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Shah JS, Figueras F, Blàzquez A, Brazal S, Buratini J, Buscà R, Canto MD, Iemmello R, Jacobs CK, Lorenzon AR, Renzini MM, Ripero M, Sakkas D. Perinatal outcomes in 6640 singleton pregnancies after donor oocyte IVF across three continents over 7 years. J Assist Reprod Genet 2023; 40:2903-2911. [PMID: 37819553 PMCID: PMC10656373 DOI: 10.1007/s10815-023-02965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Are trends in singleton donor oocyte IVF perinatal outcomes consistent over time among four international ethnically diverse infertility centers? METHODS This retrospective cohort consisted of an infertility network of four international IVF centers across three continents. Singleton live births resulting from fresh and frozen donor oocyte embryo transfers from January 1, 2012 to December 31, 2018 were included. The main outcome measures were birth weight (BW), preterm birth (PTB), large for gestational age (LGA), small for gestational age (SGA) and gestational age (GA) at delivery. RESULTS The entire cohort (n = 6640) consisted of 4753 fresh and 1887 frozen donor oocyte embryo transfers. Maternal age, parity, body mass index, neonatal sex and GA at delivery were similar for fresh and frozen donor oocyte embryo transfers in the entire cohort and within each infertility center. All four centers had a trend of decreased BW and rates of PTB before 32 weeks annually, although significance was not reached. Three of the four centers had annual increased trends of PTB before 37 weeks and LGA newborns, although significance was not reached. BWs for the entire cohort for fresh and frozen donor embryo transfers were 3166 g ± 601 g and 3137 g ± 626 g, respectively. CONCLUSION Similar trends in perinatal outcomes were present across four international infertility centers over 7 years. The overall perinatal trends in donor oocyte IVF may be applicable to centers worldwide, but further studies in more geographic regions are needed.
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Affiliation(s)
- Jaimin S Shah
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
- Boston IVF-Eugin Group, 130 Second Ave., Waltham, MA, 02451, USA.
- Present Address: Shady Grove Fertility, 2255 E Mossy Oaks Rd, Suite 620, Spring, Houston, TX, 77389, USA.
| | - Francesc Figueras
- Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Universitat de Barcelona, Hospital Clínic, 08950, Barcelona, Spain
| | | | | | - Jose Buratini
- Biogenesi Reproductive Medicine Centre-Gruppo Eugin, Istituti Clinici Zucchi, Monza, Italy
| | | | | | - Roberta Iemmello
- Biogenesi Reproductive Medicine Centre-Gruppo Eugin, Istituti Clinici Zucchi, Monza, Italy
| | | | - Aline R Lorenzon
- Huntington Medicina Reproductiva-Eugin Group, São Paulo, SP, Brazil
| | - Mario Mignini Renzini
- Biogenesi Reproductive Medicine Centre-Gruppo Eugin, Istituti Clinici Zucchi, Monza, Italy
| | | | - Denny Sakkas
- Boston IVF-Eugin Group, 130 Second Ave., Waltham, MA, 02451, USA.
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Jiang Y, Yuan JC, Song G, Zhang XH, Miao SB, Wu XH. Pregnancy outcome and follow-up of offspring of donor oocytes recipient from PCOS patients. BMC Pregnancy Childbirth 2022; 22:779. [PMID: 36261799 PMCID: PMC9580140 DOI: 10.1186/s12884-022-05114-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of donated oocytes (DO) for in vitro fertilization(IVF) treatment in patients with infertility is generally recognized, and females with polycystic ovarian syndrome (PCOS) can participate in oocyte donation programs as donor patients. However, the pregnancy outcomes and offspring follow-up in patients with PCOS as the recipients are unclear. This study was to compare the pregnancy outcomes and follow-up of offspring in PCOS and non-PCOS receptor. Methods This was a retrospective cohort study of 62 patients undergoing the oocyte reception program were separated into 2 groups: Group I, PCOS oocyte recipients (n = 30); Group II, non-PCOS recipients (n = 32). Medical records were reviewed, and rates of fertilization, cleavage, high-quality embryos and blastocysts were compared between PCOS and non-PCOS groups. Rates of implantation, pregnancy, ectopic pregnancy, early abortion, multiple pregnancies, and offspring outcomes were calculated using the first single vitrified-warmed blastocyst transfer (SVBT) analysis between the groups. Results The average recipient age and body mass index (BMI) of PCOS and non-PCOS patients was (36.3 ± 2.6 vs. 36.2 ± 2.8, and 23.4 ± 3.9 vs. 23.7 ± 4.0), respectively (P > 0.05). The fertilization, cleavage, high-quality embryos and blastocyst rates were not significantly different between the PCOS and non-PCOS groups. Rates of implantation, pregnancy, ectopic pregnancy, early abortion, and multiple pregnancies were not significantly different in SVBT between the PCOS and non-PCOS groups. The incidence of complications, such as pre-eclampsia or gestational diabetes, between PCOS and non-PCOS groups was similar (11.8% vs.11.1%, 5.9% vs.5.5%; P > 0.05). Preterm births were also similar (11.8% vs.16.7%, P > 0.05). Donor oocytes are more likely to be delivered via cesarean Sect. (80.0% vs. 86.7%: P > 0.05). The mean gestational age, birth weight, and height were comparable between the 2 groups during full-term delivery. Conclusion There was no difference in the pregnancy outcomes and follow-up of the offspring between the PCOS and non-PCOS groups.
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Affiliation(s)
- Yan Jiang
- The Center for Reproductive Medicine and Infertility, The Fourth Hospital of Shijiazhuang, Shijiazhuang Obstetrics and Gynecology Hospital affiliated to Hebei Medical University, 206 Zhong-Shan-Dong, Shijiazhuang, Hebei, 050011, People's Republic of China.
| | - Jing-Chuan Yuan
- The Center for Reproductive Medicine and Infertility, The Fourth Hospital of Shijiazhuang, Shijiazhuang Obstetrics and Gynecology Hospital affiliated to Hebei Medical University, 206 Zhong-Shan-Dong, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Ge Song
- The Center for Reproductive Medicine and Infertility, The Fourth Hospital of Shijiazhuang, Shijiazhuang Obstetrics and Gynecology Hospital affiliated to Hebei Medical University, 206 Zhong-Shan-Dong, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Xu-Hui Zhang
- The Center for Reproductive Medicine and Infertility, The Fourth Hospital of Shijiazhuang, Shijiazhuang Obstetrics and Gynecology Hospital affiliated to Hebei Medical University, 206 Zhong-Shan-Dong, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Sui-Bing Miao
- The Center for Reproductive Medicine and Infertility, The Fourth Hospital of Shijiazhuang, Shijiazhuang Obstetrics and Gynecology Hospital affiliated to Hebei Medical University, 206 Zhong-Shan-Dong, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Xiao-Hua Wu
- The Center for Reproductive Medicine and Infertility, The Fourth Hospital of Shijiazhuang, Shijiazhuang Obstetrics and Gynecology Hospital affiliated to Hebei Medical University, 206 Zhong-Shan-Dong, Shijiazhuang, Hebei, 050011, People's Republic of China
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Osaikhuwuomwan JA, Aziken ME. Pregnancy in Older Women: Analysis of Outcomes in Pregnancies from Donor oocyte In- vitro Fertilization. J Hum Reprod Sci 2021; 14:300-306. [PMID: 34759621 PMCID: PMC8527082 DOI: 10.4103/jhrs.jhrs_209_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 07/04/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: As the number of older women attempting to conceive through donor oocyte-in vitro fertilization (DO-IVF) rises, their safety in pregnancy needs to be judiciously considered. Aims: This study aims to review the obstetric and perinatal outcomes of pregnancies achieved by DO-IVF. Study Setting and Design: A retrospective study design conducted at a private health facility with services for assisted reproduction and gynecologic endoscopy. Methods: A retrospective comparative study of all pregnancies achieved using DO-IVF and that using Self oocyte In-vitro fertilization (SO-IVF) treatment over a 3 years' period was performed. Statistical Analysis: Comparative analysis of demographic variables, major obstetric, and perinatal complications was done with Chi-square test and Student's t-test as appropriate. Regression analysis was done to determine a significant predictor variable for pregnancy and delivery outcome. The significance level was set at P < 0.05. Results: A total of 343 completed IVF treatment cycles was reviewed; there were 238 DO-IVF and 105 SO-IVF cycles, with clinical pregnancy rate of 41.6% and 37.1%, respectively. The DO-IVF group was significantly older than the SO-IVF group (46.1 years vs. 34.1 years, P < 0.001). Major obstetric complications identified, were hypertensive disorders in pregnancy (23.9%), preterm labor (16.7%), antepartum hemorrhage (11.6%). There was no statistically significant difference between the two groups in terms of obstetric complications and adverse maternal or perinatal outcomes. There were 97 (77.6%) singleton and 28 (22.4%) multiple pregnancies. Pregnancy complications were significantly associated with fetal plurality, P < 0.001. Multiple pregnancy had higher odds of experiencing adverse perinatal 4.96 (1.95–12.58) and maternal 7.16 (2.05–25.03) outcomes compared to singleton pregnancies, P < 0.001. Conclusion: Key obstetric outcomes did not differ between DO or SO IVF achieved pregnancy. Even for older women, satisfactory outcomes can be expected for pregnancies achieved by DO-IVF. It is, however, instructive that for multiple pregnancies, obstetricians should institute appropriate surveillance strategies during pregnancy and delivery period and also to develop institutional capacity for quality neonatal care.
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Affiliation(s)
- James A Osaikhuwuomwan
- Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin-City, Nigeria
| | - Michael E Aziken
- Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin-City, Nigeria.,Assisted Reproduction and Endoscopy Unit, Graceland Medical Centre, Benin-City, Nigeria
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Toussia-Cohen S, Mohr-Sasson A, Tsur A, Levin G, Orvieto R, Machtinger R, Meyer R. Pregnancy and neonatal outcomes of twin pregnancies - the role of maternal age. J Perinat Med 2021; 49:559-565. [PMID: 33596607 DOI: 10.1515/jpm-2020-0386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We aim to study the association of maternal age with maternal and neonatal complications in twin pregnancies. METHODS A retrospective cohort study of dichorionic-diamniotic twin pregnancies stratified into three groups according to maternal age ("A" <25, "B" 25-34 and "C" 35-44 years old). Outcome measures included pregnancy, delivery and neonatal complications. A sub-analysis of in vitro fertilization pregnancies only was conducted. RESULTS Compared with younger women (groups A [n=65] and B [n=783]), older women [group C (n=392)] demonstrated significantly higher rates of gestational diabetes mellitus (B 6.6% vs. A 0%, p =0.027, C 10.2% vs. B 6.6%, p =0.032), were more likely to undergo cesarean deliveries (C 66.6%, B 57.6%, A 52.3%, p =0.007), and were at increased risk of having more than 20% difference in weight between the twins (C 24.5%, B 17.4%, A 16.9%, p =0.013). Other outcomes, including preeclampsia, did not differ between the groups. A sub-analysis of the in vitro fertilization only pregnancies was performed. Compared with younger women (groups A [n=18] and B [n=388]), older women (group C [n=230]) underwent more cesarean deliveries (p=0.004), and had more than 20% difference in weight between the twins (p<0.004). Other outcomes, including gestational diabetes mellitus rates and preeclampsia, did not differ between the groups. CONCLUSIONS Women at advanced maternal age with dichorionic twin pregnancies had significantly higher rates of gestational diabetes mellitus, cesarean deliveries and fetal weight discordancy as compared with younger women. In contrast, the incidence of preeclampsia was not affected by maternal age.
