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Sindy's Testimony

Testimony by Sindy, M.D., Ph.D. to Kansas State Senate on Senate Bill 509, “Women’s Health and Embryo Monitoring Program Act,” March 2010

My name is Sindy. I have an M.D. and a Ph.D. in Biology with specialization in the field of real-time live imaging of the early immune response. With my strong background in basic science research and publications in top scientific journals such as Nature and Science, I have always been an avid supporter of biological research using live subjects and donated tissue, both animal and human. However, my experiences have taught me that at times, even a scrupulous medical scientist may be tempted to make erroneous assumptions, cut corners, or risk safety in order to save time or achieve success. In my medical and research training I have learned the importance of certain principles whenever attempting a procedure or study. These include: 1) ethics, 2) subject safety, 3) informed consent, and 4) patient autonomy. I am testifying today as a former egg donor on the dangers posed to women by the egg harvesting industry. I believe that all four of the above key principles had been violated in my case. Even though I suffered immediate life-threatening complications from the process, it wasn’t until many more years of medical training that I was able to understand the full scope of how I had been taken advantage of, mislead, and abandoned by the egg harvesting industry. As a medical professional it is still difficult to accept that such abuses are allowed to exist in my profession. Meanwhile, players “behind the scenes” such as the egg donation agency and the egg brokers have left the issues of ethics, health, and safety to the doctors, so that they can concentrate on profit. It is my assessment that the egg donation industry cannot be allowed to continue without regulations aimed at preventing unethical recruitment, substandard practices, and inadequate monitoring of women for the purpose of egg harvesting.

The goal of my testimony is to illuminate the importance of placing regulations on the way that the egg harvesting industry is run -- from ethical, legal, and medical standpoints. 1) The health and safety of women must be protected first and foremost in any procedure related to ovum production, and should never be superseded by concerns of profit, costs of screening and monitoring the subject, quantity of eggs produced, quantity of eggs retrieved, or completion of the cycle. 2) Furthermore, like any other industry, the egg harvesting industry must be held accountable for reporting adverse effects and for tracking the long-term health of donors. 3) Ethically, informed consent must be properly obtained, with an admission that more research is needed to illuminate the long-term risks to donors. It is also an ethical responsibility for those who profit from egg harvesting to track the health of donors, including conducting large scale research in order to study risks.

I will now relate my experience. In 2001, while still in the combined MD/PhD program, I signed up for egg donation after seeing a university newspaper advertisement for egg donors. The monetary compensation of $6,500 seemed like a lot to me at the time, as I made barely enough to live on. Though I had a desire to help an infertile couple, money was definitely a major driving factor in my decision. Before I started, I searched the medical literature with a fine-tooth comb to verify that this procedure was indeed as harmless as advertised by the egg donation agency. I did not find any hard evidence in the literature of future infertility and cancers, and it seemed that the risks of other complications were extremely low. However, I was not told that the egg donors were rarely followed after the donation, and that doctors were under no obligation to report adverse events.1 Like many other women egg donors, I was bound by legal contracts to remain anonymous and therefore even if late complications occurred, they would be difficult to report.

At this point I had a normal gynecologic history, including normal age at first menses, regular menstrual cycles, and nothing significant on pelvic ultrasounds. It was assumed that I was healthy enough to undergo the egg harvesting protocol. Then I submitted my photographs, passed my genetic screening as a “quality assurance” for the tissue purchaser, and submitted myself to a psychological screen and IQ test administered by a psychiatrist. Based on these results I was chosen as the egg donor, from whom a “designer offspring” would be created.

The legal contract stated that the creation of these eggs were for the purpose of in vitro fertilization. The recipients of my eggs would retain all rights to my eggs and any subsequent embryos created from my eggs, “including but not limited to the ability to make all decisions regarding disposition of embryos.” The literature given by the egg donation agency outlined the possible risks of ovarian hyperstimulation syndrome (OHSS), as well as some other theoretical risks that they assured me were rare. What I did not realize at this time was that there were other hidden players in the egg industry who could potentially make money off my eggs, and that there were no laws in place to discourage hyperstimulation of many more eggs than reasonably needed for the goal of helping the infertile couple. My contract did not guarantee that third parties would not be involved in the trading or selling of these eggs, though it specifically forbade donations to other infertile couples without the donor’s consent. My eggs could have been a high-value commodity for profiteers who had nothing to do with the infertile couple, and I was not made aware of this possibility in a forthcoming and direct manner.

The below was part of the information provided to the public by the egg donation agency:

Q: How many eggs are removed during the retrieval?
A: The average is 10-15 eggs aspirated per cycle, but donors can produce 16 or more eggs.

