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Advanced Fertility CareAZ Advanced Reproductive LabAZ Advanced Surgery CenterEgg Donation(Known or Anonymous)Version 9/13/17Egg Donation ProcessDonor ScreeningPotential egg donors undergo careful screening for genetic, psychological, hormonal and physical screening beforebeing accepted as an egg donor. This screening process involves several office visits over a month or more toassess these factors.Ovarian Stimulation Injections of the natural hormones FSH and/or LH (gonadotropins) are used to cause a groupof eggs to develop to maturity.Additional medications are used to prevent premature ovulation.An overly vigorous ovarian response can occur, or conversely an inadequate response.“Fertility drugs” are used to stimulate the ovary in hopes of inducing the simultaneous growth of several oocytes(eggs) over the span of 8 or more days. Monitoring of your ovaries’ response by ultrasound is important. A typicalpattern of office visits is shown below:Preparatory CycleEggRetrievalOvarian Stimulation CycleOffice visits: This process does not cause you to run out of eggs sooner in the future. The eggs that are induced to grow bythese medications were already ‘linked’ to this cycle and would have been lost anyway had they not been inducedto grow.Medications may include the following (not a complete list): Gonadotropins, or injectable “fertility drugs” (Follistim , Gonal-F , Bravelle , Menopur ): Thesenatural hormones stimulate the ovary in hopes of inducing the simultaneous growth of several oocytes(eggs) over the span of 8 or more days. All injectable fertility drugs have FSH (follicle stimulatinghormone), a hormone that will stimulate the growth of your ovarian follicles (which contain the eggs). Someof them also contain LH (luteinizing hormone) or LH-like activity. LH is a hormone that may work with FSHto increase the production of estrogen and growth of the follicles. Low-dose hCG (human chorionicgonadotropin) can be used in lieu of LH. These medications are given by subcutaneous or intramuscularinjection. Proper dosage of these drugs and the timing of egg recovery require monitoring of the ovarianresponse, usually by way of blood tests and ultrasound examinations during the ovarian stimulation.As with all injectable medications, bruising, redness, swelling, or discomfort can occur at the injectionsite. Rarely, there can be an allergic reaction to these drugs. The intent of giving these medications is tomature multiple follicles, and many women experience some bloating and minor discomfort as the folliclesgrow and the ovaries become temporarily enlarged. Up to 2.0 % of women will develop OvarianHyperstimulation Syndrome (OHSS) [see full discussion of OHSS in the Risks to Women section thatfollows]. Other risks and side effects of gonadotropins include, but are not limited to, fatigue, headaches,weight gain, mood swings, nausea, and clots in blood vessels.Even with pre-treatment attempts to assess response, and even more so with abnormal pre-treatmentevaluations of ovarian reserve, the stimulation may result in very few follicles developing. The end resultPage 4 of 15Initials: Donor /Spouse

Advanced Fertility CareAZ Advanced Reproductive LabAZ Advanced Surgery CenterEgg Donation(Known or Anonymous)Version 9/13/17may be few or no eggs obtained at egg retrieval or even cancellation of the treatment cycle prior to eggretrieval.Concerns have been raised that the risk of ovarian cancer may increase with the use of fertility drugs, butrecent studies have not confirmed this. A major risk factor for ovarian cancer is infertility per se, and earlyreports may have falsely attributed the risk resulting from infertility to the use of medications to overcome it(see 2.b.2 for further discussion). GnRH-agonists (leuprolide acetate) (Lupron ): This medication is taken by injection. There are twoforms of the medication: A short acting medication requiring daily injections and a long-acting preparationlasting for 1-3 months. The primary role of this medication is to prevent a premature LH surge, which couldresult in the release of eggs before they are ready to be retrieved. Since GnRH-agonists initially cause arelease of FSH and LH from the pituitary, they can also be used to start the growth of the follicles or initiatethe final stages of egg maturation. Though leuprolide acetate is an FDA (U.S. Food and DrugAdministration) approved medication, it has not been approved for use in IVF, although it has routinelybeen used in this way for more than 20 years. Potential side effects usually experienced with long-termuse include, but are not limited to: hot flashes, vaginal dryness, bone loss, nausea, vomiting, skin reactionsat the injection site, fluid retention, muscle aches, headaches, and depression. No long term or seriousside effects are known. Since GnRH-a are oftentimes administered after ovulation, it is possible