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Affiliation(s)
- Shlomi Toussia-Cohen
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aya Mohr-Sasson
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Tsur
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Raoul Orvieto
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Machtinger
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Acute pulmonary edema due to severe preeclampsia in advanced maternal age women. Pregnancy Hypertens 2021; 25:150-155. [PMID: 34144403 DOI: 10.1016/j.preghy.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/27/2021] [Accepted: 05/24/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Acute pulmonary edema is a rare complication in women with preeclampsia especially at advanced maternal age. We aimed to determine the cardiovascular hemodynamics in advanced maternal age women who developed acute pulmonary edema and preeclampsia. STUDY DESIGN Retrospective cohort study of women aged over 45 years giving birth at single university affiliated tertiary medical center which developed acute pulmonary edema due to severe preeclampsia. Clinical features were identified in order to predict and potentially prevent this severe complication of pregnancy. MAIN OUTCOME MEASURES Advanced maternal age women who developed acute pulmonary edema due to preeclampsia. RESULTS Overall, during the study period 90,540 women delivered in our hospital, of them, 540 women (0.6%) above the age of 45 years gave birth. Of those, 67 women (12.4%) had preeclampsia in which 4 women (6%) were complicated with acute pulmonary edema. The common clinical relevant characteristics for all four women were: preterm delivery by cesarean section for preeclampsia with severe features, non-restrictive fluid management around the time of delivery, post-partum pain control medication with non-steroidal anti-inflammatory drug, blood pressure stabilization with oral labetalol and a sudden hemodynamic deterioration to hypertensive crisis and pulmonary edema between post-operative days 4-9. CONCLUSION Although the precise trigger for the sudden presentation of acute pulmonary edema remains unknown, we suggest that there is a multi-factorial combination of etiologies that are common to women of advanced maternal age and women with preeclampsia that could have contributed to the development of pulmonary edema.
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Berntsen S, Larsen EC, la Cour Freiesleben N, Pinborg A. Pregnancy outcomes following oocyte donation. Best Pract Res Clin Obstet Gynaecol 2020; 70:81-91. [PMID: 32741624 DOI: 10.1016/j.bpobgyn.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022]
Abstract
The use of oocyte donation (OD) has increased continuously over the last three decades, and it is now an indispensable part of assisted reproductive technology (ART). With OD, it has become possible to overcome the biological barrier of ovarian follicle pool depletion and the general age-related decline in fertility. This review contains a thorough appraisal of the safety of OD with an analysis of short-term pregnancy outcomes. Salient up-to-date evidence was evaluated, which revealed that in comparison with both IVF with autologous oocytes, and naturally conceived pregnancies, there is: (i) an increased risk of hypertensive disorders of pregnancy and preeclampsia; (ii) an increased risk of low birth weight and preterm birth and (iii) an increased risks of obstetric emergencies, following OD treatment. As a precaution, it is therefore highly encouraged to perform only single embryo transfer (SET) and to prescribe prophylactic low-dose aspirin during OD pregnancies.
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Affiliation(s)
- Sine Berntsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Kettegaard allé 30, 2650, Hvidovre, Denmark.
| | - Elisabeth Clare Larsen
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Nina la Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Kettegaard allé 30, 2650, Hvidovre, Denmark.
| | - Anja Pinborg
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Boria F, de la Calle M, Cuerva M, Sainz A, Bartha JL. Impact of oocyte donation on obstetric and perinatal complications in twin pregnancies. J Matern Fetal Neonatal Med 2020; 33:1960-1963. [PMID: 30293468 DOI: 10.1080/14767058.2018.1533944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Aim: To evaluate obstetric and perinatal outcomes of twin pregnancies obtained after in vitro fertilization with donated oocytes.Methods: This is a case-control study comparing 50 women with twin pregnancies after oocyte donation (OD) and 50 women after in vitro fertilization with autologous oocytes. Clinical records were reviewed and obstetric and perinatal outcome variables including rates of preeclampsia, gestational diabetes, pregnancy-induced hypertension, preterm delivery, premature rupture of membranes, cesarean delivery, birth weight, Apgar score, pH test were compared.Results: Women in the OD group were significantly older than those in the AO group (mean 40.8 versus 36 years old, p < .001). There were a higher risk of preeclampsia (OD 24% versus AO 8%), cesarean delivery (OD 90% versus AO 66%), and preterm birth before 37 weeks (OD 52% versus AO 32%). After adjustment for maternal age, only the risk of preterm birth remained significantly higher (OR 3.2 (1.15-8.86); p = .025). Comparing neonatal outcomes, there were no differences in birth weight, pH or Apgar score at birth.Conclusions: Twin pregnancies after OD are associated with a higher risk of preterm birth before 37 weeks of gestation. However, this did not translate into increased rate of adverse perinatal outcomes.
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Affiliation(s)
- Felix Boria
- Hospital Universitario La Paz, Madrid, Spain
| | | | - Marcos Cuerva
- Department of Obstetrics, Quiron San Jose Hospital, Madrid, Spain
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8
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Rizzello F, Coccia ME, Fatini C, Badolato L, Fantappiè G, Merrino V, Petraglia F. Comorbidities, risk factors and maternal/perinatal outcomes in oocyte donation pregnancies. Reprod Biomed Online 2020; 41:309-315. [PMID: 32576492 DOI: 10.1016/j.rbmo.2020.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/05/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
RESEARCH QUESTION To evaluate pre-existing comorbidities, obstetric risk factors and adverse obstetric and neonatal outcomes in pregnancies conceived by oocyte donation, compared with naturally conceived pregnancies or by conventional IVF/intracytoplasmic sperm injection (IVF/ICSI). DESIGN This retrospective single-centre contemporary cohort study reviewed data from singleton deliveries at the University Hospital of Careggi, Florence, from 2009 to 2017. Maternal and perinatal outcomes were analysed. RESULTS The study included 25,851 pregnancies and newborns: 276 (1.1%) children were conceived after oocyte donation, 925 (3.6%) after IVF/ICSI and 24,650 (95.4%) after natural conception. Women in the oocyte donation group were significantly older compared with IVF/ICSI and natural conception groups (P < 0.0001) and had a higher prevalence of chronic hypertension compared with the natural conception group (P = 0.0090). They were administered anticoagulant medications more frequently during pregnancy. The incidence of gestational hypertension was significantly higher than in natural conception (aOR 3.6) and IVF/ICSI pregnancies (aOR 2.7). The incidence of Caesarean section in oocyte donation pregnancies was higher than in natural conception and IVF/ICSI groups (aOR 3.4 and 2.3, respectively). An 11-fold increased risk of post-partum haemorrhage (PPH) was found in oocyte donation versus natural conception and an almost four-fold increased risk was found in oocyte donation versus IVF/ICSI; prematurity and low birthweight were more frequent after oocyte donation versus natural conception (aOR 2.4 and 1.8, respectively). CONCLUSIONS Patients undergoing oocyte donation represent a group with increased comorbidities and risk factors for adverse obstetric outcomes. Oocyte donation seems to be independently associated with gestational hypertension and PPH. Pregnancies after oocyte donation warrant clinical surveillance with proper screening and, possibly, preventive strategies.
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Affiliation(s)
- Francesca Rizzello
- Assisted Reproductive Technology Centre, Careggi University Hospital Florence, Italy.
| | - Maria Elisabetta Coccia
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence Florence, Italy
| | - Cinzia Fatini
- Department of Experimental and Clinical Medicine, University of Florence Florence, Italy
| | - Laura Badolato
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence Florence, Italy
| | - Giulia Fantappiè
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence Florence, Italy
| | - Valeria Merrino
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence Florence, Italy
| | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence Florence, Italy
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Assisted reproductive technology and the risk of gestational diabetes mellitus: a systematic review and meta-analysis. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2020. [DOI: 10.1186/s43043-020-0018-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
The use of assisted reproductive technology (ART) is increasing worldwide, and observational studies have indicated that women who conceived by ART have an increased risk of pregnancy complications including gestational diabetes mellitus (GDM). We aimed to determine the risk of GDM among women who conceived with ART by systematic review and meta-analysis.
Main text
A systematic literature search was conducted in ISI Web of Knowledge, MEDLINE, Scopus, and Embase through May 2017 for English-language articles using a list of keywords. All studies comparing GDM in women conceived by ART and those who conceived spontaneously were included. Data extraction was performed by two authors independently and discrepancies were resolved by discussion. In total, 48 studies with 91,487 pregnancies conceived through ART and 2,525,234 spontaneously conceived met the inclusion criteria. There was evidence of substantial heterogeneity among these studies (P < 0.001, I2 = 98.6%). Random effects meta-analysis showed a significant increase in GDM among those who conceived by ART compared with those who conceived spontaneously (pooled relative risk = 1.51, 95% confidence interval = 1.18–1.93). Visual inspection of the funnel plot did not reveal any publication bias, which was supported by Egger’s test and Begg’s test.
Conclusion
The findings of this systematic review indicate that the use of ART treatment is associated with a 1.51-fold increase in GDM. Women need to be counselled carefully before undergoing ART treatment about the possibility and risk of GDM.
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Al Shammary M, Shaw A, Bacal V, Menzies-Toman D, Rozon C, Weir A, Tang K, de Nanassy J, El Demellawy D. Risk of Lower Birth Weight and Shorter Gestation in Oocyte Donation Pregnancies Compared With Other Assisted Reproductive Technology Methods: Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:889-899.e1. [PMID: 31882287 DOI: 10.1016/j.jogc.2019.08.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Oocyte donation (OD) is associated with an increased risk of pregnancy-induced hypertension, but the evidence of an association between OD and infant outcomes, including birth weight and gestational age, is conflicting. This study sought to determine the associations between oocyte donation and birth weight or gestational age compared with other forms of autologous oocyte assisted reproductive technology (ART). METHODS Medline, Embase, and the CENTRAL Trials Registry of the Cochrane Collaboration were searched using a comprehensive search strategy. Studies of women over 24 weeks gestation compared infant outcomes among OD pregnancies versus other ART. Study quality was assessed, and a meta-analysis of mean birth weight and gestational age was conducted using a random effects model. RESULTS Nineteen studies were included. Four studies showed a significant association between OD and lower birth weights, and five studies found significant differences in gestational age between OD and autologous oocyte ART. The pooled difference in birth weight means between OD and autologous ART was -42 (-88, 4) . The pooled difference in gestational age was -0.4 weeks (-0.8, 0.0 weeks). CONCLUSION A high degree of interstudy heterogeneity exists, and the association between OD and infant outcomes remains unclear.
