Egg donor self-reports of ovarian hyperstimulation syndrome: severity by trigger type, oocytes retrieved, and prior history

PURPOSE

To evaluate self-reported survey data provided by US oocyte donors on their experiences with ovarian hyperstimulation syndrome and possible correlations between OHSS severity and number of oocytes retrieved, trigger type, and prior OHSS history.

METHODS

An 85-question retrospective survey was administered online. Survey questions included demographic information, reasons for donating, immediate per-cycle experiences and outcomes, perceptions of informed consent, and perceived impact of donation on long-term health. Quantitative Data for this study was collected between February 2019 and September 2020 via Qualtrics^XM (January 2019), an online survey platform. Follow-up interviews were also conducted. Participants were recruited via fertility clinics, egg donation agencies, and online forum. The research was approved by the University of California, San Francisco Institutional Review Board (#14-14765).

RESULTS

Of 420 initiated US oocyte donor online surveys, 289 (68%) respondents provided detailed information on per cycle experiences with ovarian hyperstimulation syndrome, number of oocytes retrieved, and trigger type over a total of 801 cycles. On cycles where donors reported receiving GnRH agonist triggers (n = 337), they reported milder OHSS compared to cycles with hCG or dual triggers. Among donors undergoing multiple retrieval cycles, the severity of OHSS in second cycles was strongly associated with OHSS severity in first cycles.

CONCLUSION

Self-reported OHSS in oocyte donors is lower in GnRH antagonist stimulation protocols combined with GnRHa trigger and in cycles where donors reported fewer than 30 oocytes retrieved. Donors who reported severe OHSS on a prior cycle were significantly more likely to experience severe OHSS on a subsequent cycle.

Psychosocial consequences of oocyte donation in donors: A systematic review

Assisted Reproductive Technology by means of oocyte donation is a very successful method leading to psychosocial consequences in donors. The aim of the present study was to conduct a systematic review of the existing literature on the psychosocial consequences of oocyte donation in the donors. The present study was conducted as a systematic review based on the PRISMA checklist. Searches were performed in PubMed, Web of Science, Scopus, and SID databases for the documents written between 2000 and 2020 regardless of the research methodology and the employed tools. English and Persian articles focusing on psychological and social issues of oocyte donation were reviewed. From 2,759 studies which were found, finally 14 related ones were selected. Psychosocial challenges of donors were obtained in three dimensions including short-term and long-term psychological reactions to treatment complications, emotional reactions to their function as an oocyte donor, and emotional reactions to the resulting offspring resulting and related social challenges. According to the existing studies, oocyte donation is a challenging process with short-term and long-term psychosocial consequences for donors. In order to prevent the feasible psychosocial hazards caused by the donation process, it is necessary to provide oocyte donors with psychosocial support, proper counseling, and awareness of the facts and possible issues ahead.

Alignment between expectations and experiences of egg donors: what does it mean to be informed?

This study evaluated the retrospective perceptions of egg donors regarding information communicated about immediate and long-term risks during the process of becoming an egg donor, and the alignment of that perception with their experiences and expectations of egg donation. Data were collected using an anonymous online survey. Egg donors' demographics, perceptions of being informed about immediate complications and long-term risks, and alignment between their expectations and experiences were analysed. In total, 375 current and former egg donors participated in an online survey about their decisions and experiences. Participants ranged in age from 18 to 57 years, with a median age of 24 years at first donation for compensated donors. The majority of the participants (81%) provided eggs in the USA, and 86.1% reported being compensated beyond direct reimbursement. Overall, 66% of egg donors surveyed reported feeling that their experiences matched their expectations based upon what they had been told during the informed consent process. While most participants (64.8%) felt well informed about potential short-term risks, 55.2% did not feel well informed about potential long-term risks. The findings indicate that while the majority of egg donors felt informed about immediate complications, there are gaps in knowledge about potential long-term risks. Results from this research provide insight into how egg donors understand risks and benefits, and can be used to improve counselling and informed consent forms and processes. The findings also indicate that longitudinal research on the health and well-being of egg donors is needed in order to improve informed consent.

Social egg freezing and donation: waste not, want not

The trend towards postponement of childbearing has seen increasing numbers of women turning towards oocyte banking for anticipated gamete exhaustion (AGE banking), which offers a realistic chance of achieving genetically connected offspring. However, there are concerns around the use of this technology, including social/ethical implications, low rate of utilisation and its cost-effectiveness. The same societal trends have also resulted in an increased demand and unmet need for donor oocytes, with many women choosing to travel overseas for treatment. This has its own inherent social, medical, financial and psychological sequelae. We propose a possible pathway to address these dual realities. The donation of oocytes originally stored in the context of AGE banking, with appropriate compensatory mechanisms, would ameliorate AGE banking concerns, while simultaneously improving the supply of donor oocytes. This proposed arrangement will result in tangible benefits for prospective donors, recipients and society at large.

Putting the spotlight on donation-related risks and donor safety - are we succeeding in protecting donors?

