A Step By Step Guide for the Donor
IRMS for Reproductive
Medicine and Science at Saint Barnabas
Most couples never think they will have trouble starting a family; yet one in seven couples of childbearing age will experience the pain of infertility. This can be a devastating experience.
Now, with the assistance of today’s revolutionary fertility treatments, couples have a better chance than ever of becoming pregnant. IRMS for Reproductive Medicine reports pregnancy rates that are among the highest in the nation. Our medical staff includes internationally renowned specialists in infertility treatment, as well as distinguished embryologists and biologists who pioneered many of the assisted reproductive techniques in use today.
Initial Consultation and Screening
All donors undergo a screening to determine whether or not egg donation is appropriate for them. This includes laboratory work to study the individual’s level of day 3 FSH, an indicator of whether or not she would be a suitable candidate. Other laboratory testing, such as HIV, blood type and other bloodwork, is performed. This is followed by a twopart psychological screening that includes a Personality Index Test and interviews with a nurse and mental health professional. Finally, a physician performs a medical examination.
There are two types of egg donors, known and anonymous. The known donor is usually a relative or friend of the recipient. The anonymous donor does not meet the recipient. Anonymous donors provide recipients with a medical history, educational background and psychological profile, all arranged through IRMS. After retrieval, the anonymous donor is not told whether or not the donation of her eggs resulted in a pregnancy.
Although currently anonymous, these donors should be aware that in the future the legal system could reverse their anonymity. IRMS takes multiple precautions to protect the privacy of the donors.
Egg Donation at IRMS:
Step One: Matching Donor and Recipients
Each egg donor is notified when a match has been made with a potential recipient. At this time, the nurse and the egg donor reserve a period of time for the procedure, and IRMS orders injectable medications. The egg donor now begins a class and receives detailed instructions on how to properly administer the injectables. The dose of the medication, the time it is administered and the duration of treatment vary from person to person.
Step Two: Creating the Optimum Cycle
The egg donor calls the nurse as soon as her menstruation occurs. Then, with the help of birth control pills, both the donor and recipient cycles are synchronized. In order to maximize egg donation, the egg donor undergoes stimulation of her ovaries so that multiple eggs may be harvested. More than one egg is needed because not every egg will be healthy and not every healthy egg will produce a pregnancy. Due to concerns regarding passing infectious diseases through the eggs to the recipient, the FDA now requires that we repeat some of the testing that we do at your initial evaluation around the time we start your medications. This testing will consist of a repeat physical exam, a questionnaire, blood testing and cervical cultures. If any of this testing is abnormal, the cycle may be cancelled. To reduce the risk of failing this testing, once you have applied for the donor program, please check with the nurse before traveling outside of the country. Please also avoid getting tattoos or piercings. Donation must be postponed for 1 year after obtaining a tattoo or piercing. The drugs used will depend upon the physician’s assessment of the donor, the type and dose of medications she needs. There are suppression medications that are taken to prevent premature release of the egg. One of these is Lupron, an injectable medication, which is overlapped with the birth control pills. Another suppression medication is a GnRH antagonist (brand names Gonal-F and Follistim), which is also an injectable medication. . Gonadotropins, which stimulate multiple egg production are injected by the egg donor at home and require daily to twice daily administration. They are injected for an average of 6 to 12 days per cycle. Despite the fact that these are very powerful medications, they are usually well tolerated. Most people experience some mild side effects, such as fatigue, bloating and mild cramping. Any questions or concerns about symptoms you are experiencing should be reviewed with your nurse.
• During the stimulation cycle, IRMS recommends abstinence from intercourse, as the donor is especially fertile while on these medications. If intercourse takes place, the use of condoms and spermicides together is strongly recommended to prevent pregnancy and sexually transmitted diseases.
• It is important to inform the Ovum Donation Team about any medications (prescription and over-the-counter), diets, nutritional supplements and herbal remedies you are taking. In general, during the donation cycle, any non-essential medications should be stopped. Please review this with the nurse prior to making any changes on your own.
• Tattooing and piercing should not be done within 1 year of egg donation to prevent the risk of transmission of hepatitis and HIV.
Step Three: Monitoring the Cycle
Once the stimulation cycle has started, the egg donor comes to the IRMS office in the morning in either Livingston, Hoboken, or Clark every 1-3 days to be evaluated for follicle maturation. This is determined by daily blood levels and ultrasound, which are performed between 6:30 and 8:00 a.m. in Livingston and 7:00 to 9:00 am. in Hoboken and Clark. Monitoring is performed in the morning so that the results are available by the afternoon for review by the physician. The nurse will call you at that time to make any necessary medication adjustments and to let you know when to return for more testing.
Sometimes donors have other commitments that may interfere with the cycle, and it is important to inform the team fully about this. Not everyone responds the same way to the medications and the cycle schedule does not always go as planned. Once the stimulation starts, the donor must be available for monitoring every day, if necessary, until the retrieval takes place. It is usually two weeks from the beginning to the retrieval, but may take several days longer, or may occur earlier than planned.
Step Four: The HCG Injection At an exact time determined by the physician, an injection of human Chorionic Gonadotropin (HCG) is given to bring the eggs to final maturity. This injection is performed at IRMS by one of our RN’s.
The timing of the HCG injection is critical to the success of the cycle. If it is given too early or too late, it could significantly lower the chances for obtaining healthy eggs. A nurse or physician is on call 24 hours a day, 7 days a week and 365 days a year through our main number: (973) 322-8286. If it is after hours, please ask the answering service to page the on-call nurse or doctor.
