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Doctor: Potential Egg Donors Face Risks

by Stephanie InnesArizona Daily Star
November 2nd, 2008

Dr. Jennifer Schneider, with patient Ed Gilbert at Arizona Community Physicians on El Dorado Health Campus, believes her daughter's egg donations may have led to the colon cancer that claimed her life.

The advertisements are enticing, particularly in a flagging economy: Young women may earn thousands of dollars by selling their eggs.

One California-based agency is offering $100,000 for the eggs of the "right" woman.
But a Tucson doctor and mother is issuing a controversial warning to potential egg donors.

"We really don't know the long-term risks," said Dr. Jennifer Schneider, who practices internal medicine. "These young women may take that as meaning there are no risks. Young women think they are invulnerable.

"But my daughter was like that, too, and at 31 she was gone."

Schneider's daughter, Jessica Grace Wing, a composer and filmmaker, died of colon cancer in 2003, two years after she was diagnosed with tumors in her colon and both ovaries.

Wing had donated her eggs three times, beginning when she was a student at Stanford University.

Her mother fears the egg donations may be linked to the cancer.

Wing's family has no history of any early cancer or colon cancer. Her grandfather died of non-colon cancer, but he was 85.

A DNA tissue analysis performed after Wing's death showed no genetic mutations that would have predisposed her to developing cancer, her mother says.

Medicinal combination

Schneider's suspicions point to the combination of hormonal medicines that egg donors must be given, to stimulate the development of multiple eggs within the ovary.
Those may include hormonal drugs to prevent the donor from spontaneously ovulating, and another to induce egg development. When the eggs are mature, ovulation is typically triggered with another hormone injection.

Wing injected hormones twice a day for two to three weeks before each of her egg retrievals, her mother says.

The American Society for Reproductive Medicine says there's no link between cancer and egg donation.

While older reports suggest a link between fertility drugs and ovarian cancer, more recent studies "fail to provide any convincing evidence," the society says.
There are no known links to other types of cancers, said the group's spokesman, Sean B. Tipton.

Schneider has been unable to come up with any proof linking cancer and the hormones, but she urges long-term research.

"There has been zero follow-up on the health of egg donors," she says.

The Tucson doctor and mom has written an article about risks of egg donation to be published this year in the peer-reviewed international journal Fertility and Sterility.
She has testified before Congress on the issue and gave testimony last month to an ethics committee meeting of New York state's Stem Cell Research Board.

She travels the globe giving talks about the unregulated marketplace for egg donations in the United States because she says no one is looking out for the donors' interests.
"The problem is that egg donors have been considered vendors and been treated on a model of sperm donors. As you can imagine, the process of donating sperm is very different from eggs," Schneider says.

Warnings to women

Egg donor clinics note that they do warn women about side effects and risks involved with the procedure. The long-term risks the clinics caution about are rare: blood clots and kidney failure.

Agencies say they do not warn of any cancer risk because of the lack of a link.
Many clinics, including the Reproductive Health Center on Tucson's North Side, operate on a set of guidelines set out by the American Society for Reproductive Medicine.

Those include patient warnings about possible side effects, including mild bruising, allergic reaction, and ovarian hyperstimulation syndrome, in which the ovaries produce many fluid-filled sacs, each containing an egg, and become enlarged. In rare cases, ovarian hyperstimulation syndrome can lead to blood clots and kidney failure.

The eggs are harvested through a process called transvaginal ultrasound aspiration, using a needle guide. Risks involved with the procedure include mild bleeding, injuries to organs near the ovaries like the bladder, and pelvic infection, the society says.

"When we are counseling our donors, we do not talk about cancer risk, as there are no studies that have really shown that," says Holly Hutchison, who co-owns the Reproductive Health Center in Tucson with her brother, Dr. Scott Hutchison.
"For us, it's more about the potential risk to the ovaries and reproductive system if something happened during egg retrieval, and the psychological aspects down the road."

Neither she nor her brother would ever ask a woman to donate eggs if they believed it would bring a risk of serious illness, she says.

Diana Thomas, of Phoenix-based X & Y Consulting Inc., went through three cycles of ovarian stimulation herself - just like Wing.

But in her case, it was in an effort to become pregnant through in vitro fertilization. It didn't work, and Thomas, now 52, conceived all three of her children with donated eggs.

She remains healthy.

"I am not a physician," Thomas said. "I can say that I've never seen a donor or heard of a donor coming back with any kind of cancer. If there is a statistical possibility, in the 12 years we've been in operation I've not been informed of one case of cancer, and we ask our donors to remain open with us and with the family."

In her upcoming journal article, Schneider writes that some countries, including Canada, Israel and England, do not allow egg donations for monetary gain.
She isn't advocating a similar ban in the United States.

"Sometimes it is the only way infertile women can get a child," she says. "I would have been very disappointed if I couldn't have children. Probably you do have to pay to get enough eggs; otherwise, women would not be as likely to volunteer. I just think they should get paid less."

Payments for donors

An American Society for Reproductive Medicine ethics report from 2007 says compensation of more than $5,000 for one cycle of eggs should require justification and that payment in excess of $10,000 is not appropriate.

The report says women should be compensated to acknowledge their time, inconvenience and discomfort.

But some agencies pay more, particularly if a woman is a "proven donor," whose eggs have resulted in a pregnancy.

Many agencies recruit at Ivy League schools with offers of more than $10,000. Donors who are attractive and smart will command more money, as will young women who are Asian, East Indian or Jewish.

A recent advertisement in the Stanford Daily, a newspaper that serves Stanford University, offers to pay $100,000 to the "right" egg donor who has attributes such as height, athleticism and intelligence. That company, Elite Donors, did not return a phone call, page and e-mail from the Arizona Daily Star.

Thomas, whose Phoenix company doesn't pay more than the national guidelines, has concerns about other agencies that are less judicious. She would welcome more regulations.

She has noticed an uptick in donors since the economic downturn. During the last four months, the number of donors at X & Y has doubled and is now at about 300, she says.

"I do think it's the economy, and that's why you should stick with the national guidelines," she says.

An ideal donor

Schneider isn't sure how much her daughter earned for donating her eggs, though she does know her daughter's compensation increased after her first cycle of egg donations resulted in a pregnancy.

Jessica Grace Wing was an ideal egg donor in the industry's eyes.

She was intelligent - she earned a perfect score on the math portion of her Scholastic Achievement Test, among other accomplishments.

She was athletic, tall, Jewish, didn't smoke, and followed a vegetarian diet.

"She was very smart and talented and created wonderful music, and various kinds of short films that she produced and directed," her mother says.

"I am trying my best to make her death into something positive."



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