BACKGROUND AND OBJECTIVE

The European consortium project TRANSPOSE (TRANSfusion and transplantation: PrOtection and SElection of donors) aimed to assess and evaluate the risks to donors of Substances of Human Origin (SoHO), and to identify gaps between current donor vigilance systems and perceived risks.

MATERIALS AND METHODS

National and local data from participating organizations on serious and non-serious adverse reactions in donors were collected from 2014 to 2017. Following this, a survey was performed among participants to identify risks not included in the data sets. Finally, participants rated the risks according to severity, level of evidence and prevalence.

RESULTS

Significant discrepancies between anticipated donor risks and the collected data were found. Furthermore, many participants reported that national data on adverse reactions in donors of stem cells, gametes, embryos and tissues were not routinely collected and/or available.

CONCLUSIONS

These findings indicate that there is a need to further develop and standardize donor vigilance in Europe and to include long-term risks to donors, which are currently underreported, ensuring donor health and securing the future supply of SoHO.

Mild stimulation should be mandatory for oocyte donation

The increasing commercialization of oocyte donation is a source of concern. This evolution is expressed in the fact that oocyte donors’ interests are not a priority. For decades now, people mention that oocyte donation holds serious health risks for donors, as if this is an unavoidable given. However, most of the harm is caused by high hormonal stimulation. The risk/benefit balance of high stimulation compared to the risk/benefit balance of mild stimulation does not justify causing greater harm to donors, especially given the fact that donors submit to the procedure without any medical benefit for themselves and to help others.

Views of French oocyte donors at least 3 years after donation

RESEARCH QUESTION

The study aimed to evaluate the percentage of oocyte donors who regretted their donation at least 3 years later.

DESIGN

Between December 2018 and January 2019, this single-centre study sought to contact by telephone all women who had donated oocytes during the 6-year period from 2010 to 2015 at the Lille Centre for the study and storage of eggs and spermatozoa (CECOS).

RESULTS

Among 118 women, 72 responded to the questionnaire by telephone and were included in the study. The response rate was 61%. No woman regretted having donated an oocyte, and 89% said that they would do it again in the same situation. The survey distinguished two types of donors: 'relational' (58%) and 'altruistic' (42%); some of their responses differed. Ninety per cent of the women had talked about the donation to family and friends. Among them, 74% felt supported by their family and friends, and 72% by their partner. The donation was something that 76% of the women sometimes thought about; 83% felt that this donation was something useful that they had accomplished. Finally, most donors felt that oocyte donation should remain unremunerated and anonymous.

CONCLUSIONS

None of the donors we interviewed regretted their donation. In France, the current principles governing this donation appear satisfactory to oocyte donors.

Payment to gamete donors: equality, gender equity, or solidarity?

PURPOSE

Regulation of payment to gamete donors varies substantially across countries. The development of an ethically sustainable governance system of payments in gamete donation demands that the preferences of different stakeholders be heard. This study intends to contribute to improving the understanding of payment to gamete donors by analysing the views of donors and recipients about the preferred form of payment and its associations with their sociodemographic characteristics.

METHODS

This cross-sectional study included 70 donors and 172 recipients recruited at the Portuguese Public Bank of Gametes (July 2017-June 2018). Participants completed a self-reported questionnaire. Views about the preferred form of payment were collected through a multiple-choice question and an open-ended item. Associations were quantified through χ2 tests; content analysis was conducted with the open-ended answers.

RESULTS

Both donors (48.6%) and recipients (40.7%) considered that reimbursement is the preferred form of payment to ensure solidarity-based motivations to donate. This option was followed by compensation for non-financial losses (41.4% of donors; 33.7% of recipients) based on gender equity. Preference for a fixed reward (22.7% of recipients; 8.6% of donors) was less frequent among younger donors and married/living with a partner or employed recipients, being based on the promotion of equality.

CONCLUSION

In the context of the search for cross-border reproductive care and gamete circulation across countries, the findings from this study claim for the need to create solutions for payment to gamete donors that take into account gender equity and are simultaneously sensitive to donor's actual expenses and further health complications.

Ethics and regulation of inter-country medically assisted reproduction: a call for action

The proliferation of medically assisted reproduction (MAR) for the treatment of infertility has brought benefit to many individuals around the world. But infertility and its treatment continue to be a cause of suffering, and over the past decade, there has been a steady growth in a new global market of inter-country medically assisted reproduction (IMAR) involving 'third-party' individuals acting as surrogate mothers and gamete donors in reproductive collaborations for the benefit of other individuals and couples who wish to have children. At the same time there is evidence of a double standard of care for third-party women involved in IMAR, violations of human rights of children and women, and extreme abuses that are tantamount to reproductive trafficking. This paper is the report of an inter-disciplinary working group of experts who convened in Israel to discuss the complex issues of IMAR. In Israel too IMAR practices have grown rapidly in recent years, mainly because of restrictions on access to domestic surrogacy for same sex couples and a chronically insufficient supply of egg cells for the treatment of couples and singles in need. Drawing upon local expertise, the paper describes documented practices that are harmful, suggests principles of good practice based on an ethic of care, and calls for action at the international, national and professional levels to establish a human rights based system of international governance for IMAR based on three regulatory models: public health monitoring, inter-country adoption, and trafficking in human beings, organs and tissues.