that theywill be taken early in pregnancy. The safest course of action is to use a barrier method of contraception(condoms) the month you will be starting the GnRH-a. GnRH-a has not been associated with any fetalmalformations, however you should discontinue use of the GnRH-a immediately if pregnancy is confirmed. GnRH-antagonists (ganirelix acetate or cetrorelix acetate) (Ganirelix , Cetrotide ): These are anotherclass of medications used to prevent premature ovulation. They tend to be used for short periods of time inthe late stages of ovarian stimulation. The potential side effects include, but are not limited to: abdominalpain, headaches, skin reaction at the injection site, and nausea. Human chorionic gonadotropin (hCG) (Profasi , Novarel , Pregnyl , Ovidrel ): hCG is a naturalhormone used in IVF to induce the eggs to become mature and fertilizable. The timing of this medication iscritical to retrieve mature eggs. Potential side effects include, but are not limited to: breast tenderness,bloating, and pelvic discomfort. Oral contraceptive pills: Some treatment protocols include oral contraceptive pills to be taken for 2 to 4weeks before gonadotropin injections are started in order to suppress hormone production or to schedule acycle. Side effects include unscheduled bleeding, headache, breast tenderness, nausea, swelling and therisk of blood clots or, very rarely, stroke. Other medications: Antibiotics may be given for a short time during the treatment cycle to reduce the riskof infection associated with egg retrieval or embryo transfer. Antibiotic use may be associated with vaginalyeast infection, nausea, vomiting, diarrhea, rashes, sensitivity to the sun, and allergic reactions. Antianxiety medications or muscle relaxants may be recommended prior to the embryo transfer. The mostcommon side effect is drowsiness. Other medications such as steroids, heparin, low molecular weightheparin or aspirin may also be included in the treatment protocol.Page 5 of 15Initials: Donor /Spouse

Advanced Fertility CareAZ Advanced Reproductive LabAZ Advanced Surgery CenterEgg Donation(Known or Anonymous)Version 9/13/17Transvaginal Oocyte (Egg) Retrieval Eggs are removed from the ovary with a needle under ultrasound guidanceAnesthesia is provided to make this comfortableComplications are rareOocyte retrieval is the removal of eggs from the ovary. A transvaginal ultrasound probe is used to visualize theovaries and the egg-containing follicles within the ovaries. A long needle, which can be seen on ultrasound, can beguided into each follicle and the contents aspirated. The aspirated material includes follicular fluid, oocytes (eggs)and granulosa (egg-supporting) cells. Rarely, the ovaries are not accessible by the transvaginal route andlaparoscopy or trans-abdominal retrieval is necessary. These procedures and risks will be discussed with you byyour doctor if applicable. Anesthesia is generally used to reduce, if not eliminate, discomfort. Risks of egg retrievalinclude:Infection: Bacteria normally present in the vagina may be inadvertently transferred into the abdominal cavity bythe needle. These bacteria may cause an infection of the uterus, fallopian tubes, ovaries or other intra-abdominalorgans. The estimated incidence of infection after egg retrieval is less than 0.1%. Treatment of infections couldrequire the use of oral or intravenous antibiotics. Severe infections occasionally require surgery to remove infectedtissue. Infections can have a negative impact on future fertility. Prophylactic antibiotics are sometimes used beforethe egg retrieval procedure to reduce the risk of pelvic or abdominal infection in patients at higher risk of thiscomplication. Despite the use of antibiotics, there is no way to eliminate this risk completely.Bleeding: The needle passes through the vaginal wall and into the ovary to obtain the eggs. Both of thesestructures contain blood vessels. In addition, there are other blood vessels nearby. Small amounts of blood lossare common during egg retrievals. The incidence of major bleeding problems has been estimated to be less than0.1%. Major bleeding may require surgical repair and possibly loss of the ovary. The need for blood transfusion israre. (Although very rare, review of the world experience with IVF indicates that unrecognized bleeding has lead todeath.)Trauma: Despite the use of ultrasound guidance, it is possible to damage other intra-abdominal organs during theegg retrieval. Previous reports in the medical literature have noted damage to the bowel, appendix, bladder,ureters, and ovary. Damage to internal organs may result in the need for additional treatment such as surgery forrepair or removal of the damaged organ. However, the risk of such trauma is very low.Failure: It is possible that the aspiration will fail to obtain any eggs or the eggs may be abnormal or of poor qualityand otherwise fail to produce a viable pregnancy.Page 6 of 15Initials: Donor /Spouse

