When considering egg donation, one of the first questions most women ask is: Are there risks? Unfortunately, this is one of the most difficult questions to accurately answer. Most clinic and agency websites, and advertisements to recruit egg donors, state that egg donation is safe and that the "risks are less than 1%." "Less than 1%" sounds reassuring; however, this number is not accurate, due to little short-term—and no long-term—research on egg donor health and well-being.
In reality, no one knows how frequently egg donors experience side effects from the fertility drugs, surgical complications, or immediate or long-term complications because there has been no research conducted on egg donors’ experiences over time. Most of the information available in scholarly journals pertains specifically to women who have undergone egg retrieval for their own fertility treatment—not egg donors, who are younger and more fertile. This is one reason why I started my research on egg donors—so that women considering egg donation can have more information about the range of egg donors' experiences, make informed decisions, and know how to advocate for themselves throughout the process, should they decide it is something they want to do.
What We Know
Every medication has possible side effects. Every time a person undergoes a medical procedure there are possible surgical complications, as well as possible reactions to anesthesia and post-surgical infection. We do not know how frequently egg donors experience either side effects from the drugs or surgical complications because no one is systematically keeping track of this information. Different clinics may also have different egg donor outcomes, depending upon the protocols they use, how many eggs they aim to take, and the skill of the person performing the surgery.
For egg donation, there are different categories of complications, that can occur at different stages of the process, some of which are more serious than others. These can include:
- Fertility drug side effects
- Surgical complications and reactions to anesthesia
- Post-retrieval complications
- Ovarian Hyperstimulation Syndrome (OHSS)
- Ovarian Torsion
Fertility Drug Side Effects
There are different types of fertility drugs used during an egg donation cycle. Some are commonly used by women to prevent pregnancy, such as birth control pills. Other drugs are used to stimulate the ovaries to produce more eggs. And others are used to release the eggs from the follicle so they can be surgically retrieved. Different medication protocols have different effects on your body, and no two women are alike. Some medication protocols require more injections than others over a longer period of time, and some physicians may prescribe higher dosages than others, both of which expose your body to more hormones.
It is important to understand what fertility medications you'll be taking and the effect they can have on your body. Some of the commonly used medications and their immediate side effects can include:
- Lupron—Dizziness, body pain, headaches, hot flashes, appetite loss, nausea or vomiting, trouble sleeping, constipation, redness at the injection site, bone pain
- Pergonal—Abdominal or stomach pain, bloating, chest pain or trouble breathing, decreased amount of urine, feeling of indigestion, general feeling of discomfort or illness, headache, nausea, vomiting, or diarrhea
- Gonal-F—headache, nausea, vomiting, stomach/abdominal pain, pelvic pain, bloating, injection site reactions (redness or pain), breast swelling, numbness, runny nose, sore throat, acne, skin rash, swelling, weight gain
- Follistim—severe abdominal pain, shortness of breath, nausea, diarrhea, bloating, vomiting, swelling in hands or legs, weight gain, numbness, pain or redness at injection site
- Ganirelix—nausea or vomiting, diarrhea, shortness of breath, severe pelvic pain, swelling in hands or legs, stomach bloating, headache, vaginal bleeding, pain or redness at injection site
- Fertimax/Clomid—headache, upset stomach, bloating, dizziness, vaginal bleeding, mood changes, breast tenderness
- Cetrotide—nausea/vomiting, headache, pain/bruising at injection site, rapid weight gain, rapid fluid build up in stomach/chest/heart area (OHSS), decreased urination
- hCG—headache, irritability, restlessness, fatigue, depression, swelling in feet/legs, pain at injection site, blood clots, rupturing or swelling of ovaries, increased risk for OHSS
Different women react differently to these pharmaceuticals. Some may have no or minimal adverse reactions, and others may have severe allergic reactions and need to be seen by a doctor immediately. Throughout an egg donation cycle, if any of the medications cause you to feel dizzy enough to faint or cause serious discomfort you should call the clinic right away.
The ovaries are near other major organs and arteries in the body. With almost any surgery there are risks of injuring surrounding organs. In some cases, there may be heavy bleeding from the ovaries following egg retrieval. Pelvic infection within days following retrieval can also occur. If you wake up from your retrieval in severe pain or feel light-headed or dizzy before you are sent home to recover, don't leave the retrieval without being seen by a doctor.
