking during the treatment.

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 (a willingness to help others).


What exactly is involved in the medical treatment? The most important steps in this treatment are: ď ľ stimulation of the ovaries ď ľ 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 way, you can choose for yourself during which week you want the ovarian puncture to fall, independent of your menstrual cycle. 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. 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. 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 Fund. 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. Most women feel no side effects whatsoever from the hormonal stimulation. If there are side effects, then they are usually moderate and of a temporary nature. Possible side effects include bloating, sharp pains in the lower abdomen, headache or fatigue.

The ovarian puncture (follicular aspiration, pick-up) The theory For the ovarian puncture, you must remain in the Fertility Centre for several hours. 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 may make you sleepy but with which you remain conscious and can even follow what is happening around you. This is combined with the injection of a local anaesthetic at the location where the needle is inserted in the vaginal wall. The puncture itself lasts approximately fifteen minutes, depending on the number of mature eggs. After the puncture, you must remain under medical supervision for approximately another two hours in order to rule out acute complications.

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. 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.

Treatment risks Bleeding: 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 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 (<1/1000) that a surgical procedure is needed to stop this bleeding. Infection: 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 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).

Overstimulation: 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; however, in other cases, the reaction of the ovaries is unexpectedly strong and 30 to 40 egg cells are developed. This causes significant swelling of the ovaries and can cause a number of complaints such as weight gain, a swollen abdomen, nausea and shortness of breath. Thanks to the use of modern stimulation schedules and the preventive determination of sensitivity to stimulation via a specific blood test, the risk of a true overstimulation in egg cell donation is lower than 1/1000. Just to be clear: There are no indications that carrying out a treatment like this will have health consequences in the future: your fertility remains as it was; you will not enter menopause earlier, and you are not increasing your chance of cancer. 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.

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 compensation of €500 per donation. This amount can only be paid out via bank transfer after the completion of the entire treatment. This sum is not a price that is paid for the egg cells but a compensation for the expenses incurred in donating them. Part of this sum is compensation for the non-refundable portions of the ultrasound or laboratory test, which you must pay for in advance (estimated at €100 for the total treatment). The remaining €400 can be considered as compensation for the travel expenses that you incur going to the hospital, for the time spent and for the ‘inconvenience suffered’.

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.

In conclusion 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


www.azstlucas.be

Fertility Centre AZ Sint-Lucas Groenebriel 1 – 9000 Gent tel. +329/224.60.92 – fax. +329/22406602 e-mail : Fertiliteit@azstlucas.be

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Egg cell donation for lesbian couples  

Fertility Centre AZ Sint-Lucas

Egg cell donation for lesbian couples  

Fertility Centre AZ Sint-Lucas

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