Advanced Fertility CareAZ Advanced Reproductive LabAZ Advanced Surgery CenterEgg Donation(Known or Anonymous)Version 9/13/17Anesthesia: The use of anesthesia during the egg retrieval can produce unintended complications such as anallergic reaction, low blood pressure, nausea or vomiting and in rare cases, death. Modern anesthesia isrelatively safe and uneventful so that virtually everyone can be afforded its benefits. There are several types ofanesthesia available. Your surgeon has chosen intravenous for your surgical procedure. This anesthesiatechnique is designed to reduce your anxiety and pain. It provides the patient with partial or, in most cases, totalamnesia. Medications (Versed, Fentanyl, and/or Diprovan (i.e. Propofol) are injected into the bloodstreaminducing a semi-conscious state. Most patients will sleep through the procedure, waking up shortly after theprocedure is finished.You will need to fast (not eat or drink anything) for at least 8 hours before the scheduled procedure.Due to the nature of anesthesia, fatigue or sleepiness can be expected for up to 24 to 36 hours after theprocedure, so the patient undergoing anesthesia MUST be accompanied by a responsible adult who can driveher home and care for her for at least 18 hours following the procedure in the event of an emergency. In addition,the patient may not drive during the immediate 18 hours after the procedure.Risks and hazards of intravenous sedation, although rare, can occur regardless of the experience, care and skillof your anesthesia provider. The risks and hazards of intravenous sedation include, but are not limited to: injuryto a blood vessel (phlebitis), vertigo (dizziness), post-operative nausea and vomiting, an unconscious state whichcan lead to depressed breathing, allergic reaction to one of the drugs used (which in extreme cases can lead toanaphylaxis and even death). Your anesthesia provider will do his/her very best to protect you from harm but noguarantee as to the outcome of your anesthesia can be made.Advanced Fertility Care will provide for a licensed physician anesthesiologist to provide intravenous anesthesiafor the surgical procedure. The anesthesiologist administering the intravenous sedation will have full charge ofthe administration and maintenance of the anesthesia, and that it is an independent function from surgery.Your initials at the bottom of the page and signature(s) at the end of this documentindicate your informed consent to receive anesthesia for Egg Retrieval.For the egg donor, the egg retrieval is the last step. In about 2 weeks, your normal period will begin, and by thattime your ovaries will often be back to normal size.Your eggs then become the property of the Recipient (or AFC if the purpose of the cycle is for egg banking), to beused by her or a future Recipient for procreation. Sperm will be placed with your eggs, and one or two of theresulting embryos are transferred into a uterus (either hers or a gestational carrier’s). Extra embryos can be frozenfor later use. In some cases, the recipient is not yet identified at the time your eggs are removed; instead, youreggs can be frozen and stored to be used by someone to have a baby in the future.Situations that could make egg donation impossibleThere are a number of reasons egg donation may not be possible:1. Despite the fact that all instructions are followed faithfully, the ovaries may not respond to the medication,there may not be enough eggs developing, and the cycle may need to be canceled before the egg retrieval.The ovaries may respond too well to the medications and this could lead to a potentially seriouscomplication known as ovarian hyperstimulation syndrome (OHSS) that so the cycle may need to becancelled before the egg retrieval.2. Ovulation (release of the eggs) may occur spontaneously before the eggs can be retrieved.3. In rare cases, no eggs may be retrieved.4. The eggs may not be normal.5. Infectious disease testing performed within 30 days of the retrieval may be positive.Page 7 of 15Initials: Donor /Spouse

Advanced Fertility CareAZ Advanced Reproductive LabAZ Advanced Surgery CenterEgg Donation(Known or Anonymous)Version 9/13/17Risks of Egg DonationThe following are risks and discomforts associated with this procedure:1. Blood drawing and medication injections- mild discomfort and a risk of developing a bruise at the needlesite.2. Fertility drugs and other medications used to stimulate the ovaries may cause:a) Hyperstimulation - The fertility drugs/medications previously described may cause excessiveovarian enlargement (“hyperstimulation”), which may cause discomfort (because more than onefollicle is growing). Hyperstimulation may result in ovarian enlargement requiring therapy includinghospitalization and possible surgery with removal of an ovary.b) Cyst formation- The medications described above may result in large