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Growth Hormone Administration to Improve Reproductive Outcomes in Women with Recurrent Implantation Failure (RIF): a Systematic Review. Reprod Sci 2022; 30:1712-1723. [DOI: 10.1007/s43032-022-01124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022]
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Ezeome IV, Akintola SO, Jegede AS, Ezeome ER. Perception of Key Ethical Issues in Assisted Reproductive Technology (ART) by Providers and Clients in Nigeria. Int J Womens Health 2021; 13:1033-1052. [PMID: 34764702 PMCID: PMC8572738 DOI: 10.2147/ijwh.s331917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In the past decade, developments in the field of Assisted Reproductive Technology (ART) have intensified the hopes and the desires of infertile people to overcome infertility, resulting in an increasing demand for such services worldwide. However, as developments in ART have evolved rapidly, so have ethical, social, and political controversies surrounding many aspects arisen. It is known that societal ethics is dependent on the values and culture of a given group. We sought to explore how practitioners and clients in Nigeria perceive some Key ethical issues surrounding ART. MATERIALS AND METHODS This was an explorative descriptive study involving in-depth interview of three ART providers and eight female ART clients, all domiciled in Southeastern Nigeria. Sampling was by purposive and snowballing techniques for providers and clients, respectively. Ethical approval was obtained from University of Ibadan/University College Hospital and University of Nigeria Teaching Hospital Research Ethics Committees. Responses were grouped into themes for ease of discussion. RESULTS Providers and clients were in support of sex selection for family balancing, and multiple embryo transfers. They also perceive that the health of the woman should be the factor considered and not biological age for service provision. However, views differed on marital status as an access factor. Participants were in support of legally binding regulations to guide practice. CONCLUSION A culturally sensitive national regulation is recommended to guide practice in this vital area of reproduction.
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Affiliation(s)
- Ijeoma V Ezeome
- Department of Obstetrics & Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Bioethics, Faculty of Multidisciplinary Studies and Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | - Simisola O Akintola
- Department of Bioethics, Faculty of Multidisciplinary Studies and Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
- Department of Business and Private Law, Faculty of Law, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ayodele S Jegede
- Department of Bioethics, Faculty of Multidisciplinary Studies and Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Emmanuel R Ezeome
- Department of Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
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Couture V, Delisle S, Mercier A, Pennings G. The other face of advanced paternal age: a scoping review of its terminological, social, public health, psychological, ethical and regulatory aspects. Hum Reprod Update 2020; 27:305-323. [PMID: 33201989 DOI: 10.1093/humupd/dmaa046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a global tendency for parents to conceive children later in life. The maternal dimension of the postponement transition has been thoroughly studied, but interest in the paternal side is more recent. For the moment, most literature reviews on the topic have focused on the consequences of advanced paternal age (APA) on fertility, pregnancy and the health of the child. OBJECTIVE AND RATIONALE The present review seeks to move the focus away from the biological and medical dimensions of APA and synthesise the knowledge of the other face of APA. SEARCH METHODS We used the scoping review methodology. Searches of interdisciplinary articles databases were performed with keywords pertaining to APA and its dimensions outside of biology and medicine. We included scientific articles, original research, essays, commentaries and editorials in the sample. The final sample of 177 documents was analysed with qualitative thematic analysis. OUTCOMES We identified six themes highlighting the interdisciplinary nature of APA research. The 'terminological aspects' highlight the lack of consensus on the definition of APA and the strategies developed to offer alternatives. The 'social aspects' focus on the postponement transition towards reproducing later in life and its cultural dimensions. The 'public health aspects' refer to attempts to analyse APA as a problem with wider health and economic implications. The 'psychological aspects' focus on the consequences of APA and older fatherhood on psychological characteristics of the child. The 'ethical aspects' reflect on issues of APA emerging at the intersection of parental autonomy, children's welfare and social responsibility. The 'regulatory aspects' group different suggestions to collectively approach the implications of APA. Our results show that the field of APA is still in the making and that evidence is lacking to fully address the issues of APA. The review suggests promising avenues of research such as introducing the voice of fathers of advanced age into the research agenda. WIDER IMPLICATIONS The results of this review will be useful for developing policies and preconception health interventions that consider and include prospective fathers of advanced age.
