Wherever the bar is set, everyone agreed that a great deal of effort should be taken to minimize potential risk for women who are donating their eggs for research. Therefore, much discussion at the workshop was devoted to how such potential risk can best be minimized.
There are two basic ways to minimize potential risk to egg donors. The first is to identify which potential donors have particular risk factors and to exclude them from the donor pool, since they have a higher than normal risk for complications. This is exactly how Cornell handles its egg donors, Dr. Rosenwaks said. “We eliminate patients with endometriosis, a history of PID [pelvic inflammatory disease], previous pelvic surgery, irregular menstrual bleeding, PCOS [polycystic ovarian syndrome], uterine myomas, familial thrombophilia, ovarian tumors, and any other medical condition that we feel may be a problem in terms of the stimulation. We feel that with stem cell research, we should have exactly the same criteria. We’re not dealing with IVF patients. We’re dealing with patients that are donating either altruistically or maybe for minimum pay. But at the end of the day, it is our responsibility to make sure that safety is paramount.”
In determining which potential donors to accept and which to exclude, Dr. Giudice said, the importance of a thorough medical history cannot be overstated. “It’s not enough just to ask about menstrual cycles,” she said. “You really need to nail down how regular they are.” And even things that might seem unrelated to oocyte donation—such as a pituitary tumor—can end up playing an important role. There have been rare cases, Dr. Giudice said, in which a woman with a pituitary tumor took gonadotropin-releasing hormone (GnRH) agonists as part of the hormone therapy and, as a result, suffered pituitary apoplexy.
Besides getting a thorough medical history, Dr. Giudice said, doctors should also use their diagnostic tools to identify potential risk factors. Ultrasound is particularly useful, she said, “in terms of assessing the pelvis for uterine fibroids, for possible endometriomas, for possible ovarian tumors, and also for the occasional malplaced ovary that may be in a place that may put the patient at risk for some of the surgical risks that Dr. Murphy discussed.”
Another potential way to screen research donors, Dr. Giudice said, is by age. “What is the optimal age group? Is it the reproductive age span, 18 to 50? Is it the ovum donor population currently used for reproduction, 21 to 34? This is something that we just don’t have any information on, but I think we are obliged to define that at some point for the safety of our donors.”