A recent retrospective study published in the December issue of the journal Fertility and Sterility suggests that careful monitoring and complying by the liberal cancellation policy may aid in reducing the rates of ovarian hyperstimulation syndrome (OHSS) associated with oocyte donation. Also, the study, providing the first set of data related to symptomatic minor complications that can occur in oocyte donors, may facilitate pre-procedure informed consent processes.
The study, headed by Kara N Maxwell, Department of Medicine, College of Physicians and Surgeons of Colombia University, New York, was conducted on 587 donors who underwent 973 cycles of controlled ovarian hyperstimulation and 886 oocyte retrievals for either anonymous or direct oocyte donation. Study results demonstrated the occurrence of serious complications including ovarian torsion, infection, OHSS, and ruptured ovarian cysts in 6 out of 886 retrieval cycles (0.7%). Minor complications following the retrieval process accounted to 8.5%, and were found to be severe enough to seek medical attention. The cancellation rate in both anonymous and direct oocyte donation after initiating the stimulation cycle was around 9%.
In a similar retrospective study, Bodri, et al. (Reproductive Biomedicine Online, 2008) also suggested the necessity to adequately counsel prospective donors on the risks associated with oocyte donation. To analyze the rate of complications associated with the procedure, 4,052 oocyte retrievals performed between 2001 and 2007 were evaluated, in which 30.6% cycles were stimulated using gonadotropin-releasing hormone (GnRH) antagonists and remaining 69.4% with GnRH antagonist protocol. Further, the GnRH antagonist cycles were triggered with human chorionic gonadotropin (HCG) in 1,295 cycles and GnRH agonist, in 1,519 cycles.
Complications related to oocyte retrieval were reported in 0.42% patients (n=17), which included intra-abdominal bleeding in 14, severe pain in 2, and ovarian torsion in 1 of the 17 patient. Among these, 14 subjects required hospitalization, and 6 had undergone surgical intervention. However, no pelvic infections, pelvic structure damage or anaesthesiological complications were reported in this study series. Moderate to severe OHSS was observed in 22 donors, among which, half of the study subjects required hospitalization and the other half was treated on an outpatient basis. The study also reported the comparatively lower incidence of serious complications in healthy young donors. The study concluded by stating that adoption of specific stimulation protocols, like GnRH agonist triggering, may aid in significantly reduced OHSS incidence.
Ovarian hyperstimulation syndrome, a complication of ovarian induction therapy, is characterized by massive ovarian enlargement and acute fluid shift into the extravascular space. The major symptoms of the syndrome include vomiting, nausea, lower abdominal discomfort or distension, and diarrhea. The symptoms usually occur within 10 days after ovulation or oocyte retrieval and may resolve spontaneously. In a paper prepared for the Bioethics Advisory Committee as background information on oocyte donation for research, Professor Ng Soon Chye reported that OHSS occurs as a common side effect in up to 20-30% of ART patients, and the moderate form of the syndrome, which is of major concern, occurs in 1-10% of such patients. Hence, counseling of patients on the hazards of oocyte donation, as well as pre-treatment assessment, monitoring, and judicious use of hormones need to be inculcated during the oocyte donation procedure.
References
1. Maxwell KN, Cholst IN, Rosenwaks Z. The incidence of both serious and minor complications in young women undergoing oocyte donation. Fertil Steril. 2008 Dec;90(6):2165-2171. Epub 2008 Feb 4.
2. Bodri D, Guillén JJ, Polo A, Trullenque M, Esteve C, Coll O. Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles. Reprod Biomed Online. 2008 Aug;17(2):237-43.
