Prospective Oocyte Donors Research Articles

The Influence of Socio-Cultural Factors on Oocyte Donors' Motivations and Disclosure Decisions

The study focuses on the motivations of Russian oocyte donors and the socio-cultural factors affecting these motivations. We conducted 16 semi-structured interviews with actual or prospective oocyte donors. All of them were patients of two fertility clinics located in the city of Yekaterinburg (Russia) planning to become oocyte donors within the period from 2 weeks to 3 months. We built a profile of a Russian oocyte donor: it is a 26-year-old married woman with at least one child; she has a secondary vocational education and a low income. All the women in our study displayed multiple motivations: apart from the interest in a financial reward and purely altruistic motivations, for many women the decisive factor is their desire to help their friends or relatives struggling with infertility. Interestingly, almost all of our respondents described their decision to donate as an attempt to move past a traumatic situation they once endured and to achieve closure by doing something really important and good. For many women, oocyte donation becomes a way to boost their self-esteem, to feel more significant and to promote their personal autonomy. As for barriers to donation, one of the most important is associated with the donors' unwillingness to make their identity known and to share this information even with their close circle of friends and relatives. For the majority of donors, anonymity is crucial. The disclosure of this information, in their view, will cause controversy in the donor's family and immediate circle of friends at present and will threaten their privacy in the future. The prospective donors are also concerned about the negative public attitudes or lack of understanding.

Medical research and reproductive medicine in an ethical context: a critical commentary on the paper dealing with uterine lavage published by Munné et al.

A recent study published in Human Reproduction claimed that uterine lavage offers a non-surgical, minimally invasive strategy for the recovery of human embryos from fertile women who do not want or need IVF for medical reasons but who desire preimplantation genetic testing (PGT) for embryos. To prove this hypothesis, the researchers recruited dozens of young Mexican women. The prospective oocyte donors underwent ovarian stimulation to induce the production of multiple mature oocytes. Subsequently, these women were inseminated by donor semen. A few days later, the developing embryos were collected by uterine lavage (uterine flushing) and subjected to genetic testing for aneuploidies (PGT-A). Oocyte donors with persistently elevated hCG levels, indicating the implantation of one or more embryos after uterine lavage, had to undergo uterine curettage and/or treatment with methotrexate. A critical opinion paper discussing the aforementioned study was published by De Santis and colleagues and has raised critical issues that are largely technical in nature. However, this opinion paper neglects-from our point of view-critical issues of the Mexican study regarding ethical principles and moral standards in human research. These aspects are summarized below.

Oocyte donors' comprehension as assessed by the EDICT (Egg Donor Informed Consent Tool)

To assess oocyte donors' comprehension of the process and potential risks of oocyte donation using the EDICT (Egg Donor Informed Consent Tool). Prospective cohort study. University-based, tertiary reproductive health practice. Prospective oocyte donors. Donors (N = 65) participated in an audiovisual informational session, and met with a reproductive endocrinologist individually. Donors then completed the Subjective EDICT and Objective EDICT. We report scores on Subjective and Objective EDICT, scores stratified for demographic variables, relationship between Subjective and Objective EDICT scores, and the effect of counseling on scores. In general, our cohort of oocyte donors performed well on both objective and subjective portions of the EDICT. We verified the effect of counseling on EDICT scores by comparing before and after counseling scores and demonstrating significant gains. There was no significant correlation between Subjective and Objective EDICT scores. For the first time, we report oocyte donors' comprehension of oocyte donation as assessed by the EDICT. Reassuringly, we demonstrate that oocyte donors have adequate subjective and objective comprehension of the process and risks associated with oocyte donation. We also demonstrate that oocyte donor comprehension is significantly impacted by physician counseling efforts. In addition, scores on perceived understanding (Subjective EDICT) did not predict scores on performance-based comprehension (Objective EDICT). The lack of correlation between the two scores further underscores the utility of a performance-based tool, as relying on a donor's self-report (e.g., simply signing a consent form to indicate understanding) may not reflect her actual understanding.