Q: Can a donor not produce enough eggs in a stimulated cycle?
A: Yes, if the doctor cancels the cycle for poor response the donor will be compensated between $650.00 -- $750.00.

According to my agency, failure to produce more than 4 eggs qualifies as “not enough eggs”. Four is typically higher than the target for women who are receiving fertility treatment using oral medications. However, note that there is no upper limit for the number of eggs a donor may safely “produce”, indicating that safety of ovum overproduction is being ignored. This illustrates that the drive to produce a higher number of eggs is extremely high, and failure to produce “adequate” eggs is linked with reduced financial compensation for the donor. Needless to say, this concept of “more is better” brings up ethical questions concerning the use of financial compensation for the recruitment of egg donors. This is especially alarming when no standards are in place to prevent an agency from overproducing eggs. The agency also told me that if I had a successful donation and become a proven donor, I may receive more compensation for future cycles, upwards of $8,000 (on paper) to $20,000 (verbally) – more than I would make in a year of intensive lab work. When “successful” production cycles are linked to increased financial compensation and “failures” are linked to a decrease in financial compensation, women will become more likely to tolerate untoward side effects, including those of OHSS, for fear of losing this compensation. This payment structure poses an obvious ethical conflict.

After signing my legal contract I began to administer all the medications as directed by the egg donation agency. These medications arrived by mail. I already knew how to mix and administer the medications but I don’t recall being instructed by medical personnel. At no point did they adjust my dosage. I remember receiving follow-up early on with a local doctor, and more exams after I travelled by plane to Northern California for the harvesting. Imagine my surprise when they told me that I was producing approximately 60 egg follicles! A mature follicle measures ~2 cm in diameter. The normal ovary measures approximately 4 x 2.5 x 1 cm, and is analogous to the testes. Therefore, you can imagine how 30 mature follicles of 2 cm diameter clustered within each gonad must look like and feel. I was concerned, but the doctors and nurses assured me that this was within the reasonable range for a fertile young woman.

A couple of days before the retrieval the nurse emailed me that my blood estrogen (estradiol) levels came back much higher than they had anticipated (~10,000 pg/ml). A woman in her 20s has an average estrogen level of ~150 pg/ml, with a peak of ~400 pg/ml prior to ovulation. In late pregnancy, the levels may rise 100-fold, but this rise normally occurs over a 6 month period. I asked the fertility specialist to consider altering the timing and course of this process. I was concerned because the drugs I received were probably tested on Caucasian women of average weight. I am a thin non-Caucasian woman. Studies have shown genetic differences in liver drug metabolism for ethnic populations; the examples are too many to reference and are beyond the scope of this topic. Despite my concerns, the doctor told me that even though my hormone levels were extremely high, they would not make any adjustments to the protocol because they did not want to risk failure. I continued to follow all their directions, as it stipulated in my legal contract that I “[understood] it [was] imperative” that I “not deviate from [the protocol] unless instructed to do so by the IVF physician.” Therefore, I proceeded to finish my ovarian stimulation, finishing off with a shot of human chorionic gonadotropin (HCG) to help release the eggs for the harvesting. The next morning, I underwent transvaginal needle retrieval of the eggs.

What was unknown after the surgery was that the doctor had punctured an artery during the harvesting. When I woke from the anesthesia I became weak, nauseous, and dizzy. I was scheduled to catch a plane that afternoon, to return home. They told me that I looked good and was ready to go home, even though I had problems maintaining my blood pressure. At this point I refused to leave, because I could not stand without getting dizzy – orthostatic hypotension after an invasive procedure typically raises the suspicion of blood loss. A few hours later they started giving me intravenous fluids because they thought that the anesthesia was causing my low blood pressure. Then I developed pain and difficulty breathing. An ultrasound showed that everything was fine except for fluid in my pelvis, which they said was normal (later, this was documented as “fluid pocket near the right kidney”. During this entire time the doctor and nurse persisted in trying to get me to leave, which would mean hours of traveling by car and plane. The pain in my belly became unbearable and I became convinced that I was bleeding internally; something was irritating and pushing on my diaphragm. When I asked if I could be bleeding internally, they told me that it was unlikely. My blood pressure was even lower at this time, so they gave me medication to raise it. Unfortunately giving pressors in a bleeding patient increases the bleeding rate. At 6pm, after 8 hours of slowly and painfully bleeding out, they FINALLY admitted me to the hospital. To me it seemed like they had done just about everything to get rid of me up until that point. The fertility doctor ordered me to eat something. As soon as I sat up in bed to eat, I developed sudden distress and difficulty breathing. They took my blood pressure and called out “40/20". At that moment I feared that I was going to die. In my medical records the blood pressure reported was 61/29. At this point they finally began to realize that something was terribly wrong, that I was going into shock from blood loss, so I was taken into the operating room for an emergency exploratory laparotomy to find the source of bleeding. The surgeons flipped through my bowels three times to ensure that no other organs were punctured.

