What is it Like to Undergo Egg Donation?

October 15, 2023 Bryan McColgan, MD

I have written several articles on my own journey to fatherhood (https://medium.com/@babymoonfamily/the-beginning-of-our-surrogacy-journey-d5beb833a23b and https://medium.com/@babymoonfamily/masturbating-in-a-clinic-as-a-queer-dad-to-be-44e81dbf7b25), and while the focus for queer men who are undergoing IVF and surrogacy is often on selecting an egg donor, I thought it was important to first highlight what women undergo to be egg donors.

Especially for international queer intended parents (IPs) working with clinics and agencies in the United States, some parts of the journey to fatherhood can seem a bit ‘remote.’ International male IPs really have only two instances when they have to be in the United States: sperm donation and the birth of the child. While many queer IPs choose to travel for many more appointments, sometimes this is not financially feasible.

Added to this ‘remoteness’ is the process of embryo creation for queer male IPs. After donating sperm for analysis and freezing, international male IPs return to their home country. Once the genetic testing results are finalized and assuming their sperm testing and FDA required lab testing is normal, they can proceed with selecting an egg donor.

The platforms or databases that clinics and agencies have for egg donation are very much like a Facebook profile, with a plethora of medical information. There is obviously the all important photo album, often including developmental photos from childhood, adolescence, and adulthood, and sometimes including pictures of their own children as well. Then you have detailed information on their individual medical history, as well as that of their immediate family members for at least two generations. They often state their willingness to be contacted or to have an open, semi-open, or closed relationship with the child and IPs, as well as answer personal questions and write autobiographical statements to highlight their passions, interests, and motivations for egg donation.

While there is a great deal of information on these profiles, it is not common or expected that IPs will talk with or ever meet the egg donor. There is nowhere near the same personal relationship or connection that develops with the gestational carrier (GC), but that does not diminish this woman’s contribution or engagement with the process. After all, she is contributing her genetic material, and the process — especially for queer male IPs — would never be possible without her. Therefore, I wanted to briefly describe the medical procedures for egg donation and the possible risks and complications to highlight what women can experience in order to emphasize their incredible contributions for queer men to become fathers.

There are three main stages in the process of egg donation: Screening, stimulation, and retrieval (1).

Screening of an Egg Donor

Even before a woman can undergo the procedure of producing and giving her eggs, she must undergo a series of rigorous medical and psychological screenings. In terms of psychological screening, the woman is required to have a session with a psychologist to demonstrate her understanding of the procedure, the benefits and risks, and to discuss her motivations for proceeding. From a medical perspective, she must undergo genetic testing, infectious disease screening, and drug testing. Finally, her fertility has to be assessed, usually with a combination of blood testing and ultrasound examination. The blood test is known as an anti-mullerian hormone or AMH testing (2). AMH testing can estimate a woman’s ovarian reserve, or roughly how fertile she is. AMH levels vary depending on age. In women, AMH levels start rising during adolescence and peak around 25 years old. After that, AMH levels naturally decline. In addition to AMH testing, women may also undergo a vaginal ultrasound during their menstrual cycle in order to visualize the follicle or egg development in the ovaries.

Stimulation of an Egg Donor’s Ovulation Cycle

In a natural state, the hormonal axis of reproduction begins with messaging from the region of the brain called the hypothalamus in the form of gonadotropin releasing hormone (GnRH). GnRH signals the pituitary gland to secrete luteinizing hormone (LH) and follicle stimulating hormone (FSH), in order to signal the development and maturation of the ovary. The same hormones are also responsible for sperm production in male testes, as shown below.

Source (3)

During the egg donation process, this hormonal axis has to be manipulated in order to produce more eggs and to time the retrieval of those eggs. In order to accomplish this, egg donors embark on a strict schedule of hormonal treatments and ultrasound examinations.

