This blog post is for all women who are thinking about becoming an egg donor and all intended parents using an egg donor. Since my journey through egg donation and in my career as a donor coordinator, I have noticed a gap that needs to be filled: the lack of education surrounding the ovarian stimulation and egg retrieval process associated with egg donation.
It has become my mission to close this gap, as I think it is important for parents using donor eggs and egg donors alike to fully understand the stimulation process in order to have a comprehensive grasp on the process.
The very first thing I want to bring up is ovarian stimulation is done with hormone injections. I have spoken to many donors and parents alike that did not realize that we use injectable hormones in order to stimulate a donor’s ovaries. The injections are done subcutaneously (SQ), which means they use a smaller needle that penetrates the skin and is injected into the fat around the belly button, as opposed to intramuscular injections that have a longer needle that can inject medication into the muscle under the skin and fat layers. For reference, the needles used in the SQ injections are most similar to insulin needles.
A typical ovarian stimulation starts by injecting medications that mimic the Follicle Stimulating Hormone (FSH) that women naturally produce in their pituitary gland. Generally clinics use medications called Gonal-F and Menopur. These can be given separately or be used in combination. When being done in conjunction with one another, Menopur and Gonal-F can either be mixed together and given in a single injection, or be done as two separate injections, depending on clinic preference. These FSH medications are done in the evenings for about 8-12 days, depending on ovarian response. Their whole function is to stimulate the follicles on your ovaries to mature the egg that is being held in that follicle. These mature eggs are the ones that are retrieved during the egg retrieval.
Since it is our body’s natural response to ovulate once one follicle reaches the mature size, about midway through an ovarian stimulation, a donor will begin a second injection that is done in the mornings. This hormone’s job is to keep the donor from ovulating before the clinic is confident that most of the follicles are of the proper size to be housing a mature egg. It is done in addition to the Menopur and Gonal-F injections so that the follicles can continue to grow and mature, while being stopped from ovulating prematurely. The medication typically given for this injection is either Cetrotide or Ganirellix. This is also a SQ injection and is done for about 4-6 days.
Finally when most of the follicles are at the proper size, the trigger injection is scheduled. Once this is scheduled, the Gonal-F, Menopur, and Cetrotide injections will stop. The trigger injection is a timed injection, meaning the donor will be given a very specific time to administer the shot. This medication causes the donor to ovulate approximately 36 hours after it is injected. For donors, a medication called Lupron is the most common trigger, but sometimes HCG is used as well. Lupron is the ideal medication for trigger because it lessens the likelihood that the donor will develop OHSS (ovarian hyperstimulation syndrome), but is essential that when using Lupron, the donor takes it as instructed, because it is impossible to know if it was taken properly until the retrieval is done. When HCG is used, a urine pregnancy test can confirm whether or not the trigger injection was taken, which is why it is sometimes used in combination with Lupron.
The egg retrieval will be scheduled for 36 hours after the trigger shot was taken. After the trigger shot, the donor is done with all injections. For a retrieval, a donor will be put under anesthesia. The donor will not be intubated, but will be in a very deep sleep. The attending physician at the clinic will use a transvaginal ultrasound probe and a long needle, and will use the ultrasound to guide the needle into each follicle. The doctor will use the needle to extract the fluid in the follicle as well as the egg that is housed in the follicle. The whole procedure takes about 30 minutes and the donor will recover in the clinic for about 1-2 hours and then will return to either their home if they’re donating locally or to the hotel that they are staying in. For a donor, a typical recovery time post-retrieval is about 2-4 days depending on the amount of follicles they had. Often pain medication is prescribed to help manage pain.
It is crucially important for all women considering egg donation to be educated on the process so that they can understand what they are doing to their bodies as they begin their journey to help another family achieve their dream of having a child. As with any medical procedure, there are some side-effects and risks that are generally mild and include things like bloating, cramping, and fatigue. Understanding all of this will help prepare all those involved in the egg donation process both for the stimulation and how to support those going through the stimulation. If you have any questions or want to learn even more about the stimulation process, feel free to email our donor coordinator at vfdelima@lanefertility.com or visit our website at www.fertilitylanedonoreggs.com
