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Fitzgerald O, Newman J, Rombauts L, Polyakov A, Chambers GM. Development of an IVF prediction model for donor oocytes: a retrospective analysis of 10 877 embryo transfers. Hum Reprod 2024:deae174. [PMID: 39173599 DOI: 10.1093/humrep/deae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/26/2024] [Indexed: 08/24/2024] Open
Abstract
STUDY QUESTION Can we develop a prediction model for the chance of a live birth following the transfer of an embryo created using donated oocytes? SUMMARY ANSWER Three primary models that included patient, past treatment, and cycle characteristics were developed using Australian data to predict the chance of a live birth following the transfer of an embryo created using donated oocytes; these models were well-calibrated to the population studied, achieved reasonable predictive power and generalizability when tested on New Zealand data. WHAT IS KNOWN ALREADY Nearly 9% of ART embryo transfer cycles performed globally use embryos created using donated oocytes. This percentage rises to one-quarter and one-half in same-sex couples and women aged over 45 years, respectively. STUDY DESIGN, SIZE, DURATION This study uses population-based Australian clinical registry data comprising 9384 embryo transfer cycles that occurred between 2015 and 2021 for model development, with an external validation cohort of 1493 New Zealand embryo transfer cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS Three prediction models were compared that incorporated patient characteristics, but differed in whether they considered use of prior autologous treatment factors and current treatment parameters. We internally validated the models on Australian data using grouped cross-validation and reported several measures of model discrimination and calibration. Variable importance was measured through calculating the change in predictive performance that resulted from variable permutation. The best-performing model was externally validated on data from New Zealand. MAIN RESULTS AND THE ROLE OF CHANCE The best-performing model had an internal validation AUC-ROC of 0.60 and Brier score of 0.20, and external validation AUC-ROC of 0.61 and Brier score of 0.23. While these results indicate ∼15% less discriminatory ability compared to models assessed on an autologous cohort from the same population the performance of the models was clearly statistically significantly better than random, demonstrated generalizability, and was well-calibrated to the population studied. The most important variables for predicting the chance of a live birth were the oocyte donor age, the number of prior oocyte recipient embryo transfer cycles, whether the transferred embryo was cleavage or blastocyst stage and oocyte recipient age. Of lesser importance were the oocyte-recipient parity, whether donor or partner sperm was used, the number of prior autologous embryo transfer cycles and the number of embryos transferred. LIMITATIONS, REASONS FOR CAUTION The models had relatively weak discrimination suggesting further features need to be added to improve their predictive power. Variation in donor oocyte cohorts across countries due to differences such as whether anonymous and compensated donation are allowed may necessitate the models be recalibrated prior to application in non-Australian cohorts. WIDER IMPLICATIONS OF THE FINDINGS These results confirm the well-established importance of oocyte age and ART treatment history as the key prognostic factors in predicting treatment outcomes. One of the developed models has been incorporated into a consumer-facing website (YourIVFSuccess.com.au/Estimator) to allow patients to obtain personalized estimates of their chance of success using donor oocytes. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Australian government as part of the Medical Research Future Fund (MRFF) Emerging Priorities and Consumer Driven Research initiative: EPCD000007. L.R. declares personal consulting fees from Abbott and Merck, lecture fees from Abbott, receipt of an educational grant from Merck, past presidency of the Fertility Society of Australia & New Zealand and World Endometriosis Society and being a minor shareholder in Monash IVF Group (ASX:MVF). G.M.C. declares receipt of Australian government grant funding for the research study and the development and maintenance of the YourIVFSuccess website. O.F., J.N., and A.P. report no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Oisin Fitzgerald
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Jade Newman
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Alex Polyakov
- Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and Clinical School, UNSW Sydney, Sydney, NSW, Australia
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Li Piani L, Tshilembi A, De Vos M, Buyse E, Ruttens S, Somigliana E, Tournaye H, Blockeel C. Oocyte donors' experience and expectations in a non-profit fertility care setting. J Assist Reprod Genet 2024:10.1007/s10815-024-03203-9. [PMID: 39042340 DOI: 10.1007/s10815-024-03203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE In this survey, we aimed to provide the description of previous oocyte donors' profile in a Belgian tertiary fertility hospital clinic. The research question is as follows: could certain aspects be changed or improved, according to previous oocyte donors? The final purpose is to boost adherence to future oocyte donation (OD) programs, given the large gap between supply and demand. METHODS We set up an observational cross-sectional study of oocyte donors who were recruited in a tertiary referral hospital. Participants were asked to join an anonymous online survey with questions about demographic and reproductive variables, reasons to start or discontinue OD, satisfaction rate, experience, and attitude towards presumed anonymity. RESULTS A total of 218 women were eligible to join the study, with a response rate of 49% (108/218). The emerging profile of the oocyte donor is a well-educated (102/108 with at least a high school degree), employed (86/108) woman in her thirties. Altruism and solidarity were the main drivers of their choice (105/108), and a general permissive attitude towards disclosure of their personal information to the recipient (60/108) was registered. In case of negative experience or discontinuation, concerns regarding pain management and specific long-lasting psychological support were expressed (8/20). CONCLUSIONS Our findings suggest the need to improve pain relief and to offer psychological support even beyond ending the donation process. These interventions could improve both participation and adherence to OD programs, ensuring an autonomous and free choice while avoiding any risk of exploitation.
