Ethics and Society: A survey of parental attitudes toward oocyte donation

A questionnaire was sent to couples who had successfully completedoocyte donation cycles to survey their experiences and makesuggestions to others considering this option. A majority ofcouples were successful in their first cycle, despite advancedmaternal age or length of time attempting conception. A preferencefor non-anonymous arrangements was highlighted, despite theunknown long-term impact, and the importance of finding supportwas stressed. Respondents indicated no confusion about theirrole as parents of children conceived through oocyte donation.     

Semen donor recruitment in an oocyte donation programme

The article presents a new system for the recruitment of gamete donors. The system is a partial application of the mirror exchange system: the male partner of a couple donates sperm, and in return, he receives the guarantee that his partner benefits from a greatly reduced waiting time for donor oocytes. More specifically, the woman will obtain donor oocytes within a period of 8 months. The procedure was very successful in recruiting sperm donors while avoiding the ethical objections raised against other incentives to attract donors. The data indicate that the system would also work to encourage IVF patients to share their oocytes.     

Elective single embryo transfer yields good delivery rates in oocyte donation

BACKGROUND: High pregnancy rates have been noted after oocyte donation (OD). Multiple pregnancies should be avoided, because oocyte recipients have an increased risk of obstetric complications. METHODS: We analysed our OD results from 2000-2001 when elective single embryo transfer (eSET) was introduced as a recommended policy for all recipients if at least one good quality embryo was available. The results were compared with those achieved in 1998-1999, when usually two embryos were transferred (double embryo transfer, DET). Between 1998 and 2001, 100 healthy women donated oocytes and 135 fresh embryo transfers were carried out. The mean age of the donors was 31 years and that of the recipient women was 35 years. RESULTS: The proportion of eSET of all OD transfers was 17.1% in 1998-1999 and 61.0% in 2000-2001. There was no statistically significant difference in clinical pregnancy (36.8 versus 45.8%) and delivery rates (31.6 versus 33.9%) per embryo transfer between the two time periods. The proportion of twins declined from 29% (1998-1999) to 10% (2000-2001). The delivery rate was similar after eSET and DET (32.6 versus 32.1% respectively). CONCLUSIONS: By increasing the proportion of eSETs it is possible to reduce the number of twins without affecting delivery rates in oocyte recipients.     

Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles.

BACKGROUND: The study aim was to determine whether supraphysiological estradiol (E(2)) levels reduce oocyte/embryo quality in oocyte donation cycles. METHODS: A retrospective analysis of 330 consecutive fresh oocyte donation cycles was performed in an assisted reproductive treatment programme between January 1996 and December 2000. Throughout the study period, oocyte donors and recipients followed a standard synchronization regimen that did not vary. A serum E(2) level (peak E(2)) was obtained from all oocyte donors on the morning of HCG administration. Peak E(2) values were grouped by 33rd percentile (group I, <1500 pg/ml; group II, 1500-3000 pg/ml; and group III, >3000 pg/ml). All embryo transfers were performed on day 3 after oocyte recovery. RESULTS: Comparisons between groups revealed no significant differences in the quality of oocytes retrieved, and in fertilization rates. Higher peak E(2) levels were directly correlated with a greater number of oocytes retrieved, embryos available for transfer and cryopreservation, and higher average embryo quality scores (P < 0.005). Compared with group I, group III had significantly higher embryo implantation rates (P < 0.05). CONCLUSIONS: Sustained supraphysiological E(2) levels do not adversely affect the quality of developing oocytes and embryos. On the contrary, elevated E(2) levels are associated with a larger number of oocytes and embryos and high-grade embryos for transfer/cryopreservation and, consequently, improved implantation rates.     