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Affiliation(s)
- Mofeedah Al Shammary
- Department of Obstetrics and Gynecology, King Fahad Specialist Hospital- Dammam, Damman, Saudi Arabia
| | - Ashley Shaw
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Vanessa Bacal
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | | | - Chloé Rozon
- Pathology Department, Children's Hospital of Eastern Ontario, Ottawa, ON
| | - Arielle Weir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON; Pathology Department, Children's Hospital of Eastern Ontario, Ottawa, ON
| | - Ken Tang
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Joseph de Nanassy
- Pathology Department, Children's Hospital of Eastern Ontario, Ottawa, ON
| | - Dina El Demellawy
- Pathology Department, Children's Hospital of Eastern Ontario, Ottawa, ON.
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Schwartz KM, Boulet SL, Kawwass JF, Kissin DM. Perinatal outcomes among young donor oocyte recipients. Hum Reprod 2019; 34:2533-2540. [PMID: 31750511 PMCID: PMC10072793 DOI: 10.1093/humrep/dez213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/23/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is the use of donor oocytes in women <35 years of age associated with an increased risk of adverse perinatal outcomes compared to use of autologous oocytes? SUMMARY ANSWER Among fresh assisted reproductive technology (ART) cycles performed in women under age 35, donor oocyte use is associated with a higher risk of preterm birth, low birth weight and stillbirth (when zero embryos were cryopreserved) as compared to autologous oocytes. WHAT IS KNOWN ALREADY Previous studies demonstrated elevated risk of poor perinatal outcomes with donor versus autologous oocytes during ART, primarily among older women. STUDY DESIGN, SIZE, DURATION Retrospective cohort study using data reported to Centers for Disease Control and Prevention's National ART Surveillance System (NASS) during the period from 2010 to 2015 in order to best reflect advances in clinical practice. Approximately 98% of all US ART cycles are reported to NASS, and discrepancy rates were <6% for all fields evaluated in 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS We included all non-banking fresh and frozen ART cycles performed between 2010 and 2015 in women under age 35 using autologous or donor eggs. Cycles using cryopreserved eggs, donated embryos or a gestational carrier were excluded. Among fresh embryo transfer cycles, we calculated predicted marginal proportions to estimate the unadjusted and adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for the association between donor versus autologous oocyte use and stillbirth, spontaneous abortion, preterm delivery and low birth weight among singleton pregnancies or births. Stillbirth models were stratified by number of embryos cryopreserved. All models were adjusted for patient and treatment characteristics. MAIN RESULTS AND THE ROLE OF CHANCE Among the 71 720 singleton pregnancies occurring during 2010-2015, singletons resulting from donor oocytes were more likely to be preterm (15.6% versus 11.0%; aRRs 1.39: CI 1.20-1.61) and have low birth weight (11.8% versus 8.8%; aRRs 1.34; CI 1.16-1.55) than those resulting from autologous oocytes. With zero embryos cryopreserved, donor versus autologous oocyte use was associated with increased risk for stillbirth (2.1% versus 0.6%; aRRs 3.73; CI 1.96-7.11); no association with stillbirth was found when ≥1 embryo was cryopreserved (0.54% versus 0.56%; aRR 1.15; CI 0.59-2.25). LIMITATIONS, REASONS FOR CAUTION The data come from a national surveillance system and is thus limited by the accuracy of the data entered by individual providers and clinics. There may be unmeasured differences between women using donor eggs versus their own eggs that could be contributing to the reported associations. Given the large sample size, statistically significant findings may not reflect clinically important variations. WIDER IMPLICATIONS OF THE FINDINGS Risks of preterm birth, low birth weight and stillbirth among singleton pregnancies using donor oocytes were increased compared to those using autologous oocytes. Further study regarding the pathophysiology of the potentially increased risks among donor oocyte recipient pregnancy is warranted. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- K M Schwartz
- Cleveland Clinic Foundation, Women's Health Institute, 9500 Euclid Ave., Cleveland, OH 44195
| | - S L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA 30308, USA
| | - J F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, 550 Peachtree Street, Suite 1800, Atlanta, GA 30308. USA
| | - D M Kissin
- Division of Reproductive Health, Centers for Disease Control, 4770 Buford Highway NE, Atlanta, GA 30329, USA
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Meyer R, Orvieto R, Timerman Y, Gorodesky T, Toussia-Cohen S, Kedem A, Simchen MJ, Machtinger R. Impact of the mode of conception on gestational hypertensive disorders at very advanced maternal age. Reprod Biomed Online 2019; 40:281-286. [PMID: 31870723 DOI: 10.1016/j.rbmo.2019.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/06/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
RESEARCH QUESTION To study gestational hypertensive disorders in oocyte donation pregnancies compared with other modes of conception at very advanced maternal age. DESIGN A historical cohort study of all women aged 45-47 years who gave birth to singletons at a tertiary medical centre between March 2011 and May 2018, at 24 weeks' gestation or later. Pregnancy outcomes were compared between donor oocyte (IVF-OD), IVF using autologous oocytes (IVF-A) and naturally conceived pregnancies. A multivariate logistic regression was used to evaluate the association between the mode of conception and gestational hypertensive disorders. RESULTS The final analysis included 159, 68 and 73 patients in the IVF-OD, IVF-A and natural conception groups, respectively. The rate of gestational hypertensive disorders was significantly higher among those who conceived by IVF compared with those who conceived naturally but did not differ between the two IVF groups (27.0% for IVF-OD, 19.1% for IVF-A, P = 0.204; 5.5% for natural conception, P < 0.001 and P = 0.013 compared with IVF-OD and IVF-A, respectively). The results remained similar in a multivariate logistic regression analysis. The rate of Caesarean deliveries was significantly higher in the IVF-OD and IVF-A groups compared with the natural conception group (83.6%, 70.6% and 37.0%, respectively, P < 0.001), but other pregnancy outcomes did not differ between the groups. CONCLUSIONS IVF pregnancies in the late fifth decade of life were associated with significantly higher rates of gestational hypertensive disorders compared with naturally conceived pregnancies. No difference existed between the two IVF groups. These results may highlight the impact of IVF itself on gestational hypertensive disorders at very advanced maternal age.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Timerman
- Faculty of Medicine, St George's University of London, London, UK
| | - Tal Gorodesky
- Faculty of Medicine, St George's University of London, London, UK
| | | | - Alon Kedem
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal J Simchen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Machtinger
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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13
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Maroufizadeh S, Navid B, Alizadeh A, Amini P, Almasi-Hashiani A, Mohammadi M, Khedmati Morasae E, Omani-Samani R. Risk of gestational diabetes mellitus following assisted reproductive technology: systematic review and meta-analysis of 59 cohort studies. J Matern Fetal Neonatal Med 2019; 34:2731-2740. [PMID: 31570010 DOI: 10.1080/14767058.2019.1670790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The use of assisted reproductive technology (ART) has been associated with an increased risk of gestational diabetes mellitus (GDM) in previous studies, but its risk has not been consistent. Therefore, we aimed to estimate the risk of GDM in women who conceived with ART via a systematic review and meta-analysis of cohort studies. METHODS ISI Web of Knowledge, Medline/PubMed, Scopus, and Embase databases were searched to identify studies that evaluated the risk of GDM through May 2017 using the relevant keywords. Two reviewers independently performed the screening, data extraction, and quality assessment. Meta-analysis was performed with a random effects model. RESULTS The search yielded 957 records relating to GDM and use of ART, from which 59 eligible cohorts were selected for meta-analysis (n = 96,785). There was evidence of substantial heterogeneity among these studies (χ(58)2 = 3072.34, p < .001; I2=98.1%). The pooled estimate of GDM risk using the random effects model was 9.00% (95% CI: 7.90-10.20). Visual inspection of the funnel plot indicated the presence of low publication bias, but Egger's test did not reveal publication bias. CONCLUSIONS The findings revealed that the risk of GDM was very high among women who conceived with ART treatment. GDM screening, management, and improved care are vital in ART pregnancy.
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Affiliation(s)
- Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Behnaz Navid
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Payam Amini
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Mohammadi
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Department of Health Services Research, Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Reza Omani-Samani
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Modest AM, Johnson KM, Karumanchi SA, Resetkova N, Young BC, Fox MP, Wise LA, Hacker MR. Risk of ischemic placental disease is increased following in vitro fertilization with oocyte donation: a retrospective cohort study. J Assist Reprod Genet 2019; 36:1917-1926. [PMID: 31359234 PMCID: PMC6730979 DOI: 10.1007/s10815-019-01545-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Assess the risk of ischemic placental disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. METHODS This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. RESULTS Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non-IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5-3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9-2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8-5.0 and autologous RR = 2.2; 95% CI 2.0-2.5, adjusted for age, parity, and marital status), placental abruption (donor RR = 3.8; 95% CI 2.1-6.7 and autologous RR = 2.5; 95% CI 2.1-3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1-3.4 and autologous RR = 2.0; 95% CI 1.9-2.2, adjusted for age and parity). Results were similar when restricting SGA to < 3rd percentile. CONCLUSION Pregnancies conceived using donor IVF and autologous IVF were at higher risk of IPD and its associated conditions than non-IVF pregnancies and associations were consistently stronger for donor IVF pregnancies.
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Affiliation(s)
- Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, KS 3, Boston, MA, USA.
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
| | - Katherine M Johnson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, KS 3, Boston, MA, USA
| | - S Ananth Karumanchi
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center/Harvard Medical School, 99 Brookline Avenue, RN 359, Boston, MA, 02215, USA
- Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | | | - Brett C Young
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, KS 3, Boston, MA, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
- Department of Global Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, KS 3, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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15
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Moreno-Sepulveda J, Checa MA. Risk of adverse perinatal outcomes after oocyte donation: a systematic review and meta-analysis. J Assist Reprod Genet 2019; 36:2017-2037. [PMID: 31440959 DOI: 10.1007/s10815-019-01552-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/26/2019] [Indexed: 01/10/2023] Open
Abstract
RESEARCH QUESTION In women with singleton pregnancies conceived after assisted reproductive technologies, does the in vitro fertilization with oocyte donation (IVF-OD) affect the perinatal and maternal outcomes compared to autologous in vitro fertilization (IVF-AO)? DESIGN Systematic review and meta-analysis of studies comparing perinatal and maternal outcomes in singleton pregnancies resulting from IVF-OD versus IVF-AO. An electronic literature search in Pubmed, MEDLINE, and Cochrane database was performed. The main outcome measures were hypertensive disorders in pregnancy, preeclampsia, severe preeclampsia, pregnancy-induced hypertension, preterm birth, early preterm birth, low birth weight, and very low birth weight. RESULTS Twenty-three studies were included. IVF-OD is associated with a higher risk of hypertensive disorders in pregnancy (OR 2.63, 2.17-3.18), preeclampsia (OR 2.64; 2.29-3.04), severe preeclampsia (OR 3.22; 2.30-4.49), pregnancy-induced hypertension (OR 2.16; 1.79-2.62), preterm birth (OR 1.57; 1.33-1.86), early preterm birth (OR 1.80; 1.51-2.15), low birth weight (OR 1.25, 1.20-1.30), very low birth weight (OR 1.37, 1.22-1.54), gestational diabetes (OR 1.27; 1.03-1.56), and cesarean section (OR 2.28; 2.14-2.42). There was no significant difference in the risk of preterm birth or low birth weight when adjusted for preeclampsia. CONCLUSIONS IVF-OD patients should be considered an independent risk factor for some adverse perinatal outcomes, mainly hypertensive disorders in pregnancy, preeclampsia, and severe preeclampsia. Immunological and hormonal aspects may be involved in these results, and further research focusing in the etiopathogenesis of these pathologies are needed.