Egg Donor Informed Consent Tool (EDICT): development and validation of a new informed consent tool for oocyte donors

To develop and validate a novel tool to assess the objective and subjective understanding that oocyte donors have of the process and potential risks of oocyte donation. Prospective cohort study. University-based tertiary reproductive health practice. Prospective oocyte donors. We developed an informed consent questionnaire specific to oocyte donors, the Egg Donor Informed Consent Tool (EDICT), using published informed consent guidelines and known egg donation risks. We assessed content validity, readability, and reliability after pilot testing of the EDICT. The Subjective EDICT assesses donors' perceived understanding, and the Objective EDICT measures donors' actual knowledge. Questions cover the process of oocyte donation, potential risks, and legal and psychologic issues. We demonstrated good content validity, a readability level consistent with readability goal of informed consent documents, and good reliability on pilot testing. For the first time, we describe development of a valid and reliable new tool for assessing oocyte donors' understanding of the process and risks associated with oocyte donation.

Egg donor informed consent tool (EDICT): oocyte donors' understanding as assessed by a novel valid informed consent tool

Some states have outlined specific information to be provided to oocyte donors in the informed consent process. However, there is currently no method to assess whether donors actually understand this information and as such, can provide true informed consent. Objectives: 1. Develop and validate a novel tool (EDICT) to assess prospective oocyte donors' understanding of egg donation and its potential risks 2. Assess oocyte donors' subjective and objective understanding of egg donation using the EDICT.

Evaluating the necessity for universal screening of prospective oocyte donors using enhanced genetic and psychological testing

To minimize the potential for harmful inheritable conditions, donors are rigorously screened according to standard guidelines, yet such guidelines may not be sufficient to exclude egg donors with certain known inheritable conditions. We compared universal screening of oocyte donors with Tay-Sachs, Fragile X, karyotype and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) versus standard American Society of Reproductive Medicine (ASRM) guidelines that do not include such testing. In this 12 year retrospective cohort study, results of enhanced universal screening of all anonymous oocyte donor candidates from 1997 to 2008 at a university hospital oocyte donation program were reviewed. Primary outcomes were the frequency of oocyte donor candidates excluded as a result of enhanced universal screening (Tay-Sachs, Fragile X, karyotypic analysis and MMPI-2) versus basic screening according to ASRM guidelines. Of 1303 candidates who underwent on-site evaluation, 47% passed the screening process, 23% were lost to follow-up and 31% were excluded. Genetic and psychological factors accounted for the most common reasons for candidate exclusion. Enhanced genetic screening excluded an additional 25 candidates (19% of all genetic exclusions) and enhanced psychological screening excluded an additional 15 candidates (12% of all psychological exclusions). Altogether enhanced screening accounted for 40 candidates (10%) of the total pool of excluded candidates. Although our study is limited by its retrospective nature and center-specific conclusions, we show that enhanced comprehensive screening can exclude a significant number of candidates from an oocyte donor program and should be encouraged to assure optimal short-term and long-term outcomes for pregnancies achieved through oocyte donation.