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Affiliation(s)
- Letizia Li Piani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Brussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Agathe Tshilembi
- Department Pharmaceutical and Pharmacological Sciences (FARM), Vrije Universiteit Brussel, Brussels, Belgium
| | - Michel De Vos
- Brussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Evelyne Buyse
- Brussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Sarah Ruttens
- Brussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Herman Tournaye
- Brussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Reproduction, Genetics and Regenerative Medicine, Biology of the Testis (BITE) Laboratory, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Christophe Blockeel
- Brussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium.
- Department of Obstetrics and Gynaecology, University of Zagreb School of Medicine, Zagreb, Croatia.
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Cornthwaite K, Goedeke S, Shepherd D, Rodino I. Student views on recognition and payment options for gamete donation in New Zealand. Aust N Z J Obstet Gynaecol 2023; 63:753-759. [PMID: 37221091 DOI: 10.1111/ajo.13702] [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: 09/07/2022] [Accepted: 05/01/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Demand for donor gametes in New Zealand significantly outweighs the number of willing donors. Payment for donation has been suggested as a viable solution to increase the supply and attract more donors in acknowledging the time, effort and inconvenience associated with donation. AIMS Internationally, university students are a commonly targeted group for paid gamete donation. This study aims to explore the views of university students in New Zealand to gauge their support and concerns relating to a range of options to recognise donors, including payment. METHODS Two hundred and three tertiary students completed a questionnaire exploring their views on various forms of recognition for donation and concerns relating to payment. RESULTS Participants indicated the greatest support for reimbursement for expenses directly related to the donation process. Payment constituting explicit financial advantage was regarded least favourably. Participants held concerns that payment would attract people donating for the 'wrong' reasons and lead to donors concealing relevant histories. Further concerns included payment increasing costs for recipients and causing disparities in access to gametes. CONCLUSIONS The findings of this study suggest that within a New Zealand context a culture of gift-giving and altruism are strongly held principles towards reproductive donation, including among the student population. This highlights the need to consider alternative strategies to commercial models to overcome donor shortages which are in line with the cultural and legislative context of New Zealand.
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Affiliation(s)
- Kelsey Cornthwaite
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Sonja Goedeke
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Daniel Shepherd
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Iolanda Rodino
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Goedeke S, Gamble H, Thurlow R. We want to feel valued: eggs donors' experiences of donation. HUM FERTIL 2023; 26:326-336. [PMID: 36625440 DOI: 10.1080/14647273.2022.2164226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/18/2022] [Indexed: 01/11/2023]
Abstract
Egg donation in New Zealand is identity-release, with donor-conceived individuals having the right to access donors' identifying information at the age of 18. It also allows donors and previously unknown recipients to meet prior to donation. Further, donation is altruistic, although reimbursement of costs is possible. In our previous paper we explored the motivations of 21 egg donors in this context and reported that they are motivated to donate as an act of personal gift-giving to recipients who may become known to them through donation, and that they do not want to be compensated for this financially. In this paper, drawing on in-depth interviews, we report on donors' experiences of the donation process and subsequent to donation. Donors understood their donations to be a significant act, both for the recipients and their families, but also for themselves, particularly given the multiple sacrifices which they willingly made. Donors wished for their gift and their role to be valued and acknowledged through being appreciated, informed, involved and supported by recipients and clinics before, during and after their donations. These findings have implications for clinical practice and care, offering insight into how best to support donors prior and subsequent to donation.