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Affiliation(s)
- Jose Moreno-Sepulveda
- Obstetrics and Gynecology Department, Parc de Salut Mar, Universitat Autonoma de Barcelona, Campus Universitario UAB, 08193 Bellaterra, Cerdanyola del Vallès, Balmes 10, 1-1, 08007, Barcelona, Spain. .,Clínica de la Mujer Medicina Reproductiva, Alejandro Navarrete 2606, Viña del Mar, Chile.
| | - Miguel A Checa
- Obstetrics and Gynecology Department, Parc de Salut Mar, Universitat Autonoma de Barcelona, Campus Universitario UAB, 08193 Bellaterra, Cerdanyola del Vallès, Balmes 10, 1-1, 08007, Barcelona, Spain.,GRI-BCN, Barcelona Infertility Research Group, IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
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16
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Rodriguez-Wallberg KA, Berger AS, Fagerberg A, Olofsson JI, Scherman-Pukk C, Lindqvist PG, Nasiell J. Increased incidence of obstetric and perinatal complications in pregnancies achieved using donor oocytes and single embryo transfer in young and healthy women. A prospective hospital-based matched cohort study. Gynecol Endocrinol 2019; 35:314-319. [PMID: 30626251 DOI: 10.1080/09513590.2018.1528577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In this single-center matched-cohort study, women who underwent IVF/ICSI with donor oocytes between 2007 and 2014 (n = 259) were compared to women undergoing autologous cycles during the same time period (n = 515). The matching (1:2) took into consideration the women's age, type of treatment (IVF/ICSI), and year of embryo transfer. All women were healthy and below 40 years of age at the time of IVF/ICSI, and the treatments were performed using a strict policy of single embryo transfer. Multiple logistic regression analysis, adjusted for body mass index (BMI), smoking, and parity, showed a four times increased risk of gestational hypertensive disorders (adjusted odds ratio, AOR 4.25; 95% confidence interval (CI), 2.61-6.92) and pre-eclampsia (AOR 3.99; 95% CI 2.27-7.00) in pregnancies achieved with donor oocytes. There was also a higher rate of cesarean section in women who gave birth after oocyte donation (AOR 1.69; 95% CI 1.22-2.35) and a higher risk of postpartum hemorrhage >1000 mL (AOR 1.59; 95% CI, 1.11-2.27). After further adjustment for preeclampsia in the logistic regression analysis, no additional increased perinatal risks were found. The incidence of preterm delivery, low weight at birth, need of neonatal intensive care, Apgar scores, and incidence of perinatal death were also similar between the groups.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- a Department of Reproductive Medicine, Division of Gynecology and Reproduction , Karolinska University Hospital , Stockholm , Sweden
- b Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Ann-Sofie Berger
- a Department of Reproductive Medicine, Division of Gynecology and Reproduction , Karolinska University Hospital , Stockholm , Sweden
| | - Antonia Fagerberg
- a Department of Reproductive Medicine, Division of Gynecology and Reproduction , Karolinska University Hospital , Stockholm , Sweden
| | - Jan I Olofsson
- c Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden
| | - Christina Scherman-Pukk
- a Department of Reproductive Medicine, Division of Gynecology and Reproduction , Karolinska University Hospital , Stockholm , Sweden
| | - Pelle G Lindqvist
- d Department of Obstetrics and Gynecology , Södersjukhuset , Stockholm , Sweden
- e Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden
| | - Josefine Nasiell
- e Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden
- f Department of Obstetrics and Gynecology , Karolinska University Hospital , Stockholm , Sweden
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Segal TR, Kim K, Mumford SL, Goldfarb JM, Weinerman RS. How much does the uterus matter? Perinatal outcomes are improved when donor oocyte embryos are transferred to gestational carriers compared to intended parent recipients. Fertil Steril 2019; 110:888-895. [PMID: 30316434 DOI: 10.1016/j.fertnstert.2018.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/23/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the reproductive and neonatal outcomes of cycles in which donor oocyte embryos were transferred to gestational carriers compared to intended parent recipients. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) Intended parent recipients and gestational carriers receiving donor oocyte embryos in 2014 in the United States. INTERVENTIONS(S) None. MAIN OUTCOMES MEASURE(S) Clinical pregnancy, live birth, miscarriage, plurality, prematurity, and birth weight from pregnancies conceived with donor oocyte embryos transferred to either a gestational carrier or an intended parent recipient. RESULT(S) The mean ages of intended parent recipients (N=18,317) and gestational carriers (N=1,927) were 41.6 and 31.6 years, respectively. Compared to an intended parent recipient, patients using a gestational carrier had significantly higher odds of a clinical pregnancy (65.2% vs. 56.3%, adjusted odds ratio (aOR) 1.33, 95% confidence interval (CI) 1.17-1.51) and live birth (57.1% vs. 46.4%, aOR 1.37, 95% CI 1.21-1.55) using fresh or frozen donor-oocyte embryos. Of the singletons born (n=716 using a gestational carrier and n=5,632 in intended parent recipients), the incidence of prematurity was significantly lower in gestational carriers compared to intended parent recipients (17.5% vs. 25.4%, aOR 0.78, 95% CI 0.61-0.99). The incidence of low birthweight among singletons was significantly reduced in gestational carrier cycles (6.4% vs. 12.1%, aOR 0.62, 95% CI 0.44-0.89). CONCLUSION Intended parent recipients had decreased pregnancy rates and poorer neonatal outcomes compared to a gestational carrier. This suggests that a history of infertility adversely affects the uterine microenvironment, independent of the oocyte.
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Affiliation(s)
- Thalia R Segal
- Division of Reproductive Endocrinology and Infertility, University Hospitals Fertility Center, Beachwood, Ohio.
| | - Keewan Kim
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - James M Goldfarb
- Division of Reproductive Endocrinology and Infertility, University Hospitals Fertility Center, Beachwood, Ohio
| | - Rachel S Weinerman
- Division of Reproductive Endocrinology and Infertility, University Hospitals Fertility Center, Beachwood, Ohio
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Bos M, Schoots MH, Fernandez BO, Mikus-Lelinska M, Lau LC, Eikmans M, van Goor H, Gordijn SJ, Pasch A, Feelisch M, van der Hoorn MLP. Reactive Species Interactome Alterations in Oocyte Donation Pregnancies in the Absence and Presence of Pre-Eclampsia. Int J Mol Sci 2019; 20:E1150. [PMID: 30845762 PMCID: PMC6429516 DOI: 10.3390/ijms20051150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 12/30/2022] Open
Abstract
In pregnancy, maternal physiology is subject to considerable adaptations, including alterations in cardiovascular and metabolic function as well as development of immunological tolerance towards the fetus. In an oocyte donation pregnancy, the fetus is fully allogeneic towards the mother, since it carries both oocyte donor antigens and paternal antigens. Therefore, oocyte donation pregnancies result in an immunologically challenging pregnancy, which is reflected by a higher-than-normal risk to develop pre-eclampsia. Based on the allogeneic conditions in oocyte donation pregnancies, we hypothesized that this situation may translate into alterations in concentration of stable readouts of constituents of the reactive species interactome (RSI) compared to normal pregnancies, especially serum free thiols, nitric oxide (NO) and hydrogen sulfide (H₂S) related metabolites. Indeed, total free thiol levels and nitrite (NO₂-) concentrations were significantly lower whereas protein-bound NO and sulfate (SO₄2-) concentrations were significantly higher in both oocyte donation and naturally conceived pregnancies complicated by pre-eclampsia. The increased concentrations of nitrite observed in uncomplicated oocyte donation pregnancies suggest that endothelial NO production is compensatorily enhanced to lower vascular tone. More research is warranted on the role of the RSI and bioenergetic status in uncomplicated oocyte donation pregnancies and oocyte donation pregnancies complicated by pre-eclampsia.
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Affiliation(s)
- Manon Bos
- Department of Pathology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands;
| | - Mirthe H. Schoots
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.H.S.); (H.v.G.)
| | - Bernadette O. Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and Southampton General Hospital, Southampton SO17 1BJ, UK; (B.O.F.); (M.M.-L.); (L.C.L.); (M.F.)
| | - Monika Mikus-Lelinska
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and Southampton General Hospital, Southampton SO17 1BJ, UK; (B.O.F.); (M.M.-L.); (L.C.L.); (M.F.)
| | - Laurie C. Lau
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and Southampton General Hospital, Southampton SO17 1BJ, UK; (B.O.F.); (M.M.-L.); (L.C.L.); (M.F.)
| | - Michael Eikmans
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, 2333ZA Leiden, The Netherlands;
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.H.S.); (H.v.G.)
| | - Sanne J. Gordijn
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Andreas Pasch
- Department of Biomedical Research, University of Bern, 3012 Bern, Switzerland;
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton and Southampton General Hospital, Southampton SO17 1BJ, UK; (B.O.F.); (M.M.-L.); (L.C.L.); (M.F.)
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Rymer-Haskel N, Schushan-Eisen I, Hass Y, Rahav R, Maayan-Metzger A, Hendler I. Characteristics and severity of preeclampsia in young and elderly gravidas with hypertensive disease. Eur J Obstet Gynecol Reprod Biol 2018; 228:120-125. [DOI: 10.1016/j.ejogrb.2018.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/05/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022]
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Yu B, Vega M, Zaghi S, Fritz R, Jindal S, Buyuk E. Comparison of perinatal outcomes following frozen embryo transfer cycles using autologous versus donor oocytes in women 40 to 43 years old: analysis of SART CORS data. J Assist Reprod Genet 2018; 35:2025-2029. [PMID: 30128819 DOI: 10.1007/s10815-018-1287-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To study the differences in perinatal outcomes after frozen embryo transfer cycles using autologous or donor oocytes in women of advanced maternal age. DESIGN Historical cohort study. SETTING US national database from the Society of Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 2009 to 2013. PATIENT(S) Women at 40-43 years of age undergoing autologous frozen embryo transfers (a-FET) or donor oocyte frozen embryo transfers (d-FET) resulting in singleton pregnancies that were entered in the SART CORS database from 2009 to 2013. RESULTS a-FET resulted in 4402 singleton live births whereas d-FET resulted in 2703 singleton live births. d-FET resulted in a higher risk of preterm births (< 37 weeks), with adjusted odds ratio (aOR) 1.33 (95% CI 1.02-1.75), but similar risk of small for gestational age (SGA), with aOR 1.75 (95% CI 0.85-3.7), when compared to a-FET. However, when only single blastocyst transfer cycles are considered, d-FET and a-FET showed no difference in preterm births or other adverse perinatal outcomes. CONCLUSIONS Singletons resulting from d-FET are at increased risk for perinatal morbidity. However, the risk was diminished in single blastocyst transfer cycles. Our study supports the current American Society for Reproductive Medicine (ASRM) guidelines of transferring a single blastocyst in d-FET cycles.
