"I want us to be a normal family": Toward an understanding of the functions of anonymity among U.S. oocyte donors and recipients.

BACKGROUND: Anonymity remains the more common practice in gamete donations, but legislation prohibiting anonymity with a goal of protecting donor-conceived children's right to know their genetic origins is becoming more common. However, given the dearth of research investigating the function of anonymity for donors and recipients, it is unclear whether these policies will accomplish their goals. The aim of this study was to explore experiences with anonymity among oocyte donors and recipients who participated in an anonymous donor oocyte program and to understand the ways in which anonymity functions for them. METHODS: Semistructured interviews were conducted with 50 women: 28 oocyte donors and 22 recipients who were recruited from an academic center for reproductive medicine in the United States. RESULTS: Donors and recipients view anonymity both as a mechanism to protect the interests of all parties (recipients, donors, and donor-conceived children) and as a point of conflict. Specifically, three key areas were identified where both donors and recipients saw anonymity as having an important role: relieving anxieties about family structures and obligations; protecting their interests and those of donor-conceived children (while acknowledging where interests conflict); and managing the future. CONCLUSION: As gamete donation increasingly moves away from the practice of anonymity, examining why anonymity matters to stakeholders will be helpful in devising strategies to successfully implement identity-release options.

Risk factors for a suboptimal response to gonadotropin-releasing hormone agonist trigger during in vitro fertilization cycles.

OBJECTIVE: To identify risk factors for a suboptimal response to gonadotropin-releasing hormone (GnRH) agonist trigger in in vitro fertilization (IVF) cycles. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENT(S): All 424 patients undergoing fresh IVF cycles (n = 500) between August 2007 and June 2013 in whom a GnRH agonist was used as all or part of the ovulation trigger. INTERVENTION(S): GnRH-antagonist-based IVF cycles triggered with leuprolide acetate alone or in combination with low-dose human chorionic gonadotropin. MAIN OUTCOME MEASURE(S): Suboptimal response to GnRH-agonist trigger, as defined by a serum luteinizing hormone (LH) level <15 mIU/mL on the morning after trigger. RESULT(S): The rate of suboptimal response to the GnRH-agonist trigger was 5.2%. Patients with a suboptimal hormone response had lower follicle-stimulating hormone (<0.1 vs. 3.48) and LH (<0.1 vs. 2.51) levels on day 2 of the cycle start, lower LH (0.109 vs. 0.596) on the day of trigger, and required longer stimulation and more gonadotropins than those with an adequate response. Suboptimal responders were also more likely to have irregular menses and be on long-term oral contraception. Patients with an undetectable LH on the day of trigger had a 25% chance of a suboptimal LH surge. In our study cohort, limiting the use of the GnRH-agonist trigger alone to patients with a trigger day LH ≥0.5 would have reduced the rate of suboptimal response from 5.2% to 0.2%. CONCLUSION(S): Long-term hormonal contraception use is an independent risk factor for suboptimal response to GnRH-agonist trigger. Patients with very low endogenous serum LH levels on the day of LH trigger are at increased risk for a suboptimal GnRH-agonist trigger response. Understanding the at-risk phenotype and using trigger day LH as a marker for increased risk of suboptimal GnRH-agonist trigger response can be helpful for individualizing treatment and selecting a safe and efficacious trigger medication for patients undergoing IVF.

Once you're choosing, nobody's perfect: is more information necessarily better in oocyte donor selection?

Despite a growing body of research examining the psychosocial issues involved in oocyte donation, few studies have examined the role of information in the process of donor selection. The aim of this interview-based qualitative study was to understand how donor oocyte recipients relate to information provided about potential oocyte donors, how they use this information to select donors and their preferences for, and reactions to, various types of information provided to them. Donor oocyte recipients who underwent treatment between 1995 and 2011 were recruited for participation from an academic centre for reproductive medicine. Twenty-two oocyte donor recipients participated. Findings indicate that recipients use information to select donors who they believe would enable them to fulfill their priorities: having a healthy child and 'passing' as genetically related. Obtaining more specific information prompted a focus on donor imperfections and presented a burden of choosing. Moreover, for participants preferring distance, having more information created dilemmas by making the donors less abstract. Although more information and options are often desired by oocyte donor recipients, increased choice can also present psychological dilemmas and emotional costs. Further research is needed to investigate the influence of information-related conflicts on patient decision-making, post-treatment emotional adjustment and disclosure decisions.

Should all oocyte donors receive prophylactic antibiotics for retrieval?

In a retrospective study comparing 526 oocyte donors who received prophylactic antibiotics for oocyte retrieval with a comparable group of 625 who did not, the incidence of infection after retrieval was reduced from 0.4% to 0 in the group receiving antibiotics. Donors take risks but have no medical indication for the procedures that they undergo; our data suggest that prophylactic antibiotics at retrieval should be considered to minimize the risk of infection.

The incidence of both serious and minor complications in young women undergoing oocyte donation.

OBJECTIVE: To investigate the incidence of serious and minor complications experienced by women undergoing controlled ovarian hyperstimulation and oocyte retrieval for oocyte donation. DESIGN: Retrospective study. SETTING: University-based IVF center. PATIENT(S): Five hundred eighty-seven donors underwent 973 cycles of controlled ovarian hyperstimulation and 886 oocyte retrievals for anonymous or directed oocyte donation. INTERVENTION(S): Controlled ovarian hyperstimulation; oocyte retrieval. MAIN OUTCOME MEASURE(S): Complications of the procedure. RESULT(S): The rate of serious complications, which included ovarian hyperstimulation syndrome, ovarian torsion, infection, and ruptured ovarian cyst, was 6 in 886 (0.7%) retrieval cycles. The rate of minor complications severe enough to prompt the donor to seek medical attention after retrieval was 8.5%. The cancellation rate after stimulation cycle initiation was approximately 9%, regardless of whether the donation was anonymous or directed. CONCLUSION(S): This study provides information on the incidence of serious complications experienced by oocyte donors after controlled ovarian hyperstimulation and oocyte retrieval. It provides evidence that with careful monitoring, and when a liberal cancellation policy is followed, oocyte donors experience lower rates of ovarian hyperstimulation syndrome, compared with infertile women undergoing IVF. Furthermore, the study provides the first set of data on the rate of symptomatic minor complications experienced by oocyte donors. This information will help clinicians administer appropriate informed consent to the young women who present themselves as potential oocyte donors.

Researching human oocyte cryopreservation: ethical issues.

OBJECTIVE: To evaluate some ethical concerns related to the selection of participants for oocyte cryopreservation research. DESIGN: Review of ethical issues related to human oocyte cryopreservation research. SETTING: Academic medical center. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): A discussion of some ethical concerns surrounding selection of participants for oocyte cryopreservation research. RESULT(S): Human oocyte cryopreservation has the potential to expand reproductive options for infertile couples. Care needs to be taken, however, to carefully select participants in ways that maximizes benefits to them and to society and minimizes risks. Infertility programs can do so by trying to recruit women who stand to benefit the most from participating in oocyte cryopreservation protocols. CONCLUSION(S): Biomedical research is necessary to improve current medical therapies. Oocyte cryopreservation can increase the flexibility of assisted reproductive programs and offer hope to a significant number of infertile couples. Nonetheless, scientific research cannot be attentive only to the creation of new knowledge and new technologies; it also is inextricably tied to ethical considerations about the well-being of participants.