cysts forming on theovaries. In the majority of cases, ovarian cysts induced by fertility drugs/medications disappearspontaneously without requiring any intervention. In very rare instances (less than 1% of cycles)these cysts could result in significant abdominal discomfort that could result in the need forhospitalization for observation purposes. One of these cysts could rupture requiring emergencysurgery to stop the bleeding and could result in a need for blood transfusions and possible loss ofone or both ovaries (this occurs in less than 0.1% of cycles).c) Ovarian Hyperstimulation Syndrome (OHSS)- Fluid shifts within the body may require closeobservation and even hospitalization for further observation and treatment (1%-3% of cycles). Thehigh levels of estrogen associated with the use of these medications may alter the way in which thebody handles fluids. More specifically, the blood vessels may become “leaky” resulting in theaccumulation of fluid within the abdominal cavity (ascites) or around the lungs (pleural effusion).This accumulation of fluid may result in abdominal distension and discomfort with associatedshortness of breath (due to the diaphragm being pushed upward by the accumulation of fluid in theabdomen). In severe cases, removal of this fluid from the abdomen or from the space around thelungs may be required using a small needle (0.5% of cycles). The “leaky” vessels may also result inthe individual becoming dehydrated because the fluid is in the wrong place, i.e. in the abdomeninstead of in the blood vessels. Intravenous fluid administration may be required to maintainadequate blood flow to vital organs such as the kidneys. Severe dehydration could result inirreversible organ failure or blood clot formation leading to a pulmonary embolus (blood clots in thelung) or stroke (less than 0.1% of cycles). There are extremely rare reports in the literature of deathoccurring as a result of complications of OHSS. OHSS is a risk that is inherent to ovulationinduction therapy; prevention cannot be guaranteed. At times, when monitoring shows that therisk of OHSS is unacceptably high, a cycle may be canceled. Severe OHSS will rarely occur if hCGadministration is withheld. Close monitoring of your cycle by the clinic and following its instructionsis imperative to reduce these risks.d) Cancer --Many have worried that the use of fertility drugs could lead to an increased risk ofcancer—in particular, breast, ovarian, and uterine (including endometrial) cancers. One must becareful in interpreting research studies of women taking fertility drugs. Since all of these cancersare more common in women with infertility, simply comparing women taking fertility drugs withwomen in the general population inevitably shows an increased incidence of cancer. When theanalysis takes into account the increased cancer risk due to infertility per se, the evidence does notsupport a relationship between fertility drugs and an increased prevalence of breast or ovariancancer. More research is required to examine the long-term impact fertility drugs may have onbreast and ovarian cancer prevalence rates. For uterine cancer, the numbers are too small to drawconclusions.e) Adnexal Torsion (Ovarian Twisting): Less than 1 percent (1%) of the time, the stimulated ovarycan twist on itself, cutting off its own blood supply. Surgery is required to untwist or even remove it.Page 8 of 15Initials: Donor /Spouse

Advanced Fertility CareAZ Advanced Reproductive LabAZ Advanced Surgery CenterEgg Donation(Known or Anonymous)Version 9/13/173. Egg retrieval has risks including:a) Moderate discomfort after the procedure.b) Possibility of bleeding, infection, or injury to the abdominal organs that may require immediatemajor surgery with possible resulting loss of the uterus and/or ovaries, hospitalization for antibiotictherapy, blood transfusion or, in rare cases, death.c) The egg retrieval requires the use of anesthesia. Risks associated with anesthesia includingnausea, difficulty breathing, respiratory distress or very rarely death.4. The utilization of antibiotics at the time of egg retrieval may result in an allergic reaction, which may resultin a rash. In its most severe form, an allergic reaction may be life threatening. The utilization oftetracycline/doxycycline is associated with an increased sensitivity to the sun and, therefore, caution shouldbe taken to avoid prolonged sun exposure. The utilization of antibiotics may also be associated withnausea, vomiting, diarrhea, loss of appetite and vaginal yeast infections.5. Federally mandated screening and testing for infecti

Advanced Fertility Care Egg Donation Version 9/13/17 AZ Advanced Reproductive Lab (Known or Anonymous) AZ Advanced Surgery Center Page 1 of 15 Initials: Donor_/Spouse_ Egg Donation Process, Risk, Consent and Agreement Donor Egg (DE) therapy has become an established treatment for infertility due to egg problems or