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Affiliation(s)
- Bo Yu
- Department of OBGYN, University of Washington, 1959 NE Pacific Street, Box 356460, Seattle, WA, 98195-6460, USA.
| | - Mario Vega
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - Sahar Zaghi
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - Rani Fritz
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - Sangita Jindal
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
| | - Erkan Buyuk
- Department of OBGYN and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, NY, USA
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Schwarze JE, Borda P, Vásquez P, Ortega C, Villa S, Crosby JA, Pommer R. Is the risk of preeclampsia higher in donor oocyte pregnancies? A systematic review and meta-analysis. JBRA Assist Reprod 2018; 22:15-19. [PMID: 29266893 PMCID: PMC5844654 DOI: 10.5935/1518-0557.20180001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Preeclampsia (PE) occurs in 4.6% of pregnancies worldwide. The social
phenomenon of increasing maternal age has raised the demand for donor
oocytes. Egg donation has allowed women with poor ovarian reserve, premature
ovarian failure, genetic disorders or surgical menopause to get pregnant.
Recipients provide a unique model of immune response because of the
differences in the genetic makeup of mothers and fetuses. In PE, immune
tolerance may be impaired as a result of having non-autologous eggs
implanted. Egg donation is a highly successful assisted reproductive
technology, despite the significant number of issues arising from the
implantation of non-autologous eggs. This study aimed to determine whether
there is an association between egg donation and preeclampsia. Methods A systematic review of the literature available in PubMed and Google Scholar
was carried out from January of 1995 to August of 2016 using the terms
'oocyte donation, preeclampsia', 'oocyte donation, in vitro
fertilization, preeclampsia', 'oocyte donation, preeclampsia, outcomes
pregnancies', 'oocyte donation, obstetric outcome.' Only six retrospective
cohort studies met the selection criteria. Result The meta-analysis revealed a statistically significant association between
egg donation and onset of preeclampsia (OR 4.50; 95% CI: 3.28-6.19;
p<0.0001). Conclusion Oocyte donation is associated with increased risk of preeclampsia in
singleton pregnancies. Therefore, it is crucial to properly record and
assess this finding when egg donation is the chosen assisted reproductive
technology to attain pregnancy.
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Affiliation(s)
- Juan Enrique Schwarze
- Clinical Departament of Obstetrics and Gynecology, Universidad de Santiago, Chile.,Unit of Reproductive Medicine, Clínica Monteblanco, Santiago, Chile
| | - Paula Borda
- Clinical Departament of Obstetrics and Gynecology, Universidad de Santiago, Chile
| | - Pamela Vásquez
- School of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Carolina Ortega
- Unit of Reproductive Medicine, Clínica Monteblanco, Santiago, Chile
| | - Sonia Villa
- Unit of Reproductive Medicine, Clínica Monteblanco, Santiago, Chile
| | - Javier A Crosby
- Unit of Reproductive Medicine, Clínica Las Condes, Santiago, Chile
| | - Ricardo Pommer
- Unit of Reproductive Medicine, Clínica Monteblanco, Santiago, Chile
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22
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Dior UP, Laufer N, Chill HH, Granovsky-Grisaru S, Yagel S, Yaffe H, Gielchinsky Y. Increased incidence of preeclampsia in mothers of advanced age conceiving by oocyte donation. Arch Gynecol Obstet 2018; 297:1293-1299. [PMID: 29435657 DOI: 10.1007/s00404-017-4616-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study was to evaluate the risk of preeclampsia in women of advanced age who conceived through donated oocytes as compared with natural conceptions. METHODS A historical prospective study of singleton live births of parturients ≥ 45 years of age at four university hospitals was conducted. For the purpose of the study, the population was divided by the mode of conception into two groups: oocyte donation and natural conception. The main outcome variable in this study was preeclampsia. Secondary outcomes included pregnancy-induced hypertension and Small for Gestational Age. RESULTS Two hundred and seventy pregnancies were achieved naturally and 135 women conceived by oocyte donation. Mean age at delivery for the natural conception and oocyte donation groups was 45.7 and 47.8, respectively. Preeclampsia complicated 3 out of 270 (1.1%) natural conception pregnancies and 17 out of 135 (12.6%) oocyte donation conceptions. After adjusting for confounders, oocyte donation pregnancies were found to be associated with a 12-fold increased risk for preeclampsia (P = 0.001). Among oocyte donation pregnancies, the risk of preeclampsia was not affected by parity or age. CONCLUSIONS A substantially increased risk for preeclampsia was found in oocyte donation pregnancies, suggesting that the foreign oocyte may play a specific biologic role in the development of preeclampsia after the age of 45.
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Affiliation(s)
- Uri P Dior
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Neri Laufer
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Henry H Chill
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel.
| | - Sorina Granovsky-Grisaru
- Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center and Hebrew University Medical School, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Haim Yaffe
- Department of Obstetrics and Gynecology, Sheere-Zedek Medical Center City Campus, Bikur-Holim Hospital, Jerusalem, Israel
| | - Yuval Gielchinsky
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
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23
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Yadav V, Bakolia P, Malhotra N, Mahey R, Singh N, Kriplani A. Comparison of Obstetric Outcomes of Pregnancies after Donor-Oocyte In vitro Fertilization and Self-Oocyte In vitro Fertilization: A Retrospective Cohort Study. J Hum Reprod Sci 2018; 11:370-375. [PMID: 30787523 PMCID: PMC6333036 DOI: 10.4103/jhrs.jhrs_115_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims: The aim of this study is to evaluate and compare multiple obstetric and perinatal outcomes between donor-oocyte in vitro fertilization (IVF) and self-oocyte IVF group. Settings and Design: This study was done in a tertiary care center with ART unit. This was a retrospective comparative cohort study. Materials and Methods: The present study comprised all women between 20 and 45 years who conceived from oocyte donation (n = 78) between December 1, 2010, and December 31, 2016, and compared with all women who underwent self-oocyte IVF (n = 112). The process involved controlled ovarian stimulation and retrieval of the donor oocytes, preparation of recipient endometrium, and pregnancy management. Obstetric and perinatal outcomes were compared. Statistical Analysis Used: Chi-square test was used for categorical variables. Analysis for confounding variables was performed using multivariable linear and logistic regression analysis. Results: Baseline characteristics between the two groups were comparable. Miscarriage, first-trimester bleeding, pregnancy-induced hypertension (PIH), and gestational diabetes mellitus were significantly higher in donor-oocyte IVF group compared to self-oocyte cycles (P = 0.001). Using multiple logistic regression analysis, age class adjusted PIH incidence was significantly higher in donor-oocyte group as compared to self-oocyte group (P = 0.010). There was no significant variation in perinatal outcomes between the donor- and self-oocyte IVF cycles (P > 0.05). Conclusion: Oocyte donation should be treated as an independent risk factor for PIH.
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Affiliation(s)
- Vikas Yadav
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Priyanka Bakolia
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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24
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McPherson NO, Zander-Fox D, Vincent AD, Lane M. Combined advanced parental age has an additive negative effect on live birth rates-data from 4057 first IVF/ICSI cycles. J Assist Reprod Genet 2017; 35:279-287. [PMID: 28980182 DOI: 10.1007/s10815-017-1054-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/15/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The purpose of this study is to determine if there is an additive effect of combined advanced maternal and paternal age on pregnancy and live birth rates. METHODS Retrospective data analysis of 4057 first cycles at a fertility centre between 2009 and 2013 was compiled. Donor, preimplantation genetic screening and double embryo transfer cycles were excluded. Main outcomes measured were clinical pregnancy, viable pregnancy, live birth and term birth. RESULTS Logistic regression indicated strong negative associations for maternal ages exceeding 27 years with clinical pregnancies (p < 0.001), viable pregnancies (p < 0.001), live births (p < 0.001) and term births (p < 0.001). There was evidence of negative associations between paternal age and both viable pregnancies (p = 0.06) and live births (p = 0.04), such that the probability of pregnancy was 10% further reduced for women who were 35 years with a partner over 40 years vs. women aged 35 years with a partner under 30 years. There was evidence of an interaction between maternal age and the paternal age on term births (p = 0.02) such that advanced paternal age's effect on the probability of a term birth was only evident in couples where the maternal age ranged between ~27 and 35 years. CONCLUSIONS There is an additive effect to pregnancy and live birth rates when both partners are of an advanced age, thus highlighting the need for pre-conception public health messaging and a combined approach to ART counselling assessing both parental ages in combination.
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Affiliation(s)
- Nicole O McPherson
- School of Medicine, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Level 3 Medical School South, Adelaide, South Australia, 5005, Australia.
- Repromed, Dulwich, Adelaide, South Australia, 5065, Australia.
- Freemasons Centre for Men's Health, University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Deirdre Zander-Fox
- School of Medicine, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Level 3 Medical School South, Adelaide, South Australia, 5005, Australia
- Repromed, Dulwich, Adelaide, South Australia, 5065, Australia
- Monash IVF Group, Richmond, Victoria, 3121, Australia
| | - Andrew D Vincent
- Freemasons Centre for Men's Health, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Michelle Lane
- School of Medicine, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Level 3 Medical School South, Adelaide, South Australia, 5005, Australia
- Freemasons Centre for Men's Health, University of Adelaide, Adelaide, South Australia, 5005, Australia
- Monash IVF Group, Richmond, Victoria, 3121, Australia
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25
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High-risk of preterm birth and low birth weight after oocyte donation IVF: analysis of 133,785 live births. Reprod Biomed Online 2017; 35:318-324. [DOI: 10.1016/j.rbmo.2017.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 02/04/2023]
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26
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Harrison BJ, Hilton TN, Rivière RN, Ferraro ZM, Deonandan R, Walker MC. Advanced maternal age: ethical and medical considerations for assisted reproductive technology. Int J Womens Health 2017; 9:561-570. [PMID: 28860865 PMCID: PMC5566409 DOI: 10.2147/ijwh.s139578] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This review explores the ethical and medical challenges faced by women of advanced maternal age who decide to have children. Assisted reproductive technologies (ARTs) make post-menopausal pregnancy physiologically plausible, however, one must consider the associated physical, psychological, and sociological factors involved. METHODS A quasi-systematic review was conducted in PubMed and Ovid using the key terms post-menopause, pregnancy + MeSH terms [donations, hormone replacement therapy, assisted reproductive technologies, embryo donation, donor artificial insemination, cryopreservation]. Overall, 28 papers encompassing two major themes (ethical and medical) were included in the review. CONCLUSION There are significant ethical considerations and medical (maternal and fetal) complications related to pregnancy in peri- and post-menopausal women. When examining the ethical and sociological perspective, the literature portrays an overall positive attitude toward pregnancy in advanced maternal age. With respect to the medical complications, the general consensus in the evaluated studies suggests that there is greater risk of complication for spontaneous pregnancy when the mother is older (eg, >35 years old). This risk can be mitigated by careful medical screening of the mother and the use of ARTs in healthy women. In these instances, a woman of advanced maternal age who is otherwise healthy can carry a pregnancy with a similar risk profile to that of her younger counterparts when using donated oocytes.
