can be made to that process to make it less risky for the women who take part. This approach is particularly useful when it is done on a patient-by-patient basis, modifying the different procedures to take into account the particular medical characteristics of a donor. In theory, this technique can be applied to any of the potential risks of oocyte donation, but the workshop participants focused on its application to one potential risk in particular: the development of ovarian hyperstimulation syndrome caused by hormones used to stimulate the ovaries to produce more eggs.

PREVENTING OVARIAN HYPERSTIMULATION SYNDROME

Of all the risks facing women undergoing in vitro fertilization, the most common and the most threatening is ovarian hyperstimulation syndrome (OHSS). As described in Chapter 2, studies have found that a large percentage of women undergoing ovarian stimulation experience symptoms of OHSS ranging from mild to severe, and thus women donating their eggs for research could be expected to face similar complications.

According to several of the speakers at the workshop, it should be possible to prevent many cases of OHSS, including all or almost all of the most severe cases. That prevention will require a combination of the two basic risk minimization strategies: identifying and excluding from treatment those women most at risk and, for those women who do undergo ovarian stimulation, modifying the treatment according to the characteristics of the individual patient.

For some women, Dr. Cedars said, the risk of OHSS is just too great to allow them to be research donors. “I would recommend exclusion of women with polycystic ovarian syndrome,” she said, “because I believe their response, even with careful monitoring, is quite difficult to predict and control.” She would also exclude women who don’t have full-blown PCOS but who have polycystic-like ovaries according to the ultrasound pictures and also women with irregular menstrual cycles. Some doctors, she noted, would even exclude women if they have elevated levels of androgens of luteinizing hormone, but she is comfortable leaving these in the pool if they are otherwise asymptomatic and have a normal-appearing ovary on ultrasound.

Dr. Rosenwaks said he follows a similar protocol in his center. As donors, he excludes not only women with the classic polycystic ovarian



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