If you have any doubt about your health post-retrieval or any concerns at all, it is important to contact the clinic or, if necessary, go to the emergency room. If your clinic or agency tell you what you are experiencing is “normal” and will go away in a few days, trust your gut and ask to be seen, to be on the safe side. Your health and future fertility are important, and you are your own best advocate.
Within one-to-two hours after the retrieval, you will likely be sent home with antibiotics in order to prevent infection. It is a good idea to rest for at least the rest of the day, if not a few days. Some donors recover within a few hours after retrieval surgery and can get back to a normal routine pretty quickly. Others may experience pain, swelling and bloating. The doctor should have you come back for an exam and ultrasound about a week after retrieval, to make sure your recovery is on track.
If you feel back to normal pretty quickly after your retrieval surgery, it is still important not to engage in any vigorous exercise like running, yoga, horseback riding, or other activity for at least several days, and possibly not before you have a regular menstrual period. While you may be able to get away running a marathon the next day, it’s not worth the risk. Some donors who return to normal activities too soon could put themselves at risk for ovarian torsion.
Ovarian torsion is a medical emergency that must be treated immediately. Torsion can occur when undergoing hormonal treatments because the ovary becomes enlarged due to producing a large number of fluid-filled follicles. Ovarian torsion can occur with or without OHSS, but the risk increases with OHSS. For several days to weeks after an egg donation cycle, your ovaries are still not down to their normal size. Any activity, including most types of exercise, can cause an enlarged ovary to twist in your body, cutting off blood supply to the ovary. Some women have experienced ovarian torsion even a month or more following egg retrieval. If you have any ongoing pain in your ovary it is important to be seen by a doctor right away. In some cases—especially if you delay seeking care—the doctor may need to remove your ovary.
Ovarian Hyperstimulation Syndrome (OHSS)
One of the most common complications directly related to donating eggs is known as ovarian hyperstimulation syndrome (OHSS). If it is taking you more than a few days to recover, or if you experience continued pain or bloating, this is not normal and could be a sign of OHSS.
OHSS can occur in women who inject hormone medications to stimulate the ovaries to produce more eggs. Egg donors, women who are freezing their eggs and women undergoing their own infertility treatment are all at risk for OHSS. Factors that increase the risk for OHSS include:
- People with polycystic ovary syndrome (PCOS)
- Under the age of 30
- Low BMI, or body weight
- Large numbers of follicles (generally over 20)
- A steep increase in estrogen levels before an hCG trigger shot
- Prior experience with OHSS
- hCG trigger shot
OHSS symptoms can begin during the stimulation phase of the cycle, within 10 days of injecting hormones to stimulate ovulation. In some cases, if left untreated, OHSS can be life-threatening. It is best to call the doctor at the clinic that performed your retrieval immediately if you notice any signs of bloating post-donation. If you are working with an agency, you should call your donor coordinator as well.
There are different levels of OHSS:
- Mild—abdominal bloating and/or pain, usually goes away within a few days.
- Moderate—abdominal pain, nausea, vomiting, swollen ovaries, rapid weight gain, abdominal bloating, possibly difficulty breathing. May go away on its own within a week to ten days. Bed rest may be required.
- Severe—all of the above plus difficulty urinating, difficulty breathing, continued weight gain and abdominal bloating, blood clots, increasingly swollen ovaries. Call your doctor and go to the emergency room immediately. You may need to have fluid drained from your body. Severe OHSS occurs in about 1-2% of fertility patients according to research; donors’ rates of OHSS are unknown due to lack of research.
- Critical—if OHSS is left untreated, the kidneys and other organs can begin to shut down. Hospitalization is required. Recovery can take several weeks or more.
What We Don't Know—Are There Long-Term Risks?
Due to lack of research, long-term risks of ovarian stimulation are unknown—especially for egg donors, but also for women undergoing their own fertility treatment. There are former egg donors who have had cancers, infertility, endometriosis, and other conditions, but we do not know if these conditions are directly linked to their egg donations, or if they would have had these conditions anyway. Further research is needed to track donor health over time, and to compare women who donated eggs with women of the same age who did not. To date, this has not been done.