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Affiliation(s)
| | - Tara N Hilton
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Zachary M Ferraro
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Maternal-Fetal Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Raywat Deonandan
- University of Ottawa Interdisciplinary School of Health Sciences, Ottawa, ON, Canada
| | - Mark C Walker
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Maternal-Fetal Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
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27
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28
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Porreco RP, Heyborne KD. Immunogenesis of preeclampsia: lessons from donor gametes. J Matern Fetal Neonatal Med 2017; 31:1220-1226. [DOI: 10.1080/14767058.2017.1309385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Richard P. Porreco
- Maternal Fetal Medicine, Presbyterian/St.Luke’s Medical Center, Obstetrix Medical Group of Colorado, Denver, CO, USA
| | - Kent D. Heyborne
- Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, CO, USA
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29
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Tarlatzi TB, Imbert R, Alvaro Mercadal B, Demeestere I, Venetis CA, Englert Y, Delbaere A. Does oocyte donation compared with autologous oocyte IVF pregnancies have a higher risk of preeclampsia? Reprod Biomed Online 2017; 34:11-18. [DOI: 10.1016/j.rbmo.2016.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
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30
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Bos M, Baelde HJ, Bruijn JA, Bloemenkamp KW, van der Hoorn MLP, Turner RJ. Loss of placental thrombomodulin in oocyte donation pregnancies. Fertil Steril 2017; 107:119-129.e5. [DOI: 10.1016/j.fertnstert.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/19/2016] [Accepted: 10/02/2016] [Indexed: 12/12/2022]
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31
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Cakmak Celik F, Aygun C, Kucukoduk S, Bek Y. Maternal and neonatal outcomes in advanced maternal age: a retrospective cohort study. J Matern Fetal Neonatal Med 2016; 30:2452-2456. [PMID: 27806665 DOI: 10.1080/14767058.2016.1253058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe the effect of extremely advanced maternal age (EAMA) on maternal/neonatal outcomes. METHODS This was a case-control study in which 127 women ≥40 years at the time of delivery out of 2853 singleton hospital deliveries in Ondokuz Mayis University between 1 January 2008 and 31 August 2010 constituted the study group. One hundred and twenty-seven else were chosen randomly out of 2412, 21-35 years old women, via a computer system as controls. Demographic features of 254 mothers and infants as well as maternal and neonatal complications were recorded. RESULTS Mean maternal age was 41.5 ± 1.9 (40-49) years in EAMA group and 28.9 ± 4.2 (21-35) years in controls. Primigravidity was 19.6% in the EAMA group, whereas 37.8% in controls (p = 0.003). No difference was found between groups according to route of delivery, stillbirth, preterm birth, congenital abnormalities, gender of babies, NICU admission and respiratory problems (for all p > 0.05). A 5th min Apgar score <7 was more frequent in babies born to EAMA mothers compared to controls (9.8% versus 4.9%, p = 0.004). CONCLUSION The present study shows that EAMA mothers and their offsprings have similar peri and neonatal risks compared to younger mothers, except lower 5th minute Apgar scores. We conclude that with good perinatal care, EAMA women and their babies can pass through the perinatal period with similar risks of younger women.
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Affiliation(s)
- Fatma Cakmak Celik
- a Faculty of Medicine , Department of Pediatrics, Neonatalogy Division and
| | - Canan Aygun
- a Faculty of Medicine , Department of Pediatrics, Neonatalogy Division and
| | - Sukru Kucukoduk
- a Faculty of Medicine , Department of Pediatrics, Neonatalogy Division and
| | - Yuksel Bek
- b Faculty of Medicine , Department of Biostatistics, Ondokuz Mayis University , Samsun , Turkey
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32
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Twin pregnancies after assisted reproductive technologies: the role of maternal age on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol 2016; 206:198-203. [DOI: 10.1016/j.ejogrb.2016.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
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Elenis E, Sydsjö G, Skalkidou A, Lampic C, Svanberg AS. Neonatal outcomes in pregnancies resulting from oocyte donation: a cohort study in Sweden. BMC Pediatr 2016; 16:170. [PMID: 27769207 PMCID: PMC5073900 DOI: 10.1186/s12887-016-0708-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 10/13/2016] [Indexed: 12/24/2022] Open
Abstract
Background Pregnancies resulting through oocyte donation have been associated with increased risk for adverse outcomes for the mother, such as gestational hypertensive disorders. However, little is known about possible neonatal complications of such pregnancies. The purpose of this study was to evaluate the neonatal health outcomes among singleton pregnancies in a population of relatively young and healthy oocyte recipients in Sweden, taking into account the medical indication leading to treatment. Methods This cohort study involved 76 women conceiving with donated oocytes, 149 age-matched nulliparous women conceiving spontaneously and 63 women conceiving after non-donor IVF. Participants were recruited during 2005–2008 and followed up until delivery. Data on neonatal outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from seven Swedish University Hospitals with IVF clinics. Logistic regression analyses were performed to examine the association of mode of conception and neonatal outcomes, adjusted for maternal age and BMI, gestational age and delivery by cesarean section. Results Infants conceived through oocyte donation had higher odds for premature delivery [OR 2.36, 95 % CI (1.02–5.45)], for being small for gestational age [OR 4.23, 95 % CI (1.03–17.42)] and having Apgar score below 7 at 5 min [OR 10.57, 95 % CI (1.21–92.20)] compared to spontaneously conceived infants. Similar trends were observed when comparing infants conceived through oocyte donation to those conceived by traditional IVF. Furthermore, donor oocyte infants had a lower mean birthweight and length compared to autologous oocyte neonates (p = 0.013); however no differences were noted among infants born at term. Neonatal outcomes were more favorable among women with diminished ovarian reserve compared to those with other indications for oocyte donation. Conclusions Infants conceived after oocyte donation in Sweden have higher odds of being born prematurely and having lower mean birthweight in comparison to non-donor infants. It seems that these unfavorable neonatal outcomes are present despite the age, weight and health restrictions applied to recipients before oocyte donation treatment in Sweden.
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Affiliation(s)
- Evangelia Elenis
- Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, SE-751 83, Uppsala, Sweden.
| | - Gunilla Sydsjö
- Obstetrics and Gynecology, Department of Clinical and Exprerimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, SE-751 83, Uppsala, Sweden
| | - Claudia Lampic
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, SE-751 83, Uppsala, Sweden
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Banker M, Mehta V, Sorathiya D, Dave M, Shah S. Pregnancy outcomes and maternal and perinatal complications of pregnancies following in vitro fertilization/intracytoplasmic sperm injection using own oocytes, donor oocytes, and vitrified embryos: A prospective follow-up study. J Hum Reprod Sci 2016; 9:241-249. [PMID: 28216912 PMCID: PMC5296828 DOI: 10.4103/0974-1208.197666] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/04/2016] [Accepted: 12/20/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Several global studies have assessed maternal and perinatal outcomes and complications with the type of embryo transfer (ET) following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). The present study assessed the incidence of maternal and perinatal outcomes and complications following IVF/ICSI associated with the type of embryo transferred. METHODOLOGY A total of 2112 ETs were performed in 2092 female patients aged 21-50 years between January 1 and December 31, 2014 (Group A: Fresh ET using self-oocytes: 691; Group B: Fresh ET using donor oocytes: 810; and Group C: Thaw ET using vitrified-warmed embryos: 611). RESULTS Incidence of clinical pregnancy rate, abortion rate, ectopic pregnancy rate, multiple pregnancy rate, live birth rate, and maternal complications was: Group A: 40.8%, 15.9%, 2.8%, 27.3%, 31.9%, and 17.7%; Group B: 50.2%, 21.8%, 1.6%, 32.5%, 36.9%, and 23.7%; and Group C: 42.9%, 25.2%, 1.1%, 31.3%, 29.6%, and 17.8%, respectively. Incidence of prematurity (<36 weeks of pregnancy), lower birth weight (<2500 g), perinatal mortality, and congenital abnormalities was as follows: Group A (29.52%, 36.2%, 5.22%, and 1.39%), Group B (42.58%, 46.2%, 4.6%, and 1.32%), and Group C (35.74%, 32.4%, 7.85%, and 0.94%), respectively. CONCLUSION The higher incidence of the pregnancy outcomes in oocyte donation (OD) cycles can mainly be attributed to the younger age of oocyte donors. The higher incidence of complications in OD cycles could be due to advanced maternal age, different placentation, and immune tolerance.
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Affiliation(s)
| | | | | | - Mira Dave
- Nova IVI Fertility, Ahmedabad, Gujarat, India
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35
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Dude AM, Yeh JS, Muasher SJ. Donor oocytes are associated with preterm birth when compared to fresh autologous in vitro fertilization cycles in singleton pregnancies. Fertil Steril 2016; 106:660-5. [DOI: 10.1016/j.fertnstert.2016.05.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/21/2016] [Accepted: 05/31/2016] [Indexed: 10/25/2022]
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36
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Kalayci H, Ozdemir H, Alkas D, Cok T, Tarim E. Is primiparity a risk factor for advanced maternal age pregnancies? J Matern Fetal Neonatal Med 2016; 30:1283-1287. [PMID: 27406982 DOI: 10.1080/14767058.2016.1211633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Currently, more women are delaying childbearing until their 40s.This study compared the pregnancy and maternal features, pregnancy and foetal outcomes between multiparous and primiparous patients. We compared the same factors between assisted reproductive technology (ART) and non-ART primiparous patients because of the high proportion of ART used in the primiparous patients. METHODS The study retrospectively examined 1680 patients, 35 years of age and older, between March 2008 and February 2015. RESULTS Comparing the features of these two groups, there was an increased incidence of employment and the use of ART in primiparous patients, while birthweight tended to be higher in the multiparous group. There were no significant differences in pregnancy complications other than hypertension disorders, such as pre-eclampsia and HELLP syndrome, which were significantly more frequent in primiparous patients. The rates of foetal growth retardation and perinatal death were significantly higher in primiparous women. Comparison of the data between ART and non-ART primiparous patients indicated that the ART group had a higher initial body mass index and a lower smoking rate. No significant differences in pregnancy complications or foetal outcome were observed between these two groups. CONCLUSION Primiparity is associated with increased pregnancy and foetal complications in advanced age pregnancies. However, the use of ART in this age group does not seem to be an additional risk factor.