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Affiliation(s)
- Vincent Couture
- Faculty of Nursing, Université Laval, Québec G1V 0A6, Canada.,Research Center of the CHU de Québec-Université Laval, Québec G1L 3L5, Canada
| | - Stéphane Delisle
- Research Center of the CHU de Québec-Université Laval, Québec G1L 3L5, Canada
| | - Alexis Mercier
- Faculty of Nursing, Université Laval, Québec G1V 0A6, Canada
| | - Guido Pennings
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Gent 9000, Belgium
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Jindal UN. Mid-life fertility: Challenges & policy planning. Indian J Med Res 2019; 148:S15-S26. [PMID: 30964078 PMCID: PMC6469367 DOI: 10.4103/ijmr.ijmr_647_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This review highlights the challenges, priority areas of research and planning, strategies for regulation of services and the need to develop guidelines and laws for fertility treatments during mid-life. The success rate of all treatments is poor in advanced age women because of declining ovarian reserve and natural fertility. There is often a need of third-party involvement which has its own ethical, legal and medical issues. Welfare of children born to older women and early death of parents are important concerns. Most of the new techniques such as the pre-implantation genetic diagnosis, oocyte augmentation, use of stem cells or artificial gametes, ovarian tissue preservation and ovarian transplantation are directed to improve, preserve or replace the declining ovarian reserve. These techniques are costly and have limited availability, safety and efficacy data. Continued research and policies are required to keep pace with these techniques. The other important issues include the patients’ personal autonomy and right of self-determination, welfare of offspring, public vs. private funding for research and development of new technologies vs. indiscriminate use of unproven technology. It is important that mid-life fertility is recognized as a distinct area of human reproduction requiring special considerations.
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Affiliation(s)
- Umesh N Jindal
- Department of Assisted Reproduction, Jindal IVF & Sant Memorial Nursing Home, Chandigarh, India
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Dayan N, Joseph KS, Fell DB, Laskin CA, Basso O, Park AL, Luo J, Guan J, Ray JG. Infertility treatment and risk of severe maternal morbidity: a propensity score-matched cohort study. CMAJ 2019; 191:E118-E127. [PMID: 30718336 PMCID: PMC6351248 DOI: 10.1503/cmaj.181124] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The extent to which infertility treatment predicts severe maternal morbidity is not well known. We examined the association between infertility treatment and severe maternal morbidity in pregnancy and the postpartum period. METHODS We conducted a cohort study using population-based registries from Ontario between 2006 and 2012. Pregnancies achieved using infertility treatment (ovulation induction, intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection) were compared with unassisted pregnancies using propensity score matching, based on demographic, reproductive and obstetric factors. The primary outcome was a validated composite of severe maternal morbidity or maternal death from 20 weeks' gestation to 42 days postpartum. We also calculated the odds ratio of a woman having 1, 2, or 3 or more severe maternal morbidity indicators in relation to invasive (e.g., in vitro fertilization) or noninvasive (e.g., intrauterine insemination) infertility treatment. RESULTS We matched 11 546 infertility treatment pregnancies with 47 553 untreated pregnancies. Severe maternal morbidity or maternal death occurred in 356 infertility-treated pregnancies (30.8 per 1000 deliveries) versus 1054 untreated pregnancies (22.2 per 1000 deliveries); relative risk 1.39 (95% confidence interval [CI] 1.23-1.56). The likelihood of a woman having 3 or more severe maternal morbidity indicators was increased in women who received invasive infertility treatment (odds ratio [OR] 2.28, 95% CI 1.56-3.33) but not in those who received noninvasive infertility treatment (OR 0.99, 95% CI 0.57-1.72). INTERPRETATION Women who undergo infertility treatment, particularly in vitro fertilization, are at somewhat higher risk of severe maternal morbidity or death. Efforts are needed to identify patient- and treatment-specific predictors of severe maternal morbidity that may influence the type of treatment a woman is offered.