During the harvesting of ~60 eggs, which I assume required 60 passes of the needle through my ovaries, the fertility doctor had punctured a high pressure artery in my right ovary. This tiny bleeder was easily fixed with a touch of electrocautery. I had an emergency blood transfusion to replace the 1.5 liters of blood lost. There is absolutely no reason why they should have waited so long to properly diagnose me, thus turning this into an emergency surgical situation when they could have done a small laparoscopic procedure to diagnose and fix a small bleeding artery. Had I followed their directions and gone home, I would have died. Unfortunately their disregard of the signs of OHSS, low index of clinical suspicion for post surgical complications, and their extremely slow response resulted in a horrific clinical outcome.

After the surgery, I had to be kept on a breathing machine in the intensive care unit (ICU) and treated for acidosis throughout the next day. After I was stabilized enough to move to the regular medical wards, the fertility doctor came to see me. She told me that the bleeding was probably due to a genetic bleeding disorder (i.e. my own fault) and that this has never happened before. Then she proceeded to check me for rare genetic bleeding disorders - nothing. I found the doctor’s reluctance to accept that a simple, clear-cut complication had occurred to be highly disturbing. A few days after I was admitted, the 9/11 attack occurred and all planes were grounded for a week. Despite not being able to walk or tolerate a 10 hour car ride home, the doctor told me I needed to free up medical resources and go home now. She tried to get me to leave by stating that when she had her C-section it only took her 3 days to start walking again. However, she neglected the fact that I had gone into prolonged shock caused by her own negligence, spent time in the ICU, underwent a massive surgical procedure, and had emergency blood transfusions. There were no apologies from beginning to end. I was shocked by this dismissive attitude from a top doctor of a top fertility treatment center, a medical expert who has published many articles on safety evaluation and recommendations for egg harvesting. At the same time, I was afraid to launch any complaints because I was a student in the same hospital system with plans to pursue the same field – Ob/Gyn; years later I decided on another medical specialty for unrelated reasons.

I am thankful to be alive, but I know that it was not because the doctor caught the post surgical complication. It was because I finally took a stand, and refused to go home when I knew that something was wrong. If I had died I would not be here to tell my story. I fear that cases like mine are buried deep by the fertility centers who do not want to lower their reputation. While I was in the hospital the fertility doctor told me that she would write a case report on the complication I had. When I searched the medical literature for all of her publications some years later, I wasn’t surprised to find that there was no such report. I have no way of knowing if this incident even made it into a statistical analysis somewhere in the medical literature. It makes sense that an industry thriving on profits and reputation has little incentive to report adverse events, for fear of driving away potential IVF clients and egg donors.

The $6,500 I was given has long since evaporated into medical treatments for multiple late complications caused by this incident. I developed an infection inside my incision site and required multiple steroid injections into the scar to stop it from growing out of control. I suffered from post traumatic stress for months because of my near-death incident, and was unable to work for two months due to both physical and mental deterioration. When I came off birth control a few years later I discovered that my previously normal menstrual cycles and hormone levels had become irregular. My previously normal ovaries took on a polycystic appearance, with more than 25 small follicles in each ovary. I developed occasional incontinence and pelvic pain likely as a consequence of the emergency surgery causing adhesions (fibrotic bands, analogous to scarring) around my organs.

The worst part of this is my current struggle with infertility, requiring continued exposure to the very same types of fertility drugs that I had already been overexposed to in the past – exposure whose link to cancer has not been adequately studied and may take decades to emerge.1 I may need more surgeries in the future to determine if the emergency surgery that was done had damaged my reproductive organs. I fear that the procedure may have harmed the quality of my eggs, even if the fertility experts are certain (at least theoretically) that quantity of eggs remains unaffected. Because of the high hormonal exposure during my egg donation cycle and multiple anecdotes from other egg donors, the development of early cancer is always in the back of my mind. Though a large study has found no evidence linking IVF to ovarian cancer, there is a generalized, undeniable causal relationship between transient exposure to female hormones and transient risk of rapid-growth gynecologic cancer.2 I believe that is absolutely necessary for egg donors to be followed and studied, especially if they had experienced hyperstimulation during the process. No follow up has ever been offered to me. Nobody from the egg donation agency, fertility clinics, or hospital has contacted me since, except to obtain my insurance information so that they could pass my hospital bill to my own health insurance company.