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Affiliation(s)
- Hakan Kalayci
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
| | - Halis Ozdemir
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
| | - Didem Alkas
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
| | - Tayfun Cok
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
| | - Ebru Tarim
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
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Saito S, Nakabayashi Y, Nakashima A, Shima T, Yoshino O. A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health. Semin Immunopathol 2016; 38:687-697. [DOI: 10.1007/s00281-016-0577-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/07/2016] [Indexed: 11/24/2022]
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Letur H, Peigné M, Ohl J, Cédrin-Durnerin I, Mathieu-D'Argent E, Scheffler F, Grzegorczyk-Martin V, de Mouzon J. Hypertensive pathologies and egg donation pregnancies: Results of a large comparative cohort study. Fertil Steril 2016; 106:284-90. [PMID: 27025547 DOI: 10.1016/j.fertnstert.2016.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/04/2016] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether egg donation (ED) pregnancies are at higher risk of pregnancy-induced hypertension (PIH) than those achieved by autologous assisted reproductive technology (ART; controls). DESIGN Anonymous comparative observational matched cohort study. SETTING Assisted reproductive technology centers. PATIENT(S) Two hundred seventeen ED and 363 control singleton pregnancies matched at 7-8 weeks (pregnancy date, parity, cycle type [fresh/frozen] and women's age). According to French practice, all women were under 45. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Percentage of PIH for ED versus controls. RESULT(S) The groups were comparable (mean age, 34.5). PIH was more frequent during ED pregnancies (17.8% vs. 5.3%), as was preeclampsia (11.2% vs. 2.8%) and eclampsia (1.8% vs. 0.0%). In multivariate analyses, PIH risk increased with ED (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.93-7.97) and women's age (OR, 1.08; 95% CI, 1.00-1.16). No significant effect of previous pregnancies or cycle rank/type was observed. CONCLUSION(S) This study had sufficient power to detect doubling of the PIH rate. It was demonstrated that the risk of PIH was tripled for ED versus controls. Even in young women, ED is a risk factor for PIH. An immunological explanation seems most likely, that is, the fetus is fully allogeneic to its mother. This risk must be acknowledged to inform couples and provide careful pregnancy monitoring.
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Affiliation(s)
- Hélène Letur
- Centre de Fertilité, Institut Mutualiste Montsouris, Paris, France.
| | - Maëliss Peigné
- Service de Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre Hospitalier Régional et Universitaire, Lille, France
| | - Jeanine Ohl
- Service de Gynécologie-Obstétrique, Centre Médico-Chirurgical et Obstétrical, Centre Hospitalier Universitaire, Schiltigheim, France
| | - Isabelle Cédrin-Durnerin
- Service de Médecine de la Reproduction, Assistance Publique des Hôpitaux de Paris, Hôpital Jean-Verdier, Bondy, France
| | | | - Florence Scheffler
- Médecine et Biologie de la Reproduction, Cytogénétique et Centre d'Etude et de Conservation des Oeufs et du Sperme de Picardie, Centre Hospitalier Universitaire d'Amiens Sud, Amiens, France
| | - Veronika Grzegorczyk-Martin
- Service de Gynécologie-Obstétrique, Centre Hospitalier Intercommunal des 4 Villes, Site Sèvres, Sèvres, France
| | - Jacques de Mouzon
- Institut National de la Santé et de la Recherche Médicale, Service de Gynécologie-Obstétrique II et Médecine de la Reproduction, APHP, Cochin Port Royal, Paris, France
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Is oocyte donation a risk factor for preeclampsia? A systematic review and meta-analysis. J Assist Reprod Genet 2016; 33:855-63. [PMID: 27007875 DOI: 10.1007/s10815-016-0701-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/10/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The objective of this meta-analysis is to determine whether there is a higher incidence of preeclampsia (PE) in pregnancies achieved by oocyte donation (OD) compared with pregnancies achieved by in vitro fertilization with autologous oocytes (IVF). METHODS A systematic review was performed to identify relevant studies published from January 1994 until April 2015 with at least an abstract in English using PubMed, ISI Web of Knowledge, and clinicaltrials.gov. The 11 studies included in this systematic review were retrospective and prospective cohort studies of women reporting results on the association between oocyte donation vs. in vitro fertilization (exposure) and preeclampsia (outcome). RESULTS Oocyte donation is a risk factor for the development of PE compared to IVF cycles, with a weighted OR of 3.12 under a fixed effects method (FEM: no heterogeneity between the studies). The weighted OR under a random effects model was 2.9 (REM: heterogeneity between the studies). The meta-regression analysis showed that neither multiple pregnancies (estimate = 0.08; p = 0.19) nor patient age (estimate = -2.29; p = 0.13) significantly explained the variability of the effect of oocyte donation on PE. Q statistic was 12.78 (p = 0.237), suggesting absence of heterogeneity between the studies. CONCLUSIONS Pregnancies achieved by oocyte donation confer a threefold increase in the likelihood of developing PE than those achieved by in vitro fertilization with own oocytes. Physicians should be aware of this risk in order to both counsel patients and monitor pregnancies accordingly.
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Masoudian P, Nasr A, de Nanassy J, Fung-Kee-Fung K, Bainbridge SA, El Demellawy D. Oocyte donation pregnancies and the risk of preeclampsia or gestational hypertension: a systematic review and metaanalysis. Am J Obstet Gynecol 2016; 214:328-39. [PMID: 26627731 DOI: 10.1016/j.ajog.2015.11.020] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to determine whether pregnancies that were achieved via oocyte donation, compared with pregnancies achieved via other assisted reproductive technology methods or natural conception, demonstrate increased risk of preeclampsia or gestational hypertension. Comparative studies of pregnancies that were achieved with oocyte donation vs other methods of assisted reproductive technology or natural conception with preeclampsia or gestational hypertension were included as 1 of the measured outcomes. Abstracts and unpublished studies were excluded. Two reviewers independently selected studies, which were assessed for quality with the use of methodological index for non-randomized studies, and extracted the data. Statistical analysis was conducted. Of the 523 studies that were reviewed initially, 19 comparative studies met the predefined inclusion and exclusion criteria and were included in the metaanalysis, which allowed for analysis of a total of 86,515 pregnancies. Our pooled data demonstrated that the risk of preeclampsia is higher in oocyte-donation pregnancies compared with other methods of assisted reproductive technology (odds ratio, 2.54; 95% confidence interval, 1.98-3.24; P < .0001) or natural conception (odds ratio, 4.34; 95% confidence interval, 3.10-6.06; P < .0001). The risk of gestational hypertension was also increased significantly in oocyte donation pregnancies in comparison with other methods of assisted reproductive technology (odds ratio, 3.00; 95% confidence interval, 2.44-3.70; P < .0001) or natural conception (odds ratio, 7.94; 95% confidence interval, 1.73-36.36; P = .008). Subgroup analysis that was conducted for singleton and multiple gestations demonstrated a similar risk for preeclampsia and gestational hypertension in both singleton and multiple gestations. This metaanalysis provides further evidence that supports that egg donation increases the risk of preeclampsia and gestational hypertension compared with other assisted reproductive technology methods or natural conception.
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Jeve YB, Potdar N, Opoku A, Khare M. Three-arm age-matched retrospective cohort study of obstetric outcomes of donor oocyte pregnancies. Int J Gynaecol Obstet 2016; 133:156-8. [DOI: 10.1016/j.ijgo.2015.09.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/28/2015] [Accepted: 01/12/2016] [Indexed: 01/28/2023]
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Clua E, Meler E, Rodríguez D, Coroleu B, Rodríguez I, Martínez F, Tur R. Obstetric and perinatal complications in an oocyte donation programme. Is it time to limit the number of embryos to transfer? Gynecol Endocrinol 2016; 32:267-71. [PMID: 26490075 DOI: 10.3109/09513590.2015.1111330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study is to describe obstetric and perinatal complications in pregnancies from oocyte donation (OD) cycles, delivering in our centre and to determine the impact of maternal age. Retrospective observational study of a 225 singleton pregnancies, 113 multiple pregnancies and 447 live birth. Pearson's χ(2) test or Fisher's exact test were used for the statistical analysis. A higher incidence of obstetric complications was observed in multiple compared to singleton pregnancies with regard to preeclampsia (24.8% versus 8%), premature rupture of membranes (9.7% versus 1.8%), preterm delivery at <37 weeks (54.9% versus 10.2%) and caesarean section (81.4% versus 64%) (p < 0.05). If the age factor is added, the caesarean sections are higher in the single pregnancy group aged ≥40 years than in the group of <40 years (73.5% versus 49.4%) (p < 0.05). A higher incidence is found in multiple versus singleton pregnancies for low birth weight (<2500 g) (61.1% versus 8.2%), admissions to the intensive care unit (15.2% versus 4.7%) and perinatal mortality (13.5‰ versus 0‰) (p < 0.05). It is necessary to consider preconception counselling prior to an OD cycle to inform patients about the incidence complications observed and recommend to transfer only a single embryo.
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Affiliation(s)
| | - Eva Meler
- b Service of Obstetrics and Fetal Medicine , and
| | | | | | - Ignacio Rodríguez
- c Unit of Biostatistics, Department of Obstetrics, Gynaecology and Reproduction, Hospital Universitari Quiron Dexeus , Barcelona , Spain
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Abstract
Donated oocytes are a treatment modality for female infertility which is also associated with increased risks of preeclampsia. Subsequently it is important to evaluate if there is concomitant increased risks for adverse neonatal events in donated oocyte neonates. A structured search of the literature using PubMed, EMBASE and Cochrane Reviews was performed to investigate the perinatal health outcomes of offspring conceived from donor oocytes compared with autologous oocytes. Meta-analysis was performed on comparable outcomes data. Twenty-eight studies were eligible and included in the review, and of these, 23 were included in a meta-analysis. Donor oocyte neonates are at increased risk of being born with low birth weight (<2500 g) [risk ratio (RR): 1.18, 95% confidence interval (CI): 1.14–1.22, P-value (P)<0.00001], very low birth weight (<1500 g) (RR: 1.24, CI: 1.15–1.35, P<0.00001), preterm (<37 weeks) (RR: 1.26, CI: 1.23–1.30, P<0.00001), of lower gestational age (mean difference −0.3 weeks, CI: −0.35 weeks to −0.25 weeks, P<0.00001), and preterm with low birth weight (RR: 1.24, CI: 1.19–1.29, P<0.00001), when compared with autologous oocyte neonates. Conversely, low birth weight outcomes were improved in term donor oocyte neonates (RR: 0.86, CI: 0.8–0.93, P=0.0003). These negative outcomes remained significant when controlling for multiple deliveries. The donor oocyte risk rates are higher than those found in general ART outcomes, are important considerations for the counselling of infertile patients and may also influence the long term health of the offspring.
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Vannuccini S, Clifton VL, Fraser IS, Taylor HS, Critchley H, Giudice LC, Petraglia F. Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Hum Reprod Update 2015; 22:104-15. [PMID: 26395640 PMCID: PMC7289323 DOI: 10.1093/humupd/dmv044] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/03/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reproductive disorders and infertility are associated with the risk of obstetric complications and have a negative impact on pregnancy outcome. Affected patients often require assisted reproductive technologies (ART) to conceive, and advanced maternal age is a further confounding factor. The challenge is to dissect causation, correlation and confounders in determining how infertility and reproductive disorders individually or together predispose women to poor pregnancy outcomes. METHODS The published literature, to June 2015, was searched using PubMed, summarizing all evidences concerning the perinatal outcome of women with infertility and reproductive disorders and the potential mechanisms that may influence poor pregnancy outcome. RESULTS Reproductive disorders (endometriosis, adenomyosis, polycystic ovary syndrome and uterine fibroids) and unexplained infertility share inflammatory pathways, hormonal aberrations, decidual senescence and vascular abnormalities that may impair pregnancy success through common mechanisms. Either in combination or alone, these disorders results in an increased risk of preterm birth, fetal growth restriction, placental pathologies and hypertensive disorders. Systemic hormonal aberrations, and inflammatory and metabolic factors acting on endometrium, myometrium, cervix and placenta are all associated with an aberrant milieu during implantation and pregnancy, thus contributing to the genesis of obstetric complications. Some of these features have been also described in placentas from ART. CONCLUSIONS Reproductive disorders are common in women of childbearing age and rarely occur in isolation. Inflammatory, endocrine and metabolic mechanisms associated with these disorders are responsible for an increased incidence of obstetric complications. These patients should be recognized as 'high risk' for poor pregnancy outcomes and monitored with specialized follow-up. There is a real need for development of evidence-based recommendations about clinical management and specific obstetric care pathways for the introduction of prompt preventative care measures.