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Affiliation(s)
- Natalie Dayan
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.
| | - K S Joseph
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Deshayne B Fell
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Carl A Laskin
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Olga Basso
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Alison L Park
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Jin Luo
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Jun Guan
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
| | - Joel G Ray
- Department of Medicine and Research Institute (Dayan), Department of Obstetrics and Gynecology (Basso), McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology, and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC; Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa, Ottawa, Ont.; Department of Medicine and Obstetrics and Gynecology (Laskin), University of Toronto; TRIO Fertility (Laskin); ICES (Park, Luo, Guan, Ray, Fell); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont
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Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P, Westphal LM, Inhorn MC, Patrizio P. Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review). J Assist Reprod Genet 2018; 35:1277-1288. [PMID: 29808382 PMCID: PMC6063838 DOI: 10.1007/s10815-018-1181-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Many people travel abroad to access fertility treatments. This growing phenomenon is known as cross border reproductive care (CBRC) or fertility tourism. Due to its complex nature and implications worldwide, CBRC has become an emerging dilemma deserving more attention on the global healthcare agenda. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English during the past 18 years to explore CBRC phenomenon in the new millennium. RESULTS Little is known about the accurate magnitude and scope of CBRC around the globe. In this systematic and critical review, we identify three major dimensions of CBRC: legal, economic, and ethical. We analyze each of these dimensions from clinical and practical perspectives. CONCLUSION CBRC is a growing reality worldwide with potential benefits and risks. Therefore, it is very crucial to regulate the global market of CBRC on legal, economic, and ethical bases in order to increase harmonization and reduce any forms of exploitation. Establishment of accurate international statistics and a global registry will help diminish the current information gap surrounding the CBRC phenomenon.
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Affiliation(s)
- Mahmoud Salama
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany.
- Department of Reproductive Medicine, National Research Center, Cairo, Egypt.
| | - Vladimir Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Evgenia Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Gohar Rahimi
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Lynn M Westphal
- Department of Reproductive Endocrinology and Infertility, Stanford University, Stanford, CA, USA
| | - Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Pasquale Patrizio
- Department of Reproductive Endocrinology and Infertility, Yale University, New Haven, CT, USA
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Kool EM, Bos AME, van der Graaf R, Fauser BCJM, Bredenoord AL. Ethics of oocyte banking for third-party assisted reproduction: a systematic review. Hum Reprod Update 2018; 24:615-635. [DOI: 10.1093/humupd/dmy016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/20/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- E M Kool
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - R van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
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Khatibi A, Nybo Andersen AM, Gissler M, Morken NH, Jacobsson B. Obstetric and neonatal outcome in women aged 50 years and up: A collaborative, Nordic population-based study. Eur J Obstet Gynecol Reprod Biol 2018. [DOI: 10.1016/j.ejogrb.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Menopausal women requesting egg/embryo donation: examining health screening guidelines for assisted reproductive technology. Menopause 2018; 23:799-802. [PMID: 27187010 DOI: 10.1097/gme.0000000000000622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE As more postreproductive women opt to pursue pregnancy with advanced assisted reproductive technologies (ART), the menopausal practitioner will become more involved in counseling, screening, and referral of premenopausal, perimenopausal, and postmenopausal women for these services. This review was conducted with the aim of (1) evaluating ART screening practices as they pertain to postreproductive women, and (2) reviewing the outcomes of ART using oocyte donation in postreproductive women. METHODS A total of 950 unique records were found on PubMed, Clinical Key, and Google Scholar. Of these, 252 records were screened for relevance based on their titles and abstracts. With further review of these 252 records, 93 full-text articles were assessed for eligibility, and 63 were excluded based on relevance to our study. Finally, 30 studies were included in our qualitative synthesis. RESULTS Despite the increasing use of ART in postreproductive women, there are limited guidelines for determining candidacy with regard to maternal health, the most comprehensive of which are the guidelines from the American Society for Reproductive Medicine (ASRM). Although the American Society for Reproductive Medicine guidelines state that healthy women over 50 who are prepared for parenthood are candidates for ART through oocyte donation, they note that older women should be counseled as to the increased obstetric risk associated with advanced maternal age. With aging, particularly for those women who are menopausal and postmenopausal, the woman and her fetus, however, are at risk of increased morbidity and mortality as compared with younger, healthy pregnant women. Because national trends suggest that women are delaying childbearing, the cohort of postreproductive women looking toward ART using donor oocytes as a fertility option will expand and menopausal practitioners will often participate in the ART counseling of these women. CONCLUSIONS Because maternal and fetal morbidity and mortality increase in postmenopausal women who become pregnant through ART, practitioners caring for this cohort should provide input into developing standardized, comprehensive guidelines for this population so that screening is consistent for all older women seeking this intervention and risks are objectively outlined and considered.