Retrieving the Eggs: The Final Step
The night before the egg retrieval, the donor should neither eat nor drink because the procedure involves the use of intravenous anesthesia. An empty stomach increases the safety of the procedure. A full stomach may result in the cancellation of the egg retrieval. On the day of the event, each patient must be accompanied by a person who can drive her home and stay with her for 24 hours after the procedure. If a companion is not present, the procedure may be cancelled. At 34-37 hours after the administration of the HCG injection, eggs are harvested from the donor. This procedure is performed at IRMS’s operating facility at the Atkins-Kent Building, across the street from the Medical Center. Retrieval involves aspirating the fluid in the ovarian follicles with a special needle to obtain the eggs. This minor procedure, performed with the patient under anesthesia, is done in the Same Day Surgery Center by a physician using ultrasound visualization and does not require an incision. Egg donors can return home a few hours after the egg retrieval. Safety regulations restrict the patient from driving or operating machinery after sedation. The donor should rest that day and avoid intercourse or aerobic activity. It is important the donor have a companion for the first 24 hours after the retrieval. Although complications are unlikely, the most common time for serious complications to occur is during the 24 hours after retrieval.
Intercourse should be avoided to prevent unwanted pregnancy in the donor and infection in the donor after retrieval.
Aftercare for the Egg Donor
To make sure that she recovers completely from the egg retrieval, each donor should follow a few simple guidelines. 1. Check in with IRMS within 24-48 hours after egg donation. 2. Take an antibiotic the day of the retrieval and finish the entire four-day dose. Antibiotics protect against any infection. 3. Get plenty of rest the day of the egg retrieval. 4. Resume your regular diet, but supplement it with plenty of extra fluids. 5. Be aware that you will be extremely fertile in the time before your next menstruation period and unprotected intercourse could result in pregnancy. 6. Avoid aerobic or high impact activity. 7. Avoid intercourse as the ovaries are fragile at this point and excessive movement of the ovaries could increase the risk for bleeding and twisting of the ovaries. 8. Weigh yourself every day and call IRMS if you notice more than a 2-pound weight gain in one day. 9. Monitor your urine output. If it is significantly less than the amount you are drinking or the urine becomes dark, please contact IRMS and speak with a nurse. 10. Please call a nurse at IRMS should any pain, fever, nausea, vomiting, or bleeding occur. 11. Make sure that you have a companion stay with you for the first 24 hours after retrieval. This is a requirement for your safety. 12. Call IRMS immediately should any complications occur.
Donors can expect to begin menstruation approximately 14 days after egg retrieval. At this time, the donor should call the nurse to schedule a Day Three Ultrasound appointment at IRMS. This final step ensures that the ovaries have returned to normal size. At this last appointment, all donors who have completed the retrieval process receive a compensation check for $8,000.
After the retrieval process, some egg donors wish to donate more eggs. Many donors can donate more than one time. These issues should be discussed with a nurse at IRMS.
Frequently Asked Questions about Egg Donation
Q. Will it hurt?
A. You may experience some mild lower abdominal discomfort while on the medications. During the retrieval, you will be completely asleep. After the retrieval, you will have mild to moderate pelvic discomfort for 24-72 hours. During this time, you may take over the counter pain medications. If these are not effective, you should contact a nurse at IRMS.
Q. How will this affect my ability to have children of my own?
A. Theoretically, serious complications of egg donation could diminish your future fertility. To our knowledge, no such case has ever been reported. To the best of our knowledge, an uncomplicated donor cycle should not affect your ability to have children in the future. However, egg donation is less than 20 years old and longer-term effects are not known.
Q. Will ovum donation cause cancer?
A. There have been some studies linking fertility medications to an increased risk of ovarian cancer. Many other studies show no increased risk, so this is an area of controversy. If there is an increased risk, it is low and can be decreased by the use of oral contraceptive pills (the birth control pill).
Q. What will the psychologist ask me?
A. Questions that will be asked by the mental health professional relate to your reasons for wanting to be a donor and how you feel about sharing your genetics with another individual (offspring of the recipient) that you may never know. In addition, the psychological interview is designed to help you determine if egg donation is right for you.
Q. What does the medical exam entail?
A. This is a routine physical exam of the heart, lungs, abdomen, and pelvis. Tests performed at the time of the exam include a Pap smear and cervical cultures. A transvaginal ultrasound is done to view your uterus and ovaries and help the physician determine the proper dose of fertility medications to give to you during the cycle. A probe is placed in the vagina to give the optimal view of the pelvis. The ultrasound study is brief and causes less discomfort than a standard speculum exam.
Q. How will I feel on the medications?
A. Most donors have no side effects. When side effects do occur, they are usually very mild. The most common symptoms are fatigue and mild pelvic cramping. Rarely, donors may have significant pelvic discomfort, moodiness, headaches, and bloating.
Q. What are the risks of being an egg donor?
A. Donors may risk psychological distress if they are rejected from the program or if the screening process uncovers a previously unknown medical problem. Donors rarely experience Ovarian Hyperstimulation Syndrome (OHSS), a condition where the ovaries become overly enlarged. This may require bedrest and extra test to monitor. In extremely rare cases, a donor may require hospitalization. Careful monitoring can reduce this risk. Very rarely, torsion (twisting of the ovary), bleeding, or infection of the pelvis may occur. Whether or not the risk of ovarian cancer may be slightly increased is unknown at this time (see above).
Q. What does it mean if I am rejected?
A. The most common reasons for rejection is a donor profile does not match the needs of the recipient population. If the reason for rejection has implications for the donor’s health, IRMS team will notify the candidate so she may receive the medical follow up she needs.
Q. What is the compensation for donating eggs at IRMS?
A. The compensation for completion of an egg donation cycle here is $8,000
With the help of egg donors, IRMS has helped to make dreams come true
for many families. For more information on becoming an egg donor, please call
IRMS at 1-866-50-DONOR or email Cindy Lucus @ email@example.com.