Comparison of pregnancy rates following in vitro fertilization—embryo transfer between the donors and the recipients in a donor oocyte program

Our in vitