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The egg donation medications and retrieval procedure explained.

Updated: Apr 6, 2019

This article is intended to explain the egg donation procedure to a new donor in detail including possible risks and side effects.

Once medical clearance is issued, the fertility nurse will prepare a cycle calendar for you.

Prior to becoming an egg donor, you will need to complete a series of screening tests. To learn more about these, click on the blog post titled Egg Donor Screening - What to Expect. This article follows the process and what to expect from medical and clearance to retrieval.

An egg donation match from screening to completing of egg retrieval usually takes between 6-8 weeks and requires about 10-12 office visits.

Egg Donation in a Nutshell. A lot of women think they only have one egg or oocyte every month, but that’s not entirely true. Each month, when a woman has her menstrual cycle, her body will activate multiple follicles, or fluid-filled sacs that hold the eggs. Every month, a young woman could have anywhere from 5-35 or more follicles activated but the female body will only produce enough hormones to feed and develop one follicle which is known as the dominant or lead follicle. This dominant follicle will ultimately consume the majority of the hormones that the body has produced that month in order to develop and eventually ovulate an egg. The remaining follicles and eggs will die away naturally in a process called atresia. This process happens every month from puberty to menopause.

With egg donation, as the follicles are first developing, the doctor gives you fertility medications which mimic these natural hormones produced each month, so rather than only one egg or follicle developing, there is enough available hormones for most of the follicles to develop and grow.

The physician will monitor these follicles as they develop and once these follicles have grown to an appropriate size, the fertility physician will schedule your retrieval process in order to collect the eggs from the follicles. The doctor will never know how many eggs will be retrieved until the actual day of egg retrieval. That being said, the fertility doctor will never remove any more eggs than a donor would have naturally passed in her monthly cycle in that particular month if she wasn't donating.

Getting started on Cycle Medications. The first medication you will typically be put on is birth control which you will likely be asked to begin during the screening process. When you are ready to start cycle medications, the doctor will bring you in for what they call a baseline ultrasound. This is an ultrasound done vaginally in order to confirm that you don’t have a cyst or unknown concern that would prevent you from safely starting medications. Assuming the baseline ultrasound and blood labs look good, you will take your first injection of hormones most likely that evening or within the next few days.

Most donors will take daily hormonal injections for about 10 days before they receive their trigger shot. You will be going to appointments regularly during this time period in order to be monitored by the fertility doctor and you will be taking medications 1 to 2 times per day. Almost all appointments will be preplanned but please note you have to be flexible as an appointment time may change and you will have to be willing to accommodate as this monitoring is vital to the success of the cycle and to your personal health. Your appointments will almost always be in the morning usually between 730 and 10 AM. You may need to make arrangements with work or school to accommodate. Prior to starting medications, you can provide the agency with blackout dates of when you are not available to go to appointments and we are happy to work around these.

This is an example of the type and size of the needle used in egg donation.

Monitoring while on Medications. At each appointment, you will usually have a blood draw done to check your fertility hormones and a transvaginal ultrasound to count and measure the size of your growing follicles to see how your body is responding to the cycle medications. The doctor will adjust your daily medication dosages based on these results.

Side Effects of the Shots. Regarding the medications, since they are hormonal in nature, there are some hormonal side effects you may experience which are usually mild but could include irritation at the injection site, breast tenderness, abdominal bloating, constipation, headaches, and mood swings. Basically the symptoms are very similar to what someone may experience during their monthly cycle. The medications are injectable hormonal medications which you will inject into your lower belly or upper thigh. While that may sound very intimidating, the needle is very small and is about the size of the needle a diabetic uses when taking insulin each day. In addition, you will have a lot of support provided to you. The clinic will teach you exactly how to do these injections, provide you helpful videos, and a nurse is always available should you need one. If you are not comfortable taking injections yourself, we may be able to make arrangements for a nurse to come to you. This depends on your location and availability.

Trigger Shot. When the fertility physician feels the follicles have reached their final stage of maturation, the egg donor will be given her final injection to stimulate ovulation known as the trigger shot. The retrieval is scheduled 36 hours after this shot is taken so the timing is very important.

The Retrieval Process. On the retrieval day, the donor will arrive at the fertility center at a specific scheduled time and the surgical team will check the donor in and begin preparations for the procedure such as taking basic vitals and signing consent forms. After getting registered and having your basic vitals taken, the anesthesiologist will come in and go over your allergies and health history with you and administer your  IV. The anesthesiologist will then review the type of anesthesia he or she intends to use and any associated risks with you. After this, you will be taken to the operative room where you will be asked to place your feet in stirrups in preparation for the retrieval. The anesthesiologist will then administer a light sedation medication into your IV. You will not feel or remember anything during the retrieval but the egg retrieval procedure will take about 20-30 minutes. While you are sedated, the fertility physician will retrieve the eggs vaginally using a ultrasound guided needle which the doctor will carefully insert through the vaginal wall into the ovary and into each follicle where they will then remove the eggs. These eggs are then collected and taken to the lab for fertilization. Again you will not remember or feel anything during this procedure. You will then wake up in the recovery area.

Recovery from Retrieval. It is very common to experience some cramping and discomfort after the retrieval.  The physician will offer a heat pad and may prescribe pain medication as needed. You will need to have a companion drive you to and from the retrieval procedure and stay with you while you recover. While most donors resume normal activity within 48 hours you still may have some side effects like bloating and cramping and we ask that you take things easy for the next several days and avoid any heavy activity, exercise, or sexual activity.

Most egg donation cycles do not have any medical complications beyond minor discomfort or bloating, but if you experience any side effects as a result of taking any medications prescribed by the fertility doctor or experience severe pain or bloating, you should notify the fertility doctor and our agency immediately as time is of the essence and failure to notify the doctor could result in severe complications. Obviously, your personal health and safety are so important to us so please communicate clearly with the physician about any questions or concerns you have or if you are experiencing any type of complication.

Side Effects and Risks. While this procedure is relatively safe, there are a few risks you should know about. You may have an allergic reaction to an antibiotic that is given to you to prevent infection from the retrieval procedure. Is it important to discuss any medical allergies with the treating doctor. You may also experience mild to moderate discomfort after the egg donation retrieval procedure. As with most surgical procedures, potentially serious complications including bleeding, infection, and unintended injury to an internal organ or blood vessel could result. This is extremely rare. Anesthesia will be necessary for the egg retrieval. The risks associated with anesthesia will be explained during a consultation with an anesthesiologist who will ask you about your personal reaction to anesthesia in the past.

The major risk to egg donation is something called ovarian hyperstimulation syndrome or OHSS. Research shows this happens in approximately 2-7% of cases with Egg donors. In mild to moderate cases, OHSS can cause abdominal swelling or discomfort, mild nausea, diarrhea or constipation, enlarged ovaries, or a feeling of pressure or difficulty when breathing. In extremely rare cases, hyperstimulation could lead to enlarged ovaries and an increased susceptibility to develop blood clots. It  could also lead to the development of fluid in the abdomen or lungs, kidney failure, ovarian torsion or rupture, or stroke. For this reason, donors are closely monitored after egg retrieval to reduce their risks and sometimes additional medications may be prescribed to help combat OHSS.

Still have questions? We hope that this has given you a very clear overview of the medical process of the egg donation process. If you have any questions, feel free to contact our agency directly by calling 310.822.0671. We also encourage you to speak with a fertility physician about any medical questions.

Please note: Since we are a donor agency but not the actual fertility physician, we technically cannot give you medical advice. The preceding should not be construed as medical advice but as a basic overview of the egg donation process and what to expect. We encourage you to discuss this process and any medical questions you have directly with a fertility doctor.



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