Egg donation represents a real hope for some couples who cannot have children. Due to a lack of donors, however, it remains rare in France and insufficient to meet demand. Update on this gamete donation, donor and recipient side.

Oocyte donation consists of donating oocytes (or ova), the female reproductive cell essential for fertilization with the sperm. As a reminder, the little girl is born with a stock of thousands of oocytes in her ovaries. From puberty, in each menstrual cycle, about ten develop to lead to the ovulation of a single oocyte which can be fertilized by a sperm.

This donation is intended for couples having difficulty having a baby for one of these reasons:

• the woman has no eggs due to ovarian failure, early menopause, or treatment that destroyed her eggs (chemotherapy);
• his oocytes have abnormalities;
• the couple is at risk of transmitting a serious illness to their child.

Like any donation of elements of the human body, that of oocytes is governed by the law of bioethics. And like any donation, it is voluntary, free and anonymous. Donors and recipients cannot know their respective identities and the child born from egg donation cannot know the identity of the donor.

Oocyte donation is carried out in approved centers grouped within the GEDO network (Study Group for Ovocyte Donation).

Conditions

To be able to donate her eggs, a woman must meet certain conditions:

• be between 18 and 37 years old;
• to be in a good health ;
• have the spouse’s agreement if she is in a relationship
• since January 2016 and the implementing texts of the Bioethics law of 2011, the donation of gametes is open to people who have never had children.

The donor benefits from the payment of all costs incurred by the donation: stimulation treatment, examinations, consultations, hospitalization, transport, loss of working time if necessary.

Approaches

A woman wishing to donate her oocytes must contact the approved center in her region (list on the website of the Biomedicine Agency, www.dondovocytes.fr). During a first meeting, the terms of the donation will be explained to him. She then signs a donation consent form.

The medical examination

The candidate for egg donation undergoes a medical check-up in order to check her family and medical history, assess her fertility and eliminate the risk of transmission of hereditary disease. This report includes:

• a gynecological check-up to ensure that the ovaries are functioning properly and that there are no contraindications to ovulation stimulation and ovarian puncture. This assessment includes a gynecological examination, an ultrasound and a hormonal assessment;
• a genetic test to look for a history of transmissible genetic diseases and a blood test to perform a karyotype to detect any chromosomal abnormalities;
• a pre-anesthesia assessment for the ovarian puncture;
• a blood test to determine the blood group and look for certain transmissible infections (syphilis, hepatitis B and C, HIV, HTLV, CMV). A second serology is carried out approximately 10 days before the oocyte collection. If the results are positive for HIV, syphilis, hepatitis B and C, the woman will not be able to donate her eggs;
• an interview with a psychologist.

Ovarian stimulation

In a normal cycle, only one oocyte matures. To increase the efficiency of egg donation, the donor receives an ovarian stimulation treatment so that several follicles begin to mature, and so that several oocytes can be collected. This is a daily injection of hormones, for a dozen days, by a home nurse or by the donor herself. 3 to 4 blood tests and ultrasounds make it possible to follow the response to the stimulation. Once the follicles are “mature”, ovulation is triggered by another injection and scheduled egg retrieval.

From the start of the stimulation of the donor, the oocytes are allocated to 2 or 3 recipients, taking into account the waiting list but also, if possible, certain morphological or biological criteria:

• ethnic origin ;
• the main morphological characteristics: color of the skin, hair and eyes of the recipient couple;
• the blood group (A, B, O and rhesus).

Egg collection

35 to 36 hours after the last injection, the oocyte retrieval takes place. It is performed vaginally, under ultrasound control, under local or general anesthesia. The donor can go home in the evening provided she is accompanied. A 48 hour rest is advised.

An oocyte puncture makes it possible to collect an average of ten oocytes, generally distributed over 2 or 3 recipients. They are either put directly into in vitro fertilization, or stored at very low temperature (oocyte vitrification) for subsequent in vitro fertilization.

Adverse effects

Side effects are rare and complications exceptional. The donor may have hot flashes, small bleeding at the end of resting the ovaries; a feeling of heaviness as you approach ovulation. In the event of ovarian hyperstimulation, severe abdominal pain and certain complications (sudden weight gain, digestive or even respiratory disorders) may appear. These symptoms justify an emergency consultation in an AMP center or a gynecological department. In principle, ovulation monitoring makes it possible to limit this risk of hyperstimulation.

Complications linked to the puncture surgical procedure (hemorrhage, infection, anesthetic problem, etc.) are extremely rare. In the days following the donation, the donor may feel pain and have some bleeding, which will disappear at the latest during the following periods. In rare cases, hyperstimulation syndrome can cause more pain and bleeding. The donor will then have to go to the hospital.

Stimulated oocytes are those which had already begun to mature but which, without stimulation, would have stopped their development. The treatment therefore does not intervene on the oocytes of the ovarian reserve and does not reduce the fertility of the donor.

In 2014, 501 women donated eggs. 961 in vitro fertilizations and 310 frozen embryo transfers were carried out thanks to an oocyte donation. 239 children were born following ART with donated oocytes (1).

Source: Medical and scientific report of the Biomedicine Agency 2015