Enhanced screening of prospective oocyte donors: a ten-year review

OBJECTIVE: To report on our results using enhanced oocyte screening methods and to assess the value of such measures in a large oocyte donation program. DESIGN: Retrospective analysis at a university-based IVF center from 1997-2006. MATERIALS AND METHODS: After passing initial questionnaire screening, donor candidates were examined in accordance with ASRM guidelines, which included a health status questionnaire, on-site consultation and examination with a physician and psychologist, and the mandatory tests for infectious disease, drug use, and cystic fibrosis. Enhanced screening included: face to face consultations with a genetic counselor, the Minnesota Multiphasic Personality Inventory (MMPI), universal screening for Tay Sachs, Fragile X (as of 2005), and karyotypic abnormalities. Recipient husbands were tested in the case of Ashkanazi matches. RESULTS: Of 1,071 candidates presenting for on-site evaluation, 511 (48%) passed the screening process, of whom 474 (93%) donated. Twenty percent (n=212) of candidates withdrew their applications, and 560 (32%) failed screening. Candidates failed due to genetic factors (11%), psychological factors (10%), medical conditions (6%), infectious diseases (3%), and positive drug screens (2%). Of the 121 candidates rejected for genetic factors, 68 were for abnormal genetic testing and 53 for a personal/family history suggestive of a transmissible genetic trait, such as dyslexia, early cardiac disease, and aggressive cancers. There were 29 cystic fibrosis mutation carriers, and 12 abnormal hemoglobin electrophoresis patterns. Enhanced screening accounted for 21% of the genetic exclusions, with 9 Tay Sachs carriers, 6 inconclusive Tay Sachs results, 8 abnormal karyotypes, and 2 Fragile X carriers (intermediate range). Of the 112 candidates excluded for psychological factors, 24 had a personal history of a psychological disorder, 28 with unacceptable behavioral traits, and 44 with a family history of psychological disorders. Enhanced screening accounted for 14% of the psychological exclusions, as 16 had an elevated MMPI score. CONCLUSIONS: While enhanced oocyte donor screening uncovers a significant number of donors with potential problems, it also reduces the numbers of available donors. Programs may want to use the information presented here to determine if some or all of the elements of enhanced donor screening should be incorporated into their protocols.

Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles

A retrospective study was conducted in a private infertility centre to evaluate the rate of complications in a large oocyte donation programme. A total of 4052 oocyte retrievals were performed between January 2001 and October 2007. Altogether, 1238 cycles (30.6%) were stimulated with the use of gonadotrophin-releasing hormone (GnRH) agonists and in 2814 cycles (69.4%) the GnRH antagonist protocol was used. The GnRH antagonist treated cycles were triggered with human chorionic gonadotrophin (HCG) or a GnRH agonist in 1295 and 1519 cycles, respectively. Complications related to oocyte retrieval occurred in 17 patients (0.42%) (intra-abdominal bleeding: n = 14, severe pain: n = 2, ovarian torsion: n = 1). Fourteen of these were hospitalized (0.35%) and six donors (0.15%) required surgical intervention. Pelvic infections, injury to pelvic structures or anaesthesiological complications were not observed in this series. Moderate/severe ovarian hyperstimulation syndrome (OHSS) occurred in 22 donors; 11 required hospital admission and 11 were managed on an outpatient basis. All cases were related to HCG triggering (0.87%). Serious complications related to oocyte retrieval occurred at a low rate in healthy young donors. The risk of OHSS can be substantially reduced by specific stimulation protocols, which include GnRH agonist triggering. Prospective oocyte donors should be adequately counselled about the risks related to egg donation.

Alternative solutions to the current situation of oocyte donation in Singapore

The rising incidence of age-related female infertility in Singapore, coupled with the prohibition on commercialized oocyte donation and egg sharing, has resulted in a severe shortage of donor oocytes. Infertile women are routinely encouraged by fertility doctors here to seek their close relatives and friends as prospective oocyte donors, which does not alleviate the shortage. A number of alternative solutions are discussed. The use of substantial financial remuneration to encourage oocyte donation is rejected as being legally, ethically and morally incompatible with present day Singaporean society. Egg sharing in return for subsidized fertility may have a strong case for ethical justification, but implementation would need amendment of the current legislation in Singapore. Cross- and mirror-exchange oocyte donations face less of a legal challenge in Singapore and also have a strong case for ethical justification. However, special consideration must be given to the unique socio-cultural values of Singaporean society, i.e. traditional Chinese culture. Finally, if no changes are made to restrictive regulations governing oocyte donation in Singapore, and shortage of donor oocytes still persists, then reproductive tourism abroad may be the solution for some patients; referrals by local fertility doctors are unlikely to be allowed in Singapore.