The first stage of the treatment includes daily self injections of Lupron, which is an analogue of GnRH. This hormone serves to ‘reset’ the axis, and by injecting it for between 7 and 14 days, women are able to prevent any further ovarian development and release in order to store as many eggs as possible for stimulation in the subsequent steps. After the Lupron cycle of injections is complete, the next stage is 8 to 10 days of daily self injections of FSH. This will increase the production of follicles in the ovaries, allowing for the retrieval of as many eggs as possible. During this stage, women are in the clinic almost daily for additional monitoring through vaginal ultrasounds in order to assess the follicle stimulation progress.

Retrieval of Eggs

Once the course of FSH is complete and the ultrasound monitoring indicates that the follicles are of appropriate size and quantity, the eggs can be retrieved. This is the most invasive portion of the process. In order to initiate the retrieval, another hormone — human chorionic gonadotropin (HCG) — is injected once, approximately 36 hours prior to retrieval. This hormone prepares the donor’s ovaries to release the stimulated eggs. For the procedure, women undergo light sedation, and then using an ultrasound for guidance, the physician will pass a needle through the vaginal wall in order to aspirate, or retrieve, the eggs. The procedure is generally about 30 minutes in duration, and the donors are able to go home about one hour after the procedure is completed. They can then assume normal activities the following day, assuming there are no complications.

While I enjoy writing as a descriptive exercise, videos often provide an excellent source of information, especially when it comes to physiology and medical procedures. This video from the Cleveland Clinic provides a great overview of the egg donation process, with Steps 2 and 3 focusing on the preparation and retrieval of the eggs: https://www.youtube.com/watch?v=fnYBLYfFx2Y.

Risks

As with any medical procedure, there are risks involved with egg donation. Even assuming the process goes without any complications, it is worth highlighting the inconvenience, pain, and time associated with egg donation: Daily, self-administered injections for weeks, numerous vaginal ultrasounds, and commuting almost daily back and forth to the clinic. These alone require huge effort and dedication and deserve to be recognized.

In terms of risks and possible complications, most patients tolerate the self-administered hormonal injections well, but there is a possibility of pain, redness, or minor bruising at the injection or blood draw site. With regard to the retrieval procedure, there is a 1 in 1,000 person risk of serious complications, which could include bleeding that requires observation in the hospital, blood transfusion, or both; damage to internal organs; and infection. Lastly, the hormonal medications themselves pose a risk of inducing ovarian hyperstimulation syndrome (OHSS). Because the procedure’s intent is to maximize egg production and retrieval, the hormonal stimulation can result in overproduction, and OHSS has a spectrum of potential symptoms. In the mild form, swelling of the ovaries, bloating, weight gain, and abdominal pain are common and resolve within several days. In a more severe form, occurring about 1% of the time, there can be rapid weight gain, severe abdominal swelling or pain, shortness of breath, nausea and vomiting, and even blood clots. The severe form can require hospitalization for monitoring and management, and it generally resolves within about a week (4).

It is also worth noting that while there is no evidence that egg donation increases risk of infertility, it is well known that women have a limited egg reserve. Unlike men, who produce sperm throughout their lifetimes, women are born with all the eggs they will ever have. At birth, a woman has around 6 million ovaries. By the time a woman reaches puberty, she has about 400,000 remaining eggs. During a women’s reproductive time period, she loses about 1,000 immature eggs each month. By the time a woman is 40 years of age, she has about 10% of her total egg supply remaining (5). Given the process of egg donation is meant to develop and retrieve as many eggs as possible, it is not known if these eggs are all ones that would never have developed or if they are ones that could have been fertilized. Again, the current evidence does not suggest that women who undergo egg donation are any less fertile when they attempt to have their own children, but this is an area where more research is needed.

Given the time, effort, risks, and potential complications with egg donation, it is very important that we — especially as queer male IPs — recognize the tremendous and vital role that they play in making parenthood a reality. Of course there is compensation involved, but, like GCs, that is not the only reason these women do this. The vast majority feel a tremendous motivation to help other people, and they sacrifice and undergo a great deal to do this through egg donation. We should celebrate them and know what they experience in order to have the utmost respect and admiration for them.

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