A program of oocyte donation and gamete intra-Fallopian transfer

The outcome of a series of 19 patients with premature ovarianfailure (POF) undergoing gamete intra-Fallopian transfer (GIFT),utilizing donated oocytes, is described. The steroid replacementprotocol consisted of the administration of increasing dosagesof 17-oestradiol (E2) and progesterone (P4). Hormonal replacementwas maintained until day 100 of gestation. All patients underwentan evaluation cycle in which serum levels of E2 and P4 weremonitored and an endometrial biopsy was performed either 7 or11 days after initiation of progesterone administration. Allcases of GIFT were performed between days 12 and 15 of the inducedmenstrual cycle. Of the 19 patients treated, 11 became pregnant,giving a clinical pregnancy rate of 58% (visualization of gestationalsac by ultrasound). Two patients aborted between the 4th and5th weeks of gestation. No ectopic pregnancies occurred. Threeof the seven deliveries involved multiple births. Details ofthe circulating hormone levels and endometrial response arediscussed     

Implantation: Uterine receptivity in an oocyte donation programme

Oocyte donation is a useful model for the assessment of potentialfactors affecting implantation since embryos generated are fromyounger oocytes than in in-vitro fertilization programmes andare therefore expected to have higher and more consistent implantationrates. Transvaginal sonographic measurement of endometrial thickness,echogenic pattern and uterine artery impedance, measured aspulsatility index (PI) and resistance index (RI), were retrospectivelycompared in 99 recipient women following 117 fresh embryo transfersthat resulted in 51 conception cycles and 66 non-conceptioncycles. The prevalence of a multilayered echogenic pattern wassignificantly greater (91.2%) in conception than in non-conception(44.4%) cycles. No differences in endometrial thickness, PIor RI were observed between conception and non-conception cycles.However, no pregnancy occurred when the PI was 3.4 (sensitivity100%). The number of days or cumulative dose of oestrogen intakeand the serum oestradiol concentration prior to progesteroneadministration were not different in the multilayered patternversus other echogenic pattern groups. The data show that itmay be beneficial to await achievement of a PI < 3.4 anda multilayered pattern endometrium prior to embryo transferin an oocyte donation programme.     

The evolution and outcome of pregnancies from oocyte donation

A total of 199 patients participated in the oocyte donationprogramme in 336 replacement cycles in whom 69 clinical pregnancieswere achieved, of which 53 reached term and delivery. Data concerningthe evolution and outcome of pregnancies were retrieved in 52cases, which involved 39 women with ovarian failure and 18 withfunctional ovaries. The most frequent complications of pregnancywere uterine bleeding in the first trimester in 18 cases (34.6%),hypertension in 17 (32.7%) and intra-uterine growth retradation(IUGR: 11.5%). These complications were more prominent in twinpregnancies. The Caesarean section rate was 63.5% and a highpercentage of elective sections (54.5%) was observed. Of singletonpregnancies, 54.6% had a birth weight of >3000 g at fullterm (>37 weeks), while 62.5% of twins weighed between 2000and 3000 g. One intra-uterine death occurred, so that the perinatalmortiality was 1.7% and one newborn was operated on for stenosisof the pulmonary artery, while the incidence of premature labourwas low (1.9%). A comparison of complications between pregnanciesassociated with ovarian failure and with functional ovariesrevealed a higher frequency of bleeding in the first trimester(38.2% and 27.8% respectively) and of hypertension (38.2% and22.2% respectively) in those with ovarian failure, althoughthe differences were not statistically significant. In conclusion,women who become pregnant after oocyte donation and especiallythose with ovarian failure should be considered as high-riskobstetric patients.     

Public opinion regarding oocyte donation in Sweden

BACKGROUND: Oocyte donation has been permitted by Swedish legislation since January 2003. According to the law, offspring have the right to receive identifying information about the donor when they reach a mature age. The aim of the present study was to investigate public opinion regarding different aspects of oocyte donation. METHODS: A study-specific questionnaire regarding attitudes towards aspects of oocyte donation was sent to a randomized sample of 1000 women (73% response) and 1000 men (56% response). RESULTS: A majority of respondents supported treatment with oocyte donation. Seventeen per cent of the women considered donating in the future, whereas 56% of the men would support their partner. While nearly half of the respondents considered that offspring should receive identifying information of the donor, one-third were opposed to this. Overall, women were more positive towards disclosure to the offspring than were men (P < 0.001). CONCLUSIONS: The present results indicate strong support for the use of oocyte donation among a subset of the Swedish population. There was considerable interest among women in donating oocytes anonymously. While a majority advocated openness regarding the donation between parents and child, there was less support for the offspring to have a legal right to receive identifying information about their donor.     