Ethical issues in paying for long-distance travel and accommodation expenses of oocyte donors

In many countries where the sale and purchase of donor oocytes is banned, a legal loophole often exploited is the use of free air tickets and hotel stay to entice prospective oocyte donors, in lieu of monetary payment. Such a means of procuring much-needed donor oocytes is ethically unsound. There is a lack of transparency and the personal motivation of the oocyte donor may be clouded by the desire for a ‘free’ holiday. Moreover, such a system is open to abuse by medical professionals. Private fertility clinics may source for oocyte donors to attract patients. The oocyte donor is paid nothing (except free travel and hotel stay), while the medical professional makes a handsome profit from treating infertile patients, which is not equitable. Medical professionals can also easily make a profit by marking up the price of air tickets and hotel stay to the patient (oocyte recipient). This would be thoroughly unprofessional, since the money earned is not directly related to the medical skills and expertise of the fertility specialist. Hence, it is imperative that various regulatory authorities should critically re-examine the giving of free travel and accommodation to oocyte donors, instead of monetary compensation.

Financial incentives in recruitment of oocyte donors

Financial incentives in recruitment of oocyte donors

Psychological screening of prospective oocyte donors

Objective: To report our experience with psychological screening of potential oocyte donor candidates and to assess the frequency with which psychological issues resulted in the exclusion of donor candidates.Design: Retrospective analysis of the psychological screening outcomes for anonymous oocyte donor candidates from 1997 to 2001 at a large university-based oocyte donation program.Materials/Methods: Psychological evaluation of potential oocyte donation candidates included testing with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as well as a clinical interview with a staff psychologist.Results: Of 607 potential donor candidates, 63 were rejected based on psychological testing results and a clinical interview. Candidates could be excluded based on their family’s histories or their own personal history. Eighteen candidates were excluded because of a significant family history of mental illness, suicide, substance abuse, criminal arrest, or learning disabilities. Alcohol abuse or learning disabilities evident in two or more family members including grandparents, aunts, uncles, first cousins and immediate family members was necessary for exclusion. Forty-five candidates were excluded based on their personal histories for the above criteria. Other reasons for exclusion in these cases included unresolved issues as a result of physical or sexual abuse, misrepresentation in the clinical interview, immaturity, or marital dispute about ovum donation. Of the 63 cancelled donors, only 6 donors were eliminated based on MMPI-2 findings alone, and in each case the clinical interview validated the test results. An additional five candidates who would have been excluded by the psychological screening were cancelled for genetic or medical reasons. Thus, 68 (11%) of the oocyte donor applicants had psychological findings that excluded them from proceeding with the donation.Conclusions: Psychological testing and a clinical interview may exclude a significant number of donor candidates in an ovum donor program. Screening should be encouraged to optimize the donor’s experience and safety and to minimize negative outcomes in pregnancies achieved through oocyte donation.Supported by: None. Objective: To report our experience with psychological screening of potential oocyte donor candidates and to assess the frequency with which psychological issues resulted in the exclusion of donor candidates. Design: Retrospective analysis of the psychological screening outcomes for anonymous oocyte donor candidates from 1997 to 2001 at a large university-based oocyte donation program. Materials/Methods: Psychological evaluation of potential oocyte donation candidates included testing with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as well as a clinical interview with a staff psychologist. Results: Of 607 potential donor candidates, 63 were rejected based on psychological testing results and a clinical interview. Candidates could be excluded based on their family’s histories or their own personal history. Eighteen candidates were excluded because of a significant family history of mental illness, suicide, substance abuse, criminal arrest, or learning disabilities. Alcohol abuse or learning disabilities evident in two or more family members including grandparents, aunts, uncles, first cousins and immediate family members was necessary for exclusion. Forty-five candidates were excluded based on their personal histories for the above criteria. Other reasons for exclusion in these cases included unresolved issues as a result of physical or sexual abuse, misrepresentation in the clinical interview, immaturity, or marital dispute about ovum donation. Of the 63 cancelled donors, only 6 donors were eliminated based on MMPI-2 findings alone, and in each case the clinical interview validated the test results. An additional five candidates who would have been excluded by the psychological screening were cancelled for genetic or medical reasons. Thus, 68 (11%) of the oocyte donor applicants had psychological findings that excluded them from proceeding with the donation. Conclusions: Psychological testing and a clinical interview may exclude a significant number of donor candidates in an ovum donor program. Screening should be encouraged to optimize the donor’s experience and safety and to minimize negative outcomes in pregnancies achieved through oocyte donation. Supported by: None.