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Moaddab A, Chervenak FA, Mccullough LB, Sangi-Haghpeykar H, Shamshirsaz AA, Schutt A, Arian SE, Fox KA, Dildy GA, Shamshirsaz AA. Effect of advanced maternal age on maternal and neonatal outcomes in assisted reproductive technology pregnancies. Eur J Obstet Gynecol Reprod Biol 2017; 216:178-183. [PMID: 28783553 DOI: 10.1016/j.ejogrb.2017.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/25/2017] [Accepted: 07/23/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare maternal and neonatal outcomes between women with assisted reproductive technologies pregnancy aged <40, 40-44, 45-49, and ≥50 years. STUDY Design In a population-level analysis study, all live births by ART identified on birth certificate between 2011 and 2014 were extracted (n=101,494) using data from the Center for Disease Control and Prevention-National Center for Health Statistics (CDC-NCHS). We investigated and compared maternal and neonatal outcomes based on conditions routinely listed on birth certificates. RESULTS Of 101,494 ART live births, 79,786 (78.6%), 16,186 (15.9%), 4637 (4.6%), and 885 (0.9%) were delivered by women aged <40, 40-44, 45-49, and ≥50 years, respectively. Comparing to women aged <40years, women aged 40-44, 45-49, and ≥50 years were at increased risk for gestational hypertension (aRR: 1.26, 1.55, and 1.61, respectively), gestational diabetes (aRR: 1.23, 1.40, and 1.31, respectively), eclampsia (aRR: 1.49, 1.51, and 2.37, respectively), unplanned hysterectomy (aRR: 2.55, 4.05, and 3.02, respectively), and ICU admission (aRR: 1.64, 2.06, and 2.04, respectively). The prevalence of preterm delivery was slightly higher in women aged 45 and older. (35%, 36.9%, and 40.2% in women aged <40 years, 45-49 years, and ≥50 years, respectively) CONCLUSIONS: Advanced age ART was significantly associated with higher rates of maternal morbidities. Except for preterm delivery, neonatal outcomes were similar between ART pregnancies in women aged ≥45 years and younger women. These data should be interpreted with caution because of potential confounding by potentially higher use of donor eggs by older women, the exact rates for which we were unable to ascertain from the available data.
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Affiliation(s)
- Amirhossein Moaddab
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY, United States
| | - Laurence B Mccullough
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY, United States
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Amir A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Amy Schutt
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Sara E Arian
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Karin A Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Gary A Dildy
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Alireza A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States.
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Abstract
PURPOSE OF REVIEW Utilization of cryopreserved instead of fresh donor oocytes has rapidly increased in recent years. Whether treatment outcomes are comparable has, however, remained controversial. RECENT FINDINGS More than 24% of initiated oocyte donation cycles in the USA during 2013-2014 involved previously cryopreserved oocytes. The use of cryopreserved-donated oocytes may simplify logistics and lower costs per treatment cycle. Whether cryopreserved donor oocytes also lower costs per live birth is still undetermined as they result in lower live birth rates in comparison to fresh donor oocyte cycles. National data regarding the safety of donated oocytes, including miscarriage rates and neonatal health outcomes, are lacking. SUMMARY Currently available data on cryopreserved-donated oocytes are incomplete and, therefore, still insufficient to claim equivalency between fresh and cryopreserved donor oocytes. Until sufficient data are available, patients should be advised about advantages and disadvantages of both methods of oocyte donation, and the use of cryopreserved oocytes should be considered only with caution and appropriate informed consent. Because banking of donated human oocytes facilities their commercial trade, it challenges basic ethical considerations, which have been the basis of oocyte donation since its inception.