Psychology: Psychological aspects in anonymous and non-anonymous oocyte donation

A study, in which 110 patients were screened by a psychoanalyst,included 69 recipients who chose non-anonymous oocyte donation,i.e. they received oocytes from a known donor, most frequentlya sister or a close relative. Another 41 recipients receivedanonymous oocytes, but had to bring a donor. Psychological motivationsfor either choice are reported, and significant topics suchas attitudes towards confidentiality and links to the childare compared. No specific psychopathology is reported at thisstage. An additional study on children born by these techniquesis ongoing.     

Follow-up study of Finnish volunteer oocyte donors concerning their attitudes to oocyte donation

A questionnaire was sent to the first 30 Finnish volunteer oocytedonors at 12–18 months after donation to determine theirexperiences concerning treatment and attitudes to donation.All donations were carried out anonymously and without payment.The donors were recruited by advertising in newspapers. Mostdonors were very satisfied with the experience. The side-effectsof the treatment had been slight and tolerable. In all, 85%of the respondents reported no gynaecological problems afterwards.The problems reported by the other 15% were minor and unrelatedto the donation. A total of 67% of the respondents would haveliked to have known if pregnancy had been achieved in the recipient,and 89% reported that they had thought about the possibilityof a child from their donation. Some 42% of the respondentspreferred to receive no information concerning either the childor the recipient couple. Of the respondents, 59% thought theoffspring should be told about its origin and 33% thought thechild should be given identifying information about the donor.About half of the others would agree to the release of non-identifyinginformation. In all, 96% of the respondents reported that theirown feelings were sufficiently taken into consideration duringthe treatment and 78% would donate again. No-one regretted theirdonation.     

Immunology: Repeat trials of oocyte donation to women with previous donor oocyte success

Oocyte donation has proven to be highly successful in establishingpregnancy in functionally agonadal women. Both implantationand ongoing pregnancy rates in women using this method havesurpassed those normally seen in standard in-vitro fertilization(IVF) patients. Over a 5 year period, seven women who had previouslyconceived using oocyte donation elected to attempt pregnancyand deliver a second child using the same donor. In each casethe paramount consideration was to provide a sibling of thesame genetic make-up as the child or children previously borne.Of the seven women studied, whose ages ranged from 24 to 44years, five became pregnant on subsequent cycles. The time toconception varied from one to a maximum of three attempts withthree of the five women becoming pregnant on the first cycleand two requiring three cycles to establish the subsequent pregnancy.The overall rate of success in this group was 12 pregnanciesin 20 cycles of embryo transfer (60%). An exaggerated implantationrate (25.6%) was also noted (23 individual embryo implantationsfrom 90 embryos transferred). Of the 12 pregnancies establishedin these seven women, four (33%) were multiple gestations (threetriplets, one twin). We conclude that women who have previouslyexperienced pregnancy following oocyte donation are highly likelyto conceive in a subsequent trial at a rate that may be higherthan that normally seen in the general population of women undergoingoocyte donation.     

Anonymous and non-anonymous oocyte donation preliminary results

During the past year, we have developed an oocyte donation programmein 10 patients with complete absence of endogenous ovarian function(premature ovarian failure in seven cases, castration in twocases and Turner's syndrome in one case). In cases of anonymousdonation, donors were volunteers devoid of any major geneticalrisk who were included in our IVF programme and who consentedto donate one oocyte when at least seven oocytes were recovered,and two oocytes when at least 11 oocytes were recovered, toa recipient couple. As far as possible, morphological characteristicsof both couples were paired. In cases of non-anonymous donation,donors were ‘affective’ donors, having at leastone child. The resulting embryos after IVF of donated oocyteswere either replaced directly in recipient women which requiredsynchronization of the donor's and recipient's cycles, or cryopreservedand then thawed, usually at day 16 of recipient's artificialcycle, i.e. 2 days after introduction of the progestatlonalcompound. On the 10 patients entering this oocyte donation programme(20 cycles), 13 transfers were carried out resulting in fourclinical pregnancies in three patients with premature ovarianfailure and one with Turners syndrome (20% pregnancy per cycleand 31% per transfer). Despite the small numbers, these goodresults prompted us to develop this protocol.     