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Affiliation(s)
- Sonja Goedeke
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Heather Gamble
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Rebecca Thurlow
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Pennings G. When elective egg freezers become egg donors: practical and ethical issues. Reprod Biomed Online 2023; 47:151-156. [PMID: 37198006 DOI: 10.1016/j.rbmo.2023.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 04/04/2023]
Abstract
Many people hope that the unused and unwanted eggs frozen by women for self-use could be applied to reduce the shortage of donor eggs. However, several practical (additional screening and counselling) and ethical (informed consent and reimbursement) issues may dampen this hope. This paper also considers the question of whether elective egg freezers who want to donate their eggs should be reimbursed for the costs they have met for the IVF cycle and storage. It is argued that a partial reimbursement for the collection (hormonal stimulation and retrieval) is morally acceptable because it is limited to proven expenses (and does not violate the altruism rule) and because the recipients should contribute to the costs of a scheme from which they are benefiting. The storage fee should be paid by the egg freezer herself and no reward for effort, time and inconvenience should be given. This compromise benefits both donors and recipients.
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Affiliation(s)
- Guido Pennings
- Universiteit Gent, Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Science, Gent, Belgium.
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Rowlinson E, Da Silva SM, Olisa NP, Campo-Engelstein L. Should patients pay for sperm given for free? Results from a pilot study on fertility clinics' views on the charging for altruistically donated sperm. J Assist Reprod Genet 2023; 40:1063-1070. [PMID: 36943574 PMCID: PMC10239429 DOI: 10.1007/s10815-023-02776-1] [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: 10/04/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE Many countries prohibit payment for gamete donation, which means fertility clinics do not have to compensate donors. However, acquiring and utilizing donor sperm can still be expensive for fertility clinics. This study evaluates international fertility workers' views on charging patients for altruistically donated sperm. METHODS Using social media and email, we disseminated a SurveyMonkey survey with a question that was specifically focused on opinions about charging patients for altruistically donated sperm. Clinicians were able to select multiple pre-populated answer choices as well as write answers that reflected their views as an open-ended response. Snowball sampling was utilized to reach international fertility clinicians. RESULTS Of 112 respondents from 14 countries, 88% believe it is acceptable to charge for altruistically donated sperm based on one or more of four different assenting categories: so patients appreciate that sperm is valuable, because it generates funds for the running of the clinic, to cover specific costs associated with sperm, and to make a profit for the clinic. CONCLUSIONS The consensus that charging for altruistically donated sperm is acceptable was not surprising since recruiting and processing donor sperm can be expensive for clinics. However, there were geographical differences for specific assenting answer choices which may be based on countries' income, and healthcare system, as well as religious and cultural beliefs.
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Affiliation(s)
- Emma Rowlinson
- The University of Texas Medical Branch John Sealy School of Medicine, 301 University Boulevard, Galveston, TX, 77550, USA.
| | | | | | - Lisa Campo-Engelstein
- The University of Texas Medical Branch Institute for Bioethics & Health Humanities, 301 University Boulevard, Galveston, TX, 77550, USA
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Pennings G. Balancing rules in postmortem sperm donation. JOURNAL OF MEDICAL ETHICS 2022; 48:270-271. [PMID: 33762298 DOI: 10.1136/medethics-2020-107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
Postmortem sperm donation implies the acceptance of a very low sperm quality threshold. This threshold has two important consequences: recipients will have to submit to burdensome and expensive in vitro fertilisation/intracytoplasmic sperm injection, and many more living donors will be accepted, thus making postmortem donors largely superfluous. Given these strong arguments against the use of postmortem collected sperm, a good alternative to enlarge the donor pool would be men who stored sperm for self-use and no longer have the intention to use it.