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Affiliation(s)
- Vitaly A Kushnir
- aThe Center for Human Reproduction, New York, New York bWake Forest School of Medicine, Winston-Salem, North Carolina cFoundation for Reproductive Medicine dThe Rockefeller University, New York, New York, USA
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Paulson RJ. Perinatal complications of oocyte donation to women of advanced reproductive age. Fertil Steril 2016; 107:62-63. [PMID: 27865445 DOI: 10.1016/j.fertnstert.2016.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Richard J Paulson
- USC Fertility, Keck School of Medicine, University of Southern California, Los Angeles, California
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Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion. Fertil Steril 2016; 106:1319-1323. [DOI: 10.1016/j.fertnstert.2016.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/04/2016] [Indexed: 11/20/2022]
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García D, Vassena R, Prat A, Vernaeve V. Poor knowledge of age-related fertility decline and assisted reproduction among healthcare professionals. Reprod Biomed Online 2016; 34:32-37. [PMID: 28341417 DOI: 10.1016/j.rbmo.2016.09.013] [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] [Received: 04/11/2016] [Revised: 09/15/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Reproduction is a matter of concern for individuals and society due to the postponement of childbearing, and healthcare professionals are the main source of information and counselling. This study aims to evaluate how knowledgeable healthcare professionals are about fertility and assisted reproduction, and to explore attitudes towards social oocyte freezing. A cross-sectional study was performed with 201 professionals (gynaecologists, physicians and nurses) from four public centres in Spain. Participants completed a survey about fertility, IVF, oocyte donation (OD) and social oocyte freezing, between May 2013 and March 2014. Reported mean age limits for pregnancy were 39.5 ± 4.5 (spontaneously), 43.7 ± 5.2 (IVF) and 49.0 ± 6.5 (OD). Gynaecologists reported a younger limit for spontaneous and IVF pregnancies (P < 0.001); 36.1% reported a limit for a spontaneous pregnancy >39, compared with 77.3% of other physicians and 72.9% of nurses. Regarding social oocyte freezing, 41.8% of gynaecologists thought it should be offered to every young woman, versus 62.7% of other physicians and 48.9% of nurses (P = 0.041). In conclusion, gynaecologists are more knowledgeable about fertility and assisted reproduction, while more restrictive towards social oocyte freezing. Knowledge and attitudes could influence the quality of information and counselling given to patients.
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Affiliation(s)
| | | | - Andrés Prat
- Department of Public Health, School of Medicine, University of Barcelona, Spain
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Simó González M, Calaf Alsina J, Terribas Sala N, Luqui Scarcelli N, Plana Borrás J, Polo Ramos A. Pregnancy beyond 65: report of a unique case and discussion of a controversial issue. EUR J CONTRACEP REPR 2016; 21:496-498. [PMID: 27666894 DOI: 10.1080/13625187.2016.1234599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We present the case report of a 66-year-old woman who was attended at our gynaecology department at a tertiary university hospital in Barcelona, Spain for a high-risk pregnancy and comment on the obstetric implications and bioethical issues. We retrospectively analysed clinical data about the case and bibliographic references related to the issue. The woman underwent in vitro fertilisation of donated embryos in a private centre and came to our unit at 27 weeks of gestation for pregnancy care. At 33 weeks, she presented pre-eclampsia and a caesarean section was performed. She gave birth to healthy twin boys. Four months later, she returned to our centre with the diagnosis of ovarian cancer and died 30 months after delivery. We present the clinical course and management of this pregnancy and comment on the obstetric implications, the impact on maternal and neonatal health, and bioethical issues related to assisted reproduction techniques in pregnancies beyond the natural reproductive age.
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Affiliation(s)
- Marta Simó González
- a Department of Obstetrics and Gynecology , Hospital de la Santa Creu i Sant Pau, Universitat Autonoma , Barcelona , Spain
| | - Joaquim Calaf Alsina
- a Department of Obstetrics and Gynecology , Hospital de la Santa Creu i Sant Pau, Universitat Autonoma , Barcelona , Spain
| | - Núria Terribas Sala
- b Grifols Foundation of Bioethics, Universitat de Vic - Central de Catalunya , Barcelona , Spain
| | - Nerea Luqui Scarcelli
- a Department of Obstetrics and Gynecology , Hospital de la Santa Creu i Sant Pau, Universitat Autonoma , Barcelona , Spain
| | - Juliana Plana Borrás
- b Grifols Foundation of Bioethics, Universitat de Vic - Central de Catalunya , Barcelona , Spain
| | - Ana Polo Ramos
- a Department of Obstetrics and Gynecology , Hospital de la Santa Creu i Sant Pau, Universitat Autonoma , Barcelona , Spain