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Affiliation(s)
- Silvia Vannuccini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Vicki L Clifton
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Ian S Fraser
- Department of Obstetrics and Gynaecology, Center for Women's Health, University of New South Wales, Sydney, Australia
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Hilary Critchley
- MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 550 16th Street, Floor 7, Box 0132, San Francisco, CA 94143, USA
| | - Felice Petraglia
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy
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Luisi S, Orlandini C, Regini C, Pizzo A, Vellucci F, Petraglia F. Premature ovarian insufficiency: from pathogenesis to clinical management. J Endocrinol Invest 2015; 38:597-603. [PMID: 25596661 DOI: 10.1007/s40618-014-0231-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
Premature ovarian insufficiency (POI) represents a condition characterized by the absence of normal ovarian function due to an incipient (by 3-10 years) ovarian aging. In most of the women affected there are no signs or symptoms that precede the interruption of menstruation and the onset of POI and the majority of women have a normal history of menarche, regular menstrual cycles and normal fertility. The possible genetic role in the development of POI has been largely demonstrated and many genes have been involved; on the other hand, ovary is not protected immunologically and the detection of autoantibodies directed against various ovarian targets strongly support the hypothesis of an autoimmune etiology. In approximately 5-10% of women with a diagnosis of POI with a normal karyotype, a spontaneous pregnancy could occur even if the recovery of ovarian function is temporary and poorly predictable. Embryo donation and adoption are other alternatives that should be considered. POI and subsequent loss of reproductive capacity is a devastating condition and a difficult diagnosis for women to accept so it requires an individualized and a multidisciplinary approach. Hormonal replacement therapy (HRT) should be commenced as soon as possible to prevent and to contrast the onset of the symptoms related to hypoestrogenism and to improve the quality of life for these women.
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Affiliation(s)
- S Luisi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100, Siena, Italy.
| | - C Orlandini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100, Siena, Italy
| | - C Regini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100, Siena, Italy
| | - A Pizzo
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100, Siena, Italy
| | - F Vellucci
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100, Siena, Italy
| | - F Petraglia
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100, Siena, Italy
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Weissmann-Brenner A, Simchen MJ, Zilberberg E, Kalter A, Dulitzky M. Combined effect of fetal sex and advanced maternal age on pregnancy outcomes. Med Sci Monit 2015; 21:1124-30. [PMID: 25892459 PMCID: PMC4416462 DOI: 10.12659/msm.893057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fetal sex and maternal age are each known to affect outcomes of pregnancies. The objective of the present study was to investigate the influence of the combination of maternal age and fetal sex on pregnancy outcomes in term and post-term singleton pregnancies. MATERIAL AND METHODS This was a retrospective study on term singleton pregnancies delivered between 2004 and 2008 at the Chaim Sheba Medical Center. Data collected included maternal age, fetal sex, and maternal and neonatal complications. The combined effect of fetal sex and maternal age on complications of pregnancy was assessed by multivariable logistic regression models. RESULTS The study population comprised 37,327 pregnancies. The risk of operative deliveries increased with maternal age ≥ 40 and in pregnancies with male fetuses. The risk of maternal diabetes and of longer hospitalization increased as maternal age increased, and in women ≥ 40 carrying male fetuses. The risk of hypertensive disorders increased in pregnancies with males as maternal age advanced. The risk of shoulder dystocia and neonatal respiratory complications increased in male neonates born to women<40. The risk of neonatal hypoglycemia increased in males for all maternal ages. CONCLUSIONS Risk assessment for fetal sex and advanced maternal age were given for different pregnancy complications. Knowledge of fetal sex adds value to the risk assessment of pregnancies as maternal age increases.
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Affiliation(s)
- Alina Weissmann-Brenner
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Michal J Simchen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Eran Zilberberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Anat Kalter
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Mordechai Dulitzky
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
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Younis JS, Laufer N. Oocyte donation is an independent risk factor for pregnancy complications: the implications for women of advanced age. J Womens Health (Larchmt) 2015; 24:127-30. [PMID: 25646636 DOI: 10.1089/jwh.2014.4999] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Maternal age at first pregnancy and age-related infertility are steadily increasing, and the demand for assisted reproductive technologies (ART) to treat age-related infertility is also on the rise. The latest registry findings from Europe and the United States show that the meager results of ART in women above 43 years of age have not improved much over the past 10 years. The latest evidence shows that the demand for oocyte donation (OD) is steadily increasing. Contrary to previous belief-attributing increased perinatal complications in OD recipients to advanced maternal age and multifetal pregnancy-accumulating evidence from the past few years suggests that OD itself is a significant and independent risk factor for pregnancy complications, mostly for pre-eclampsia. The increased rate of chronic maternal disease and medical complications in pregnancy observed in advanced maternal age, coupled with the growing demand for OD, with its independent association with pre-eclampsia, create an urgent need to adopt a clear policy taking these risks into account. We present recent evidence showing that OD is an independent risk factor for pre-eclampsia and suggest recommendations for women approaching OD treatment in advanced age.
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Affiliation(s)
- Johnny S Younis
- 1 Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center , Tiberias, Israel
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Levron Y, Dviri M, Segol I, Yerushalmi GM, Hourvitz A, Orvieto R, Mazaki-Tovi S, Yinon Y. The 'immunologic theory' of preeclampsia revisited: a lesson from donor oocyte gestations. Am J Obstet Gynecol 2014; 211:383.e1-5. [PMID: 24657130 DOI: 10.1016/j.ajog.2014.03.044] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/10/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the prevalence of placental complications in patients conceived through donor versus autologous oocytes. STUDY DESIGN A retrospective cohort study including 2 groups of patients who conceived through in vitro fertilization using: (1) donor oocyte (n = 139) and (2) autologous oocyte (n = 126). Only singleton gestations were included. The rate of placental complications including preeclampsia, gestational hypertension, and intrauterine growth restriction was compared between these 2 groups. RESULTS The women who conceived using donor oocytes were older compared with women who conceived using autologous oocytes (median maternal age 45 vs 41, P < .01). The rate of hypertensive diseases of pregnancy including gestational hypertension and preeclampsia was significantly higher in ovum donor recipients compared with women conceived with autologous oocytes (25% vs 10%, P < .01). Similarly, the rate of intrauterine growth restriction was also higher among patients conceived through oocyte donation although it did not reach statistical significance (9.3% vs 4%, P = .08). When maternal age was restricted to ≤45 years, the rate of hypertensive diseases of pregnancy remained significantly higher among ovum donor compared with autologous oocyte recipients (22% vs 10%, P = .02). Adjustment for maternal age, gravidity, parity, and chronic hypertension revealed that oocyte donation was independently associated with higher rate of hypertensive diseases of pregnancy (P = .01). CONCLUSION Patients conceived through oocyte donation have an increased risk for placental complications of pregnancy. These findings support the 'immunologic theory' suggesting that immunologic intolerance between the mother and the fetus may play an important role in the pathogenesis of preeclampsia.
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van Dorp W, Rietveld AM, Laven JSE, van den Heuvel-Eibrink MM, Hukkelhoven CWPM, Schipper I. Pregnancy outcome of non-anonymous oocyte donation: a case-control study. Eur J Obstet Gynecol Reprod Biol 2014; 182:107-12. [PMID: 25268777 DOI: 10.1016/j.ejogrb.2014.09.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 08/27/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the maternal and neonatal outcome of non-anonymous oocyte donation compared to in vitro fertilization. Study design We compared 84 oocyte donation pregnancies with a 251 matched in vitro fertilization cohort. Maternal and neonatal outcomes were retrieved from a nationwide perinatal registry. Oocyte donation and in vitro fertilization pregnancies were matched for maternal age, study center, ZIP code and embryo transfer date. Both maternal and neonatal complications and outcome were compared between oocyte donation and in vitro fertilization with univariate and multivariate logistic regression analyses, adjusting for maternal age, donor age, socio-economic status, ethnicity, and parity. RESULTS In total, 277 women underwent 541 oocyte donation cycles. The median recipient age was 34.9 years (IQR: 31.5-38.5), while the median donor age was 34.4 years (IQR: 31.7-37.0). Clinical pregnancy rate was 26.6%, which is comparable to standard in vitro fertilization treatment. Donor age in years (OR 0.93, 95% CI 0.88-0.99) and a previous pregnancy of the recipient (OR 1.69, 95% CI 1.02-2.78) were significantly associated with clinical pregnancy rate. Both singleton and multiple oocyte donation pregnancies were associated with pregnancy-induced hypertension compared with in vitro fertilization singleton and multiple pregnancies (OR 1.99, 95%CI 1.02-3.89, OR 6.43, 95% CI 1.67-24.72, respectively). No significant differences in neonatal outcome were observed. CONCLUSION Oocyte donation pregnancies are associated with an increased incidence of pregnancy-induced hypertension compared with age-matched in vitro fertilization controls. However, no significant differences in neonatal outcome were observed between oocyte donation and in vitro fertilization.
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Affiliation(s)
- Wendy van Dorp
- Department of Gynaecology and Obstetrics, Division Reproductive Medicine, Erasmus MC-University Medical Centre Rotterdam, s'Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands; Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
| | - Annemarie M Rietveld
- Department of Gynaecology and Obstetrics, Division Reproductive Medicine, Erasmus MC-University Medical Centre Rotterdam, s'Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Joop S E Laven
- Department of Gynaecology and Obstetrics, Division Reproductive Medicine, Erasmus MC-University Medical Centre Rotterdam, s'Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Gynaecology and Obstetrics, Division Reproductive Medicine, Erasmus MC-University Medical Centre Rotterdam, s'Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands; Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
| | - Chantal W P M Hukkelhoven
- Department of Gynaecology and Obstetrics, Division Reproductive Medicine, Erasmus MC-University Medical Centre Rotterdam, s'Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands; The Netherlands Perinatal Registry, PO Box 8588, 3503 RN Utrecht, The Netherlands
| | - Izaäk Schipper
- Department of Gynaecology and Obstetrics, Division Reproductive Medicine, Erasmus MC-University Medical Centre Rotterdam, s'Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Effect of oocyte donation on pregnancy outcomes in in vitro fertilization twin gestations. Fertil Steril 2014; 101:1326-30. [DOI: 10.1016/j.fertnstert.2014.01.055] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/12/2014] [Accepted: 01/28/2014] [Indexed: 11/22/2022]
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