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Goedeke S, Shepherd D, Rodino IS. Fertility stakeholders' concerns regarding payment for egg and sperm donation in New Zealand and Australia. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:8-19. [PMID: 34703916 PMCID: PMC8523861 DOI: 10.1016/j.rbms.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/30/2021] [Accepted: 07/29/2021] [Indexed: 05/31/2023]
Abstract
New Zealand and Australia are countries which currently prohibit donor payment and require open-identity forms of donation. This study explored the concerns of fertility stakeholders regarding payment which would constitute financial reward for gamete donation, and factors predicting such concerns. A total of 434 participants from across New Zealand and Australia completed an online survey anonymously. Participants included those with infertility and treatment experience, donors, recipients, donor-conceived people and clinic professionals. Results indicated that participants' concerns related to their assumptions about the type of donor motivated by financial reward, and the possibility that, if paid, donors might conceal information relevant to treatment and the donor-conceived person. Furthermore, participants were concerned about increasing recipient costs. Participants with personal experience of infertility held stronger concerns overall. Professionals expressed concerns of clinical relevance, such as the withholding of donor information relevant to treatment outcomes. The lowest levels of concern were expressed in relation to payment devaluing the meaning of human life. Qualitatively, themes highlighted concerns regarding payment enticing the 'wrong' type of donor, increased cost to recipients, and concern about the wellbeing of donor-offspring. Collectively, such concerns must be understood against the New Zealand and Australia open-identity donation context which enables the possibility of contact between donors and offspring. These findings indicate that donor recruitment campaigns need to account for different stakeholder concerns, and consider ways to address donor shortages effectively while remaining compliant with legislative requirements.
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Affiliation(s)
- Sonja Goedeke
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Daniel Shepherd
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Iolanda S. Rodino
- Medical School, The University of Western Australia, Perth, WA, Australia
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Cross-border reproductive care: an Ethics Committee opinion. Fertil Steril 2022; 117:954-962. [PMID: 35216836 DOI: 10.1016/j.fertnstert.2022.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
Cross-border reproductive care is a growing worldwide phenomenon, raising questions about why assisted reproductive technology patients travel for care, what harms and benefits may result, and what duties health care providers may have in advising and treating the patients who travel for reproductive services. Cross-border care may benefit or harm assisted reproductive technology stakeholders, including patients, offspring, providers, gamete donors, gestational carriers, and local populations in destination countries. This document replaces the previous document of the same name, last published in 2016.
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Goedeke S, Gamble H, Thurlow R. Motivations for egg donation to previously unknown recipients: donation as a personal, relational act of giving. HUM FERTIL 2021:1-11. [PMID: 34794344 DOI: 10.1080/14647273.2021.2005263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Egg donation has becoming increasingly common however there is a shortage of donors in many countries, including New Zealand. Research regarding motivations to donate in the context of New Zealand's open-identity and altruistic donation policy and practice is, thus far, limited. This in-depth qualitative study comprised interviews with 21 women to examine their motivations in donating to recipients previously unknown to them. Donors valued parenthood highly and had become aware of the fertility struggles of other women through their own experiences, those of friends or family, or through online personal accounts or advertising. The ability to select recipients and build a comprehensive picture of them, such as through reading recipient profiles or meeting them in person, as is possible in New Zealand, deepened their identification with recipients and thus their empathy and desire to help. They resisted commercial models, positioning themselves as by nature altruistic and regarding their donations as expressions of solidarity and acts of personal gift-giving to specific others who became known to them through donation. Donation was interpreted as a socially relational process, setting up expectations around relationships and ongoing connection. Such understandings have implications for recruitment as well as ongoing experiences and support needs.
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Affiliation(s)
- Sonja Goedeke
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Heather Gamble
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Rebecca Thurlow
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Polyakov A, Rozen G. Social egg freezing and donation: waste not, want not. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106607. [PMID: 33402431 DOI: 10.1136/medethics-2020-106607] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 05/03/2023]
Abstract
The trend towards postponement of childbearing has seen increasing numbers of women turning towards oocyte banking for anticipated gamete exhaustion (AGE banking), which offers a realistic chance of achieving genetically connected offspring. However, there are concerns around the use of this technology, including social/ethical implications, low rate of utilisation and its cost-effectiveness. The same societal trends have also resulted in an increased demand and unmet need for donor oocytes, with many women choosing to travel overseas for treatment. This has its own inherent social, medical, financial and psychological sequelae. We propose a possible pathway to address these dual realities. The donation of oocytes originally stored in the context of AGE banking, with appropriate compensatory mechanisms, would ameliorate AGE banking concerns, while simultaneously improving the supply of donor oocytes. This proposed arrangement will result in tangible benefits for prospective donors, recipients and society at large.
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Affiliation(s)
- Alex Polyakov
- Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Genia Rozen
- Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne IVF, East Melbourne, Victoria, Australia
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