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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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Dayan N, Spitzer K, Laskin CA. A Focus on Maternal Health Before Assisted Reproduction: Results From a Pilot Survey of Canadian IVF Medical Directors. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:648-655. [PMID: 26366823 DOI: 10.1016/s1701-2163(15)30204-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe current physician practice patterns in Canada with regard to performing in vitro fertilization in high-risk patients. METHODS All medical directors of IVF clinics registered with the Canadian Fertility and Andrology Society (n=35) were invited to participate in an online survey between January and May 2014. We carried out descriptive analyses of participants' responses regarding implementation of local restrictive policies for access to IVF. Whether practice patterns differed in hospital versus community-based clinics was assessed using chi-square testing with significance set at alpha<0.05. RESULTS The response rate was 77.1%. More than one half of clinics (55.6%) were university-affiliated, and 29.6% were hospital-based. The majority of respondents (70.4%) used an upper age limit for permitting IVF (median 50 years, IQR 44 to 50), mostly because of lower pregnancy and live birth rates. Approximately one half of respondents limited treatment according to BMI (median upper permitted BMI 38 kg/m2, IQR 35 to 40 kg/m2) to minimize complications during pregnancy. Most respondents (77.8%) believed that routine pre-IVF medical assessment would be useful in their daily practice. There was a non-significant trend towards more restrictive policies in hospital-based clinics compared with community-based clinics. CONCLUSION Our findings confirm that Canadian reproductive medicine physicians are taking maternal health factors into consideration when assessing patients' suitability for IVF. Nevertheless, there is between-clinic variability in the parameters used to assess eligibility for treatment. In light of the changing maternal demographic, more research is needed on assisted reproductive technology and perinatal outcomes in women who are at risk for pregnancy complications.
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Affiliation(s)
- Natalie Dayan
- Department of Medicine, Division of General Internal Medicine, McGill University Health Centre, Montreal QC; LifeQuest Centre for Reproductive Medicine, University of Toronto, Toronto ON; Departments of Medicine and Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
| | - Karen Spitzer
- LifeQuest Centre for Reproductive Medicine, University of Toronto, Toronto ON
| | - Carl A Laskin
- LifeQuest Centre for Reproductive Medicine, University of Toronto, Toronto ON; Departments of Medicine and Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
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18
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Zweifel JE. Donor conception from the viewpoint of the child: positives, negatives, and promoting the welfare of the child. Fertil Steril 2015; 104:513-9. [DOI: 10.1016/j.fertnstert.2015.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/29/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
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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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20
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Abstract
Oocyte number and quality decrease with advancing age. Thus, fecundity decreases as age increases, with a more rapid decline after the mid-30s. Patients more than 35 years old should receive prompt evaluation for causes of infertility after no more than 6 months of attempted conception. Patients with abnormal tests of ovarian reserve have a poorer prognosis and may need more expedited and aggressive treatment. Although oocyte donation is the best method to overcome age-related infertility, other treatment options may help women proceed quicker toward pregnancy. Patients at an advanced age should be counseled and evaluated before undergoing infertility treatments.
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Affiliation(s)
- Natalie M Crawford
- Reproductive Endocrinology and Infertility, University of North Carolina, 4001 Old Clinic Building, CB 7570, Chapel Hill, NC 27599, USA.
| | - Anne Z Steiner
- Reproductive Endocrinology and Infertility, University of North Carolina, 4001 Old Clinic Building, CB 7570, Chapel Hill, NC 27599, USA
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Yeh JS, Goldfarb JM, Muasher SJ. Using Society for Assisted Reproductive Technology data to track pregnancy outcomes in older recipients: is it justifiable? Fertil Steril 2014; 101:e43. [PMID: 24803418 DOI: 10.1016/j.fertnstert.2014.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Jason S Yeh
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | | | - Suheil J Muasher
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
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22
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Yeh JS, Steward RG, Dude AM, Shah AA, Goldfarb JM, Muasher SJ. Pregnancy outcomes decline in recipients over age 44: an analysis of 27,959 fresh donor oocyte in vitro fertilization cycles from the Society for Assisted Reproductive Technology. Fertil Steril 2014; 101:1331-6. [PMID: 24626061 DOI: 10.1016/j.fertnstert.2014.01.056] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/22/2014] [Accepted: 01/28/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To use a large and recent national registry to provide an updated report on the effect of recipient age on the outcome of donor oocyte in vitro fertilization (IVF) cycles. DESIGN Retrospective cohort study. SETTING United States national registry for assisted reproductive technology. PATIENT(S) Recipients of donor oocyte treatment cycles between 2008 and 2010, with cycles segregated into five age cohorts: ≤34, 35 to 39, 40 to 44, 45 to 49, and ≥50 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Implantation, clinical pregnancy, live-birth, and miscarriage rates. RESULT(S) In donor oocyte IVF cycles, all age cohorts ≤39 years had similar rates of implantation, clinical pregnancy, and live birth when compared with the 40- to 44-year-old reference group. Patients in the two oldest age groups (45 to 49, ≥50 years) experienced statistically significantly lower rates of implantation, clinical pregnancy, and live birth compared with the reference group. Additionally, all outcomes in the ≥50-year-old group were statistically significantly worse than the 45- to 49-year-old group, demonstrating progressive decline with advancing age. CONCLUSION(S) Recent national registry data suggest that donor oocyte recipients have stable rates of pregnancy outcomes before age 45, after which there is a small but steady and significant decline.
