Can Egg Donation Cause Ectopic Pregnancies in Egg Donors?
Rae is a scientist in the United States who loves being outdoors — including hiking, camping, kayaking, and skiing. You may have already read her experience of being denied her medical records as an egg donor due to a HIPAA loophole. Since writing that article, the information she shared helped a lot of egg donors negotiate their contracts such that the clinic is required to share the medical records of their cycle with them.
Rae has gone on to donate her eggs multiple times and is currently trying to conceive. After experiencing a recent loss, she learned some important considerations egg donors should have on their radar. As egg donors, we deserve better information on the understudied health outcomes of egg donation — thank you, Rae, for sharing your experiences with our community.
Enter Rae.
I wanted to share my experience of trying to conceive after multiple egg donations because I know this is an important topic. My most recent retrieval was three months ago and 45 eggs were retrieved. Weeks later, my post-retrieval period started. My husband and I started to try for a baby with my next ovulation, which occurred around the following December; I had been using ovulation predictor kits and basal body temps to track my cycle. I had light bleeding later that December and finally got a faint positive at-home pregnancy test right before New Year’s Eve.
HCG (Human Chorionic Gonadotropin) is often called the “pregnancy hormone” because it is produced by the placenta after implantation. Urine tests can pick up on HCG levels around 12-14 days after conception. Typically, the HCG levels will double every 72 hours until peaking during the first 8-11 weeks of pregnancy, before they decline and level off through the rest of pregnancy.
When I was 17 days past ovulation, my blood test showed my beta HCG level was 26, which is very low. I kept pushing my OB-GYN for more blood tests; on Jan. 2, my beta was only 58. I started having a dull pain in my right side. I went to Urgent Care two days later, and they could not see anything on the ultrasound. My HCG was 117, and two days later it was 201.
Despite my concern, my doctor thought it was doubling fine and refused to do any more blood tests even after I reminded her of my recent donation. I knew something wasn’t right. I felt no symptoms at all, except the dull pain that persisted on my side.
On Jan. 10, I got a second opinion with a different OB-GYN. Again, nothing alarming showed up on the ultrasound but he agreed my beta HCG was low. That day we found out my HCG had dropped to 174 and my progesterone was only 3.5. Both of these numbers confirmed this was not a viable pregnancy. I decided to wait for one more HCG test to see if I would naturally miscarry, and my beta HCG had gone up to 176, which was indicative of an ectopic pregnancy, also known as an extrauterine pregnancy. This is when a fertilized egg grows outside the uterus and has no chance of being viable. The Fallopian tubes are the most common site for ectopic pregnancies, but they can occur on the ovary, endocervical canal, or even in the abdominal area. Ectopic pregnancies are generally considered to be rare, occurring in about 1.5% of all pregnancies, and could be fatal without prompt treatment.
That day I chose to receive a methotrexate injection to end the pregnancy. This was the worst gynecological pain I have ever experienced and it persisted for four days. It was worse than any recovery from egg donation, including the time I had OHSS. The emotional toll of seeing my past Intended Parents welcome their babies into the world only to be told I was losing my own was devastating.
When I brought up my recent and repeat donation history with this new OB-GYN, for once in my life I felt like a doctor understood the risks and concerns of undergoing egg retrievals so many times — and doing it so recently. I had tried to conceive only 21 days after my most recent egg donation. I asked him if I should have waited longer to try and conceive and he said yes. The problem is that I was never told otherwise until it was too late.
My doctor explained that there is a small risk that the Fallopian tubes can be damaged during the egg retrieval process by the aspiration needle, although he said this should be very easy to avoid. But the main concern is that a history of pelvic surgeries is linked to a greater risk of ectopic pregnancy, even where the Fallopian tubes are never directly impacted.
“Pelvic surgeries” can include anything from an appendectomy, perforation of the uterus from an IUD, and minimally invasive adnexal surgery (e.g. egg retrieval). There’s a very good chance that even if my Fallopian tubes were never damaged during retrieval or subsequent healing processes — which we cannot know for sure at this point — that at the very least I didn’t give my body enough time to fully heal from my last egg retrieval. Following egg retrieval, it can take 6-8 weeks for ovaries to return to normal size and any amount of swelling of the ovaries or surrounding connective tissue can slightly kink or put pressure on the Fallopian tube, making it difficult for the embryo to make it to the uterus.
This isn’t to say that prior donors haven’t been successful conceiving the cycle after retrieval because several donors in the We Are Egg Donors community have. I felt it was important to share my experience and the information that I wish I had prior to deciding on when to start conceiving. Never has a reproductive endocrinologist told me about this risk and any documents I signed always said that donors shouldn’t resume sexual intercourse until after their post-retrieval period and assumed donors resume birth control after a donation cycle. Now that I’ve had one ectopic pregnancy, in addition to my history of pelvic surgeries, my risk of yet another ectopic pregnancy is that much greater.
My fellow donors deserve this information.
If you’re a donor trying to conceive, please consult with your doctor. Many donors assume that the reproductive endocrinologist overseeing their egg donation cycle is their doctor. Yes and no. They are the Intended Parents’ doctor — but their primary objective is to fulfill someone else’s pregnancy. It’s important to remember what you’re undergoing is not “medical treatment.” This sounds obvious, but it’s important to have a medical professional looking out for YOUR health, first and foremost. Even though ectopic pregnancies are generally considered rare — happening to about 2 out of every 100 pregnancies — this number may differ for egg donors. But we simply don’t know: there have been no long-term studies on the health outcomes of egg donation.
As egg donors, and as patients, we will continue to advocate for research on our health and our fertility.
Our health is important, too.
Ectopic Pregnancies: Resources and Studies