The commercialization of human eggs in mitochondrial replacement research

After the development of induced pluripotent stem cells (IPSCs) in 2007, the pressure to commercialize women's eggs for stem cell research could have been expected to lessen. However, the pressure to harvest human eggs in large quantities for research has not diminished; rather, it has taken different directions, for example in germline mitochondrial research. Yet there has been little acknowledgement of these technologies' need for human eggs, the possible risks to women and the ethical issues concerning potential exploitation. Rather, there has been a renewed campaign to legalize payment for eggs in research, although the actual scientific advances are at best modest. This article shows why a market in women's eggs is ethically problematic in terms of the doctor's duty to do no harm and the limitations of 'informed' consent.

Recruiting egg donors online: an analysis of in vitro fertilization clinic and agency websites' adherence to American Society for Reproductive Medicine guidelines

OBJECTIVE

To examine compliance with ethical guidelines of the American Society for Reproductive Medicine (ASRM) regarding trait-based payment variation, presentation of risks, and minimum recruitment age.

DESIGN

In June 2010, we systematically examined 207 websites, of which 102 were egg donor agency or IVF clinic websites that both recruited online and displayed compensation amounts.

SETTING

The Internet.

PATIENT(S)

None.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Mention of increased payment for particular donor traits, recruitment age less than 21 years, noting risks to donors.

RESULT(S)

Of the 102 sites, considerable numbers were noncompliant with ASRM's guidelines that prohibit varying compensation based on a donor's traits (34%), and recommend an age of 21 years or older (41%), and presentation of risks alongside compensation (56%). Trait-based payment variation was associated with being an agency rather than a clinic, location in the West, not being endorsed by ASRM or Society of Assisted Reproductive Technology (SART), and referring to ASRM's guidelines about compensation. Of sites mentioning traits, prior donation success was the most commonly paid for trait (64%).

CONCLUSION(S)

Our data, the first to systematically analyze agency and clinic websites reveal that many do not follow ASRM's guidelines. These data have critical implications for policy, practice, and research, suggesting needs for consideration of possible changes in guidelines, and/or improvements in compliance and monitoring by ASRM or others.

Donor age is a major determinant of success of oocyte donation/recipient programme

BACKGROUND

In recent years, particularly in developed countries, women have tended to delay childbirth until over 40 years of age. Our study aims to identify whether the donor's age or recipient's age influences the pregnancy and live birth rate following oocyte recipient cycles.

METHODS

A population study included 3889 fresh oocyte recipient cycles. Pregnancy and live delivery rates were compared in recipient age groups (<35, 35-39, 40-44 and ≥45 years) and donor age groups (<30, 30-34, 35-39 and ≥40 years).

RESULTS

The highest live birth rate was of cycles in donors aged 30-34 years (25.0%), it decreased (P< 0.05) to 24.1% in donors aged <30 years, 20.7% in donors aged 35-39 years and 11.5% in donors aged ≥40 years. The multivariate analysis showed no significant differences in the success by recipient's age. Compared with cycles in donors aged 30-34 years, cycles in donors aged 35-39 years had 14 and 18% less chance to achieve a pregnancy [adjusted rate ratio (ARR) 0.86, 95% confidence interval (CI) 0.75-0.98] and a live delivery (ARR 0.82, 95% CI 0.71-0.96), while cycles in donors aged 40 years or older had 42 and 54% less chance to achieve a pregnancy (ARR 0.58, 95% CI 0.41-0.84) and a live delivery (ARR 0.46, 95% CI 0.29-0.73).

CONCLUSIONS

Older recipients with younger donors did not have a poorer pregnancy outcome compared with younger recipients with younger donors. Choosing a donor aged <35 years would increase the chance of pregnancy and live delivery for older recipients.

Patient experiences in advertising for an egg donor

Advertising is a commonly used means of recruiting an egg donor within Australia. The aim of this study was to explore the experiences and outcomes of people's attempts to recruit an egg donor through advertising in a printed publication, Melbourne's Child. Individuals and couples who placed a new advertisement between July 2007 and December 2008 were invited to participate (n = 84), and those who expressed interest were mailed a questionnaire specifically designed for the purposes of this study. Thirty-one advertisers (37%) agreed to be sent the questionnaire and 28 were completed and returned (33%). Results showed that over half (56%) of respondents successfully recruited an egg donor through their advertisement in Melbourne's Child, 75% received at least one genuine reply and most people received a response within 2 weeks (50%) or 1-2 months (32%) after publication. At the time of completing the questionnaire, 48% had undergone a treatment cycle using donor eggs. Advertising was recalled as a stressful experience and 79% of respondents felt that more information about the success of advertising would have been helpful prior to embarking on this process. Results will be used to inform current clinical practice in assisting patients to recruit an egg donor.