Monday, Nov 24, 2014

Egg donor’s death: Internal bleeding, ovaries severely enlarged, says report

Written by Pritha Chatterjee | New Delhi | Posted: February 9, 2014 3:06 am | Updated: February 9, 2014 4:44 am

An initial post-mortem report of the 23-year-old Yuma Sherpa, who died after an egg donation procedure at an IVF clinic in Lajpat Nagar on January 29, has said she sustained internal bleeding in her pelvic region and her ovaries were “hypertrophied.” The report has been submitted to the police by AIIMS, and the viscera has been sent for more tests to establish the cause of death.

According to sources, the post-mortem has found haematoma or clotting of blood in the peritoneum (stomach cavity), around the uterus and ovaries, indicating internal bleeding. The report has also found her ovaries were “severely hypertrophied” or enlarged. “The ovaries were enlarged due to hormones injected to trigger the ovaries to produce more than the usual number of eggs, since she had undergone a procedure to donate her eggs. We are trying to understand the quantity of hormones that were injected, through viscera tests and chemical and physical examination of the ovary cells to analyse the number of follicles that were formed in the ovary,” a source said.

Sources said Sherpa was given general anaesthesia in the procedure, and the ovary has been probed by a catheter to retrieve the eggs under suction puncture, which has led to the internal bleeding. Sources said even the possibility of a reaction from anaesthesia had not been ruled out yet. “The procedure was performed under general anaesthesia, many patients have adverse reactions to anaesthesia. Tests on visceral samples will help us establish that,” a source said.

Sources confirmed no blood vessels around the ovaries were found to be torn or ruptured in the procedure. Sherpa, the mother of a three-year-old, who worked as a help in a shop, had gone to New Life India Fertility Clinic for her first egg donation. She collapsed after the retrieval procedure last week. When she did not respond to resuscitation efforts, she was taken from the clinic to a  hospital in Green Park where she was declared dead on arrival.

When contacted for comments, the medical director of the New Life India Fertility Clinic, denied any irregularities. “We are awaiting the post-mortem report. The patient’s full consent was taken, she was screened as per procedure and we also conducted all necessary pre-anaesthetic tests. All records have been handed over to police. She even called her husband after the procedure. She lost consciousness suddenly in the recovery room,” she said. She added that when the treating team realised that Sherpa was not responding, an ambulance was arranged to have her transported to a Green Park hospital, where the anaesthetist from New Life clinic was a consultant. “They also failed to resuscitate her. It appears she had a sudden cardiac arrest. We are also awaiting the post-mortem report to find out what went wrong,” the medical director added.

Sherpa’s husband had made a PCR call from the Green Park hospital after she was declared dead, on the basis of which a complaint was filed by the police. A medical board was constituted at AIIMS under the chairmanship of a professor of forensic medicine to conduct the post-mortem. “The preliminary report has stated certain physical findings in the body. We are waiting for the viscera report to establish the final cause of death. We will initiate investigations after we get the viscera report,” a police officer said.

In oocyte donation procedures, hormones known as Gonadotrophins are administered to the donor during her menstrual cycle to boost ovaries to produce a number of eggs, against the normal production of one follicle that matures into an egg every month. Doctors say in rare cases this can lead to a condition of Ovarian Hyper Stimulation Syndrome (OHSS), which leads to a cascade of reactions when the ovary is stimulated very strongly to produce an excess of eggs. “While mild to moderate OSH can happen in 8-10 percent cases, severe OSH cases are very rare, and between 1-3 per cent. I think at AIIMS our incidence will be less than 1 percent,” an IVF specialist from AIIMS said. The dosage of the hormones is determined by doctors on the basis of the patient’s BMI, ovarian reserve and hormone levels. Doctors said OSSH can also be prevented by screening tests for donors, like identifying levels of some hormones like AMH and checking the ovarian reserve of the patient. “If the patient has high AMH levels, or very high ovarian reserves, or number of eggs, she should ideally not be used as a donor, because such women have a tendency to go into OSH with stimulation,”the AIIMS doctor explained.

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