Increasingly, digital health technologies on the market today are providing tools, such as robust tracking capabilities or wireless temperature monitoring, which empower women to better understand their own bodies.  For many women and couples, these devices and mobile apps are trusty guides when navigating the sometimes complicated process of conceiving or avoiding conception.  At the population level, many digital reproductive health technologies aim to improve access to educational information, shed societal taboos associated with female health, and contribute data to facilitate research and science. 

The growth of these digital technologies is a welcome trend as, overall, female and reproductive health is a vastly under-served area with large gaps in research still waiting to be filled.  Egg donation, a procedure used in in vitro fertilization (IVF)—a method of assisted reproductive technology (ART)—is one example of an under-researched area of reproductive health that could use more data, both at the individual and population level, to better understand and improve female health. 

For those struggling with infertility, particularly women of advanced reproductive age, egg donation can be an effective form of assisted reproduction, expanding individuals’ options for having children. For more than 30 years, women have been donating eggs, harvested from their ovaries, to infertile women and couples, resulting in over 200,000 births (1).

These happy outcomes speak for themselves. And yet it’s essential to consider potential health effects for donors, especially as the process continues to rise in popularity.  While short-term complications of egg donation have been well-studied (2), important questions remain regarding long-term medical and psychological effects for donors (3).  

Donors have not been surveyed in meaningful ways over lengthy periods of time about their personal fertility, cancer incidence, or psychological states following participation. It is possible there are no serious long-term complications; however, to gain a true sense of egg donation’s risks and complications and best equip clinicians to inform donors about the procedure, more long-term data is needed (3).

To understand the data gaps in egg donation research—and technology’s ability to forge those gaps—let’s begin by taking a deeper dive into what we know and don’t know about egg donation.

Egg donation is widespread. In the United States, 92 percent of fertility clinics offer the procedure and donor eggs are used in 10.5 percent of ART cycles. Egg donation is an especially important option for women over age 40, as approximately 50 percent of their IVF cycles are successful when donor eggs are used compared to below 25 percent when using non-donor eggs (1).

Although you may know that many infertile women rely on ovulation-stimulating drugs to participate in ART, you may not be aware that egg donors are given these drugs too, in order to synchronize menstrual cycles with egg recipients and also fuel egg production. Once an egg is retrieved from the egg donor, IVF is performed, where the egg is fertilized with sperm in a laboratory dish, and the fertilized egg is implanted in the infertile woman’s uterus.

For individuals who have never donated before, the process can seem foreign, and curious individuals will naturally have a lot of questions.  Providing accurate and informed answers to those questions is particularly important as increasing numbers of women, mostly young, look to become egg donors.  A clinician, when discussing egg donation with a potential donor, should be able to answer questions about the long-term effects of egg donation, such as, “Am I at increased risk of cancer from my use of ovarian-stimulating drugs?” or “How is my future fertility affected?” and “Am I at greater risk for future psychological issues?” Unfortunately, research to date has poorly equipped them to do so (3).

What do we know about risks to egg donors?

Fortunately, short-term complications from egg donation appear to be rare—less than one percent. Such complications include ovarian hyper-stimulation syndrome, intra-abdominal bleeding, infection, ovarian torsion, and short-term subfertility (2).

Past studies on long-term health issues, such as infertility or reproductive cancers, in egg donors are few in number and have methodological shortcomings. Limitations include reliance on self-reported data and insufficient follow-up times (3).

Potential psychological implications, such as depression or anxiety, also need study. For example, donors may experience a range of feelings knowing their genetic progeny are being raised by unknown parties (3).

Long-term medical effects for infertile women who’ve undergone IVF have been studied to a greater extent than those for egg donors. But, despite technical similarities, it’s not clear we can apply results from one group to the other. Infertility itself may make comparisons difficult (3).

How can emerging digital health technology help us close knowledge gaps in women’s reproductive health?

In an article I co-authored on egg donation, we explore possible solutions to fill this critical gap in research, ultimately advocating for a data-driven approach (3).  Specifically, funding a multi-decade longitudinal follow-up study to better understand long-term medical and psychological risks of egg donation for female donors.  This, of course, will not take place overnight – it would be a major financial and time commitment, but the resulting data would be quite reliable (3).

Here at HITLAB, we recognize the benefits of a data-driven approach in egg donation research. We also know that digital health technology can be harnessed to advance this specific inquiry, not to mention women’s overall reproductive health.  Digital health technologies focusing on women’s health may also be able to further research into egg donor health; for example, through offering a new method of monitoring and tracking health outcomes of individuals prospectively over time.  Already there exist a host of apps, connected devices, and sensors dedicated to tracking and monitoring menstrual cycles, body temperature, fertility windows, and other reproductive health metrics. Digital health technologies, and the valuable, often real-time, data they collect, have enormous potential to help egg donors, egg recipients, and women in general.

Ovatemp and Kindara are two companies offering mobile apps and wireless devices to help individuals track their basal body temperature, as well as other fertility related metrics. Clue, a digital female health company behind a popular period and fertility tracking app, has partnered with multiple research institutions, including Columbia University, on research into menstrual cycles.

These technologies and others on the horizon can help not only individuals as they face daily reproductive and overall health decisions, but also researchers as they gather data and structure effective research methods.  For example, what if, instead of relying on retrospective reports from egg donors about stress or abnormal pain, researchers could instead use data from egg donors tracking their own health in near real-time?  Whether the goal is to close the gap in the scientific literature on egg donor health or understand the relationship between menstrual cycles and mood, data driven approaches to improving health for men and women can help us get there.  And now, in the age of “big data,” smartphone apps, and wearable devices, we have many more tools at our disposal to accelerate research into these areas.

In conclusion, many questions remain to be answered regarding the long-term health and psychological effects of egg donation. Answering these questions is important for ensuring full egg donor informed consent and better understanding, and potentially improving, one aspect of female health (3). Emerging technologies have the potential to help investigators as they consider various options to study these potential risks. A government-funded longitudinal follow-up study of egg donors may have the best potential to improve understanding, and digital technology will likely play an important role in the process. 

We at HITLAB are eager to see how healthcare technology will be leveraged by researchers and scientists across the globe, in low resource and high resource settings, closing the gaps in our evidence base and improving reproductive health, one data point at a time.

References

(1)    Center for Disease Control and Prevention. 2013 assisted reproductive technology: national summary report. Atlanta, Georgia: Society for Assisted Reproductive Technologies; 2013. http://www.cdc.gov/art/pdf/2013-report/art_2013_national_summary_report.pdf

(2)    Bodri D. Risk and complications associated with egg donation. In: Sauer MV, editor. Principles of oocyte and embryo donation. New York: Springer; 2013:205–19.

(3)    Woodriff, Molly et al.  Advocating for the longitudinal follow-up of the health and welfare of egg donors. Fertility and Sterility, Volume 102, Issue 3, 662-666; 2014.

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