Turner's syndrome and pregnancies after oocyte donation

A total of 20 clinical pregnancies was achieved among 18 women with Turner's syndrome who were treated in an oocyte donation programme. The oocytes were donated by voluntary unpaid donors. A mean of 1.8 embryos per transfer was given to each recipient by way of 28 fresh and 25 frozen embryo transfers. With fresh and frozen embryos, 13 and seven pregnancies respectively were achieved. The clinical pregnancy rate per fresh embryo transfer was 46%, and the implantation rate 30%, being similar to the corresponding rates among our oocyte recipients with primary ovarian failure in general. The corresponding rates with frozen embryos were 28 and 19%. Of these pregnancies, 40% ended in miscarriage. This high rate may be explained by uterine factors. Six women were hypertensive during pregnancy, a rate comparable with that in other oocyte donation pregnancies. All these women delivered by Caesarean section. Pregnancy and implantation rates after oocyte donation were high in women with Turner's syndrome, but the risk of cardiovascular and other complications is high. Careful assessment before and during follow-up of pregnancy are important. Transfer of only one embryo at a time to avoid the additional complications caused by twin pregnancy is recommended.     

Psychological considerations of anonymous oocyte donation

This study involved 50 patients interviewed in conversationswith a psychologist. It was found that it was possible to characterizethe kind of couples using assisted reproductive techniques interms of diagnostic and psychological profile. Other observationsincluded the repercussions of this action on the couples' stabilityin case of failure or success, the desire for children and theplans concerning them, the secrecy theme and questions arisingfrom the practice of anonymous or non-anonymous oocyte donation.The relationship between recipients and donors, as well as thespecific relationship between couples and their consultants,were also examined. It is concluded that the problems encountereddiffer according to the infertility diagnosis. Donor anonymityallows oocyte recipients to impose their own identity patternsonto the future child and to introduce him/her in an unbiasedway to their own lives. Artificial techniques to assist in theconception of a child do not appear to interfere with the couple'srelationship and their desire for a child, which remains constantfor each member of the couple.     

A qualitative follow-up study of women's experiences with oocyte donation

Oocyte donation is growing at an exponential rate. Currently, thousands of women donate each year. The health services that donors receive deserve evaluation. Thirty-three former donors were recruited from IVF clinics, a matching agency, the Internet, advertisements, and word of mouth. In-depth interviews were conducted to learn what motivated the donation, to determine how satisfied donors were with the experience and what issues played a role in donor satisfaction, and to identify recommendations to improve the process. None of the participants regretted their decision to donate, but they were not always completely satisfied with the donation experience. The physical process, compensation, quality of medical care, and level of involvement in the process were the primary factors that affected satisfaction. Matching agencies and IVF clinics may improve donor satisfaction by: minimizing trips to the clinic; using protocols that limit the number of intramuscular injections; reducing the risk of hyperstimulation syndrome; providing follow-up care; reimbursing for expenses such as lost work, travel, and child care; separating direct reimbursements from 'income' to decrease the amount of taxes donors must pay on compensation; treating donors with respect and appreciation; and informing them about the outcome. Improved donor satisfaction is likely to improve donor recruitment and retention.     

Infertility: Oocyte donation: comparison between recipients from different age groups

Oocyte donation was carried out in 87 patients in 141 replacementcycles. These patients received oocytes from 108 women undergoingassisted reproductive technology procedures at our centre. Standardizedhormonal replacement therapy and in-vitro fertilization procedureswere performed. We divided recipients into four groups accordingto their age (group A, 21–35 years; B, 36–40 years;C, 41–49 years; and D, 50–61 years). Oocytes donorswere 21–35 years old, and equally spread across thesedifferent age groups. There were significant differences inthe pregnancy and implantation rates according to the age ofthe recipients; which were 45% and 23% respectively in women21–35 years old (group A) versus 23% and 10% in women41–49 years old (group C). A comparison of data betweenoocyte donors and their specific recipients showed similar resultsin donors and young recipients, with pregnancy rates of 45%and 42% and implantation rates of 23% and 19.5% respectively.Statistically significant differences were found between donorsand the older recipients, pregnancy rates being 43% versus 23%,and implantation rates 18% versus 10%. These data seem to demonstratea lesser likelihood of pregnancy and implantation in older recipientsbecause of increasing uterine age.     

