Medication

The egg donation process involves a series of specific medications that are intended to control when your body releases eggs.  Different clinics use different fertility medications.  Be sure to inform your clinic if you have any allergies, as some medications can cause allergic reactions.  The medications used in the egg donation process can come with short- and long-term side effects and health risks.  Ask your clinic about all of the potential risks and side effects so that you are fully informed before starting the process.  Also, because many medications must be taken at a specific time and in a specific way, make sure you understand when and how you are supposed to take each of your medications.

Questions to ask:

What medications will I be taking? What do they do?

The first medication you will take contains Gonadotropin-Releasing Hormone Agonist Analogues, which are used to suppress the release of luteinizing hormone (LH) by the pituitary gland.  Luteinizing hormone normally triggers eggs to mature within the body. Taking Gonadotropin-Releasing Hormone Agonist Analogues creates an “artificial menopause” in donors.  Physicians can then control the timing of egg maturation and ovulation through the administration of other medications.

Commercial forms of Gonadotropin-Releasing Hormone Agonist Analogues include:

• Buserelin/Suprefact
• Lupron
• Goserelin/Zoladex
• Nafarelin
• Triptorelin
• Synarel
• Prostap

You will then take a Follicle Stimulating Hormone (FSH) or Human Menopausal Gonadotropin (hMG), which is administered after your hormone levels have been suppressed by the Gonadotropin-Releasing Hormone Agonist Analogues.  Either the FSH or hMG will encourage your body to develop multiple egg follicles, which allows the physician to retrieve several mature eggs at one time.

Commercial forms of FSH or hMG include:

• Gonal/f
• Pergonol
• Humegon
• Menagon
• Urofollitropin/Metrodin
• Clomid tablets

Once tests indicate that your eggs have matured, ovulation is triggered through a single injection of Human Chorionic Gonadotropin.  This drug causes your follicles to release the eggs so that the eggs can be retrieved.  Egg retrieval occurs 34-36 hours after this injection.

Commercial forms of Human Chorionic Gonadotropin include:

• Pregnyl
• APL
• Oxidrel

How will I take the medications? What do I have to do?

After you and the intended mother/gestational surrogate synchronize your menstrual cycles, you must administer your own subcutaneous (just below the surface of the skin) injections.  These injections will include three different medications taken at various times over the course of about three weeks.   Each clinic has its own protocol, so make sure you fully understand which medications to take on which days.  .

During one of your visits to the clinic you will be taught how to give yourself the injections.

As an alternative to multiple injections, some clinics may prescribe a daily nasal spray or administer a single injection of Depot Lupron at the beginning of treatment.

All progress will be monitored through visits to the infertility doctor, where they will regulate your hormone levels.

What are the side effects of the medications? Is it safe?

While allergic reactions to fertility medications are unlikely, the most common side effects women experience include but are not limited to:

- abdominal swelling
- tension and pressure in the ovarian area
- mood swings
- bruising at injection sites as a result of fertility drugs
- temporary menopause-like symptoms, including vaginal dryness and hot flashes

Some treatment centers do not require egg donors to abstain from sexual intercourse during the medication phase.  It is important to understand that these drugs are intended to increase the number of eggs that are matured and released, so if you do not abstain from vaginal sexual intercourse with a male, unintentional pregnancy is another common complication.

A less common risk is ovarian hyperstimulation syndrome (OHSS).  OHSS is a serious complication in which fluid builds up in the ovaries and causes cystic enlargement. OHSS can cause permanent injury and even death.

Less than 1% of the time, drugs can also cause adnexal torsion, a condition that results when a stimulated ovary twists on itself and cuts off its blood supply. Surgery is required to untwist and, in some cases, to remove the ovary.

Additionally, some studies suggest that clomiphene, a drug sometimes used during hyperstimulation, may increase your chance of developing ovarian cancer. However, this risk applies mostly to women who take the drug for a year or more.

A few case reports have shown that the drug Lupron can aggravate existing tumors of the pituitary gland and cause strokes.

Controversy: Safety - Long-term data

A major controversy associated with egg donor health is whether or not the lack of long-term health and wellness data is acceptable. So far no longitudinal studies have been done to determine the effects of these medications on egg donors several years after a donation cycle.  ASRM insists that egg donation is safe when women are properly screened and treated, but acknowledge that there are risks associated with the drugs.

Women’s health advocates disagree, questioning how drugs can be deemed as “safe” without long-term data. Currently, there is an absence of long-term egg donor health and wellness data, in part because the technology is relatively new and also because there are a limited number of ongoing research projects addressing the issue.

Women’s health advocates are also concerned about the “off-label” use of Lupron, one of the drugs commonly used in egg donation.  A drug that is used in a way that is different from that described in the FDA-approved drug label is called “off-label.”  Lupron was originally developed to treat advanced prostate cancer in men, endometriosis or fibroid tumors in women, and premature puberty in children. This “off-label” drug - while legal in the United States, has not been approved by the Food and Drug Administration for use in multiple egg extraction - is a major concern for advocates when paired with the lack of long-term data on Lupron.

Resources:
1) Egg Donation for IVF and Stem Cell Research: Time to Weigh the Risks to Women’s Health – Resource Page raising questions about egg donation safety
2) The Surrogacy Lawyer – discusses the risks as acceptable, when undertaken by a consenting adult.

Controversy: Unclear data about OHS

Currently, there are disagreements about the percentages of women who suffer  from OHSS, and other facts and figures pertaining to egg donation.

Can I get pregnant while taking these medications?

The medications will temporarily increase your fertility. Because of this, many programs will require you to abstain from vaginal sexual intercourse with a male at this point to protect against unwanted pregnancy.

Consideration: Pregnancy

Due to the number of eggs that are stimulated by these drugs, there is a possibility of becoming pregnant with twins, triplets and quadruplets if having unprotected intercourse.