Monday, October 16, 2006

Risks of egg donation - new research

Approximately 3% of women who undergo egg stimulation and treatment will develop severe ovarian hyperstimulation syndrome. 1% will have pain that requires hospitalization.

The risks of egg donation is the subject of a newspaper article in the Kansas City Star, in anticipation of the vote in November on stem cell research.

Of course, the focus of much of the debate is on the ethics of embryonic stem cell research. Embryonic stem cell research requires that embryos be destroyed and in order to study and produce human embryonic stem cells. In order to get human embryos, you need human oocytes or eggs.

Most of us probably know at least one woman who has undergone the hormone treatments to stimulate egg production. The series of shots reset the menstrual cycle and cause the woman to produce more than the usual one or two eggs. The hormones can have side effects that can range from uncomfortable to life-threatening. Ovarian Hyperstimulation is one of the side effects and can be mild or it can cause fluid build up in the lungs and abdominal cavity, and a risk of blood clots.

Retrieval of the eggs is normally done transvaginally. A laparascopic needle is placed into the pelvic cavity through the wall of the vagina, in order to get to the ovaries where the eggs are.

Because infertility treatment and especially in vitro fertilization and embryonic research has not been federally funded - and because the whole abortion/women's rights/compassion for infertile women conversation is a touchy political issue - there is also very little oversite and even less formal reporting of side effects and complications.

Since there's little reporting, there's not much information available in the medical literature about the risks. However, there is finally information on the short term effects, even if none on the long term effects, yet.

A prospective cohort study (the patients are identified in advance and followed through the study period) of over a thousand women who underwent oocyte retrieval (OR) in Germany has been published on line at Human Reproduction, (in advance of actual printing in the dead tree version). The abstract, or outline is available for free on line. Here's the results:

RESULTS: A total of 1166 OR were performed during the study period, of which 1058 (90.7%) ORs were included prospectively. Incomplete data meant that the remaining 9.3% were excluded. No complications were caused by sedation or general anaesthesia. Vaginal bleeding was observed in 2.8% of procedures, without any cases of intra-abdominal bleeding. An injury of pelvic structures (a ureteral lesion) occurred in one case. No case of pelvic infection, but one case of unexplained fever, was observed. A severe ovarian hyperstimulation syndrome (OHSS) occurred in 2.7% of cases. Although most patients tolerated the OR well, 3% of patients experienced severe to very severe pain after the OR and 2% of patients were still suffering from severe pain 2 days after the procedure. The pain level increased with the number of oocytes retrieved. About 0.7% of patients required hospitalization for pain treatment.



Resource:
Ludwig, AK, et. al. ”Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of greater than 1000 oocyte retrievals.” Human Reproduction, Advance Access published on July 27, 2006.

1 comment:

Suricou Raven said...

There was something in New Scientist recently that caught my attention - I dont know much about it, but there is a new technique in development, "In vitro maturation." Rather than use drugs to induce hyperovulation, it harvests immature egg cells direct from the overy and allows them to mature outside the body... I expect you already know all the details better than me :)

From what little I know, its still some way from being ready for use in humans, but I see potential. Much safer, without the drug.