Whose Patient is the Egg Donor?

Episode: 
109

In her early 20s, Anna donated her eggs four different times to infertile couples. But the fourth time, within hours, she was vomiting and her abdomen began to swell.  Two days later she was admitted to the hospital with ovarian hyperstimulation syndrome.[1]

Like Anna, Melanie also arrived at the fertility clinic with many more eggs in her ovaries than the doctors expected. Within hours of being sent home, she developed many of the same symptoms as Anna. Melanie “was given IV rehydration, four types of painkillers, blood thinners and compression stockings to prevent a clot;” she ended up staying in the hospital for nine days.[2]

Not every woman who donates eggs goes through this. She might have mild nausea, moderate bleeding and pain.[3] Some women have reported changes to their menstrual cycle. Ovarian hypserstimulation syndrome seems to range from 1-10% of all egg extractions, but the numbers are hard to track.[4],  There’s almost no data or follow-up of egg donors.

Which brings us to the crux of the problem: Whose patient is the egg donor anyway? The fertility doctor takes care of the infertile couple, but who takes care of the egg donor?  This sets up a conflict of interests. For example, canceling a cycle for the donor’s health doesn’t benefit the client, who has to pay large amounts of money for each cycle, regardless of success. We shouldn't be surprised if fertility doctors are tempted to minimize, overlook, or even ignore side effects in the egg donor in order to make their clients happy.

In other settings, we protect patients against conflicts of interest.  Medical regulations require the medical team for organ donors to be different than the transplant team. There are no rules to protect egg donors. 

Egg donors may be “satellite patients,” living far from the IVF clinic. Their complications can emerge when they return home, but may not have a doctor qualified to care for them. After successful egg retrieval, the donor may be dismissed. One journalist found that some fertility doctors did not keep accurate records about egg donors, failed to record complications and the number of eggs retrieved, and refused to provide copies of the records to patients.[5]

It’s not much better when donating eggs for research. Earlier this year, researchers successfully cloned a human embryo.[6] One of the keys to their success was the use of “fresh” eggs—that is, eggs that have just been harvested from a woman—rather than eggs that had been frozen.[7] Demand for fresh eggs pits the interest of the researcher against the interest of the egg donor, putting her at risk.

Failing to treat egg donors as patients is the equivalent of treating them as medical resources, objects to be bought, sold, or traded for parts. Egg donors should have their own doctor, one who will treat them with dignity and respect, and care for them when things go wrong.

 



[1] Alison Motluk, “Is Egg Donation Dangerous?” MaisonNeuve, June 2, 2013, http://maisonneuve.org/article/2013/01/21/egg-donation-dangerous/ (accessed May 28, 2013).

[2] Ibid.

[3] “Ovarian hyperstimulation syndrome,” Mayo Clinic, January 15, 2011, http://www.mayoclinic.com/health/ovarian-hyperstimulation-syndrome-ohss/DS01097 (accessed May 28, 2013).

[4] Bodri D Guillen, JJ, Polo A. Trullenque, C. Esteve, O. Coll, “Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles,”  Reprod. Biomed Online, August 17, 2008 (2):237-43. http://www.ncbi.nlm.nih.gov/pubmed/18681998. Cf. A. Sismongolu, H.I. Tekin, H.F. Erden, N.H. Ciray, U.Ulug, M. Bahceci, “Ovulation triggering with GnRH agonist vs. hcG in the same egg donor population undergoing donor oocyte cycles with GnRH antagonist: a prospective randomized cross-over trial.” J. Assist. Reprod. Genet. May 2009; 26(5): 251–256. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719073/

[5] Maisonneuve.org.

[6] M. Tachibana, P. Amato et al., “Human Embryonic Stem Cells Derived by Somatic Cell Nuclear Transfer,” Cell, May 15, 2013. http://www.ncbi.nlm.nih.gov/pubmed/23683578. See also, Monya Baker, “Stem Cells Made by Cloning Adult Humans,” Nature, April 28, 2014. http://www.nature.com/news/stem-cells-made-by-cloning-adult-humans-1.15107.

[7] Tachibana and Amato.

 

 

 

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