Summary and Conclusion:

1) Ethical considerations:

Financial compensation for eggs disproportionately targets college women with financial hardships. These women usually have long academic careers ahead of them and have not considered childbearing yet, so any infertility caused by the procedure would cause more psychological and physical damage to these women. Docked pay for failure to produce a target number of eggs and escalating pay scales for subsequent cycles are factors that may encourage underreporting of adverse side effects by the egg donor.

2) Subject safety:

Subject safety is variable, being highly dependent on the individual clinician’s practice. This is why there needs to be standardized safety practices and mandatory reporting of complications. In the article “Assessing the Medical Risks of Human Oocyte Donation for Stem Cell Research: Workshop Report (2007)”, one fertility expert advocated the following:3

By working from such information as a patient’s age, weight, and follicle count… a doctor can begin with an FSH dose based on those factors and then modify it as necessary. We monitor during the course of the stimulation to further decrease the dose if too many follicles are developing or the estradiol levels are too high.

To reduce risk of hyperstimulation, these actions were also recommended:

  • Modify stimulation protocol
    • Decrease gonadotropin dosage
    • OCP/Lupron/Low dose gonadotropins
  • Reduce the ovulatory dose of hCG
  • Delay administration of hCG: “Coast”
  • Cancellation of cycle eliminates the risk of OHSS
  • Withhold hCG administration

Basically the safety recommendations for egg donors include determining the initial dosing of these powerful drugs on the weight and age of the patient. If there is any evidence of producing more eggs or hormones than expected during routine monitoring, then the drug dosage should be reduced, the administration of stimulating medications delayed, or the cycle cancelled. None of these recommendations were followed in my case. In fact, it was one of my own egg donation doctors who was consulted and quoted in the above article.

Regarding the risk during surgical retrieval of the eggs, the perceived negligible risk of complications is likely due to incomplete data:2

It is difficult to know, however, exactly how often such complications occur . . . Although excellent statistics are kept on such things as how many viable eggs each procedure produces, the statistics are not so complete on the complications that ensue during and after.

As my case illustrates, this perceived near-zero risk is inherently dangerous because it will not raise red flags when complications do occur, resulting in delayed intervention and a poorer-than-expected outcome. When a complication does occur, the denial of medical responsibility based on statistical rarity is a faulty and circular argument. This denial of responsibility would also prevent egg donors from obtaining monetary compensation for treatment of complications and appropriate follow-up. As my case illustrates, poor management of retrieval complications can be a problem even in the hands of the most experienced clinician.

Lastly, I received no follow up after my procedure. It is the ethical duty of the fertility industry to conduct timely follow-up and research studies in order to promote safety. This is true of any other industry especially pharmaceutical – so why make fertility an exception?

3) Informed consent:

Many are improperly informed about the risks of the egg harvesting process. Verbally I was told that risk was virtually non-existent and that studies have not linked the procedure to cancer and infertility. I should have been told that there were not enough studies or long-term follow up to determine risk.

It should be made abundantly clear if embryos or stem cells may potentially be secondarily sold, traded, or gifted. The amount of profit potentially generated from each transaction and the purpose of each transaction should be transparent to everyone involved, especially the donor. Without this information, the egg donor cannot possibly make an informed decision.

4) Patient autonomy:

I was hyperstimulated with approximately 60 eggs retrieved. During the procedure I expressed concerns about not using weight-based dosing of fertility medication, the excessive number of follicles produced, and skyrocketing estradiol levels. Nothing was done to personalize my procedure based on clinical findings, which is clearly incongruent with the standard of care. After the procedure my concerns about internal bleeding were not adequately acknowledged until I went into shock and had to undergo an emergency laparotomy. In my experience, the pressure to complete a successful cycle became stronger as I became more invested in the process, and thus I progressively lost my right to make decisions regarding my own body.

Final thoughts:

Even the tiniest risk of complication needs to be taken seriously especially when dealing with perfectly healthy young women, who have no need to undergo a potentially life-threatening procedure. Procedures with risk are performed on sick patients with the understanding is that the benefits of the procedure outweigh the risks or the consequences of doing nothing. In egg donation there is no medical benefit, only risk. It represents a conflict of interest when the physician does not perceive the egg donor as a patient for whom they have the responsibility to minimize risk. This aspect must be considered when treating healthy young women with everything to lose.



1. Nature. 2006 Sep 7;443(7107):26. Health effects of egg donation may take decades to emerge.

2. American Journal of Epidemiology Vol. 153, No. 11 : 1079-1084.

3. Assessing the Medical Risks of Human Oocyte Donation for Stem Cell Research: Workshop Report (2007).




© 2010-2012 The Center for Bioethics and Culture Network