Risk Information Provided to Prospective Oocyte Donors in a Preliminary Phone Call

In order to accommodate for the present shortage of oocyte donors, oocyte-donation programs place ads in college newspapers and provide large monetary compensation to encourage participation. Large compensation acts as a strong incentive for young women to undergo the potentially risky procedure of donation. In this enticing situation, it is particularly important for programs to fully inform prospective donors of the risks of the procedure so that they can accurately weigh the costs and benefits of donating. However, because oocyte-donor programs must alleviate the shortage of donors if they wish to maintain a financially viable business, there is reason to fear that they may minimize or misrepresent risks when recruiting egg donors. In this pilot study, the risk information provided by programs (n=19) to prospective oocyte donors in a preliminary phone call inquiry was investigated. The majority of the programs provided incomplete and/or inaccurate risk information. Policy changes are recommended to reduce the potential for undue influence and to standardize and regulate the risk information provided to prospective egg donors.

Recruitment and screening policies and procedures used to establish a paid donor oocyte registry.

We have reviewed the demographic characteristics of, and report abnormalities noted in, the de-novo growth and development of a paid oocyte donation programme. The personal profiles of all prospective oocyte donors were reviewed. Acceptance or rejection of candidates was based upon screening the results of medical, genetic and psychological testing. A total of 603 candidates initially responded to our advertisement. From this pool, 313 individuals were considered suitable and contacted by telephone. Following further conversation, 176 women were scheduled an entry interview. On completion of the formal screening process, 17.6% (n = 31) of those actually interviewed were denied entry. Thus, from the initial interested parties, only 23% of women wishing to participate in oocyte donation were considered suitable candidates. Given the high attrition rate, we concluded that the need for rigorous and thorough medical, psychological and genetic testing is mandatory for the establishment of a donor registry. Furthermore, professional counselling of prospective donors with respect to the results of tests and the implications of test results with respect to their future medical and reproductive health, are important parts of providing comprehensive care.

Genetic screening of prospective oocyte donors

Objective: To report our experience with genetic screening of oocyte donor candidates and to determine the frequency with which significant genetic issues are identified. Design: Prospective genetic screening of oocyte donor candidates. Setting: University hospital oocyte donation program. Patient(s): Women presenting consecutively as volunteer oocyte donors. Intervention(s): Genetic screening was performed by pedigree analysis and laboratory studies. Main Outcome Measure(s): Inclusion in the oocyte donor pool based on the results of clinical evaluation and laboratory tests consisting of polymerase chain reaction–based mutational analysis for cystic fibrosis carrier status, cytogenetic analysis for karyotype, enzymatic assay for Tay-Sachs disease carrier status, and complete blood count and hemoglobin electrophoresis. Result(s): Eight (11%) of 73 oocyte donor candidates were excluded from the donor pool because of a potentially serious genetic finding. Cystic fibrosis mutations were identified in 5 candidates (7%), abnormal karyotypes were found in 2 (3.5%), and an autosomal dominant skeletal dysplasia was identified in 1 (1.4%). Conclusion(s): A significant proportion of women who present as candidates for oocyte donation are inappropriate for donation because of their genetic history or genetic testing results. A thorough genetic evaluation, including a history and laboratory screening, is essential to any oocyte donation program to maximize positive outcomes in pregnancies achieved through assisted means.

Choice and Precycle Preparation of Prospective Oocyte Donors and Recipients

Choice and Precycle Preparation of Prospective Oocyte Donors and Recipients