CASE REPORT: Quadruplet pregnancy in a 51-year-old menopausal woman following oocyte donation

A quadruplet pregnancy occurred in a woman 51 years of age followingoocyte donation and embryo transfer. Successful pregnancy occurredfollowing two previously unsuccessful attempts. The patientunderwent a selective reduction of her pregnancy to two fetusesat approximately 13 weeks gestational age. Her pregnancy continueduneventfully and she underwent the delivery of two viable infantsat 38 weeks gestational age by Caesarean section. This caserepresents the first quadruplet pregnancy to be establishedin a woman of 50 years of age or older. It illustrates boththe benefits and risks of oocyte donation to women of advancedreproductive age.     

The role of oocyte donation in women who are unsuccessful with in-vitro fertilization treatment.

Oocyte donation improves the chances of becoming pregnant in some women who are unsuccessful with in-vitro fertilization (IVF) treatment. A total of 119 IVF cycles achieved a pregnancy rate per cycle of 2.5% whereas the same women, when treated with 45 cycles of oocyte donation, achieved a 24.5% pregnancy rate per cycle. To ascertain which women may be helped by oocyte donation, IVF data were analysed according to the outcome of oocyte donation. There was a difference in the number of previous natural conceptions and live births, and in the IVF fertilization rate. There was no difference in the age of the women and the numbers of oocytes collected per cycle of IVF. New criteria are therefore suggested for recommending oocyte donation to women who have previously failed to become pregnant with IVF treatment.     

Oocyte and embryo quality after coasting: the experience from oocyte donation

BACKGROUND: Oocyte donation provides us with an opportunity to study the clinical outcome of oocytes, retrieved from women undergoing coasting, in recipients in whom endometrial receptivity is unaltered by the coasting procedure. Thus, our aim was to describe oocyte donation outcome in donors undergoing coasting, the oocyte and embryo quality obtained from these cycles, and to determine the influence of coasting duration in the cycle outcome. METHODS: Matched-paired analysis included 15 oocyte donors with high response to ovarian stimulation and submitted to coasting and 15 oocyte donors with normal response to ovarian stimulation and not undergoing coasting. There were 38 oocyte recipients who shared oocytes from the donors under coasting and 37 from donors not undergoing coasting. RESULTS: Both groups of donors were comparable in terms of days and dose of ovarian stimulation, oocytes retrieved, metaphase II oocytes obtained, and in the appearance of ovarian hyperstimulation syndrome. Both groups of oocyte recipients were comparable in male-associated factor, pregnancy and implantation rates, as well as in embryo quality. Recipients from donors with coasting for >4 days had significantly lower implantation and pregnancy rates. CONCLUSIONS: the outcome of oocyte donation from donors undergoing coasting is not impaired, as good implantation and pregnancy rates are achieved. Embryo quality, according to our current standards, does not seem to be compromised by coasting itself. However, if coasting in oocyte donors is prolonged for >4 days there is a significant decrease in both implantation and pregnancy rates.     

Successful pregnancy following oocyte donation in a patient with Diamond-Blackfan syndrome and premature ovarian failure

Diamond-Blackfan anaemia (DBA) is a rare congenital conditioncharacterized by profound anaemia associated with an absenceof red cell precursors on bone marrow examination. This reportrepresents the first case of pregnancy following egg donationin a patient with DBA and premature ovarian failure. The patientwas a 24 year old woman who had been diagnosed with DBA whenaged 6 months. Shortly after menarche, the patient became amenorrhoeicand was diagnosed as suffering from premature ovarian failure.She was entered onto an assisted conception programme and conceivedafter one cycle of egg donation. The pregnancy was characterizedby a gradual decline in haemoglobin concentration, reachinga low of 8.1 g/dl, necessitating a single blood transfusionat 29 weeks of gestation. The patient suffered preterm ruptureof the membranes at 29 weeks of gestation and was deliveredby emergency Caesarean section at 30 weeks of gestation becauseof chorioamnionitis and breech presentation. Comparing thiscase with other reports of pregnancy in patients with DBA, ourpatient suffered a less dramatic fall in haemoglobin concentrationand required only a single blood transfusion. It is suggestedthat because the pregnancy arose from donated genetic material,this may have conferred some protective effect.