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Affiliation(s)
- Jason S Yeh
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | - Ryan G Steward
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | - Annie M Dude
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | - Anish A Shah
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina
| | | | - Suheil J Muasher
- Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, North Carolina.
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Kawwass JF, Monsour M, Crawford S, Kissin DM, Session DR, Kulkarni AD, Jamieson DJ. Trends and outcomes for donor oocyte cycles in the United States, 2000-2010. JAMA 2013; 310:2426-34. [PMID: 24135860 PMCID: PMC4307377 DOI: 10.1001/jama.2013.280924] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The prevalence of oocyte donation for in vitro fertilization (IVF) has increased in the United States, but little information is available regarding maternal or infant outcomes to improve counseling and clinical decision making. OBJECTIVES To quantify trends in donor oocyte cycles in the United States and to determine predictors of a good perinatal outcome among IVF cycles using fresh (noncryopreserved) embryos derived from donor oocytes. DESIGN, SETTING, AND PARTICIPANTS Analysis of data from the Centers for Disease Control and Prevention's National ART Surveillance System, to which fertility centers are mandated to report and which includes data on more than 95% of all IVF cycles performed in the United States. Data from 2000 to 2010 described trends. Data from 2010 determined predictors. MAIN OUTCOMES AND MEASURES Good perinatal outcome, defined as a singleton live-born infant delivered at 37 weeks or later and weighing 2500 g or more. RESULTS From 2000 to 2010, data from 443 clinics (93% of all US fertility centers) were included. The annual number of donor oocyte cycles significantly increased, from 10,801 to 18,306. Among all donor oocyte cycles, an increasing trend was observed from 2000 to 2010 in the proportion of cycles using frozen (vs fresh) embryos (26.7% [95% CI, 25.8%-27.5%] to 40.3% [95% CI, 39.6%-41.1%]) and elective single-embryo transfers (vs transfer of multiple embryos) (0.8% [95% CI, 0.7%-1.0%] to 14.5% [95% CI, 14.0%-15.1%]). Good perinatal outcomes increased from 18.5% (95% CI, 17.7%-19.3%) to 24.4% (95% CI, 23.8%-25.1%) (P < .001 for all listed trends). Mean donor and recipient ages remained stable at 28 (SD, 2.8) years and 41 (SD, 5.3) years, respectively. In 2010, 396 clinics contributed data. For donor oocyte cycles using fresh embryos (n = 9865), 27.5% (95% CI, 26.6%-28.4%) resulted in good perinatal outcome. Transfer of an embryo at day 5 (adjusted odds ratio [OR], 1.17 [95% CI, 1.04-1.32]) and elective single-embryo transfers (adjusted OR, 2.32 [95% CI, 1.92-2.80]) were positively associated with good perinatal outcome; tubal (adjusted OR, 0.72 [95% CI, 0.60-0.86]) or uterine (adjusted OR, 0.74 [95% CI, 0.58-0.94]) factor infertility and non-Hispanic black recipient race/ethnicity (adjusted OR, 0.48 [95% CI, 0.35-0.67]) were associated with decreased odds of good outcome. Recipient age was not associated with likelihood of good perinatal outcome. CONCLUSIONS AND RELEVANCE In the United States from 2000 to 2010, there was an increase in number of donor oocyte cycles, accompanied by an increase in good outcomes. Further studies are needed to understand the mechanisms underlying the factors associated with less successful outcomes.
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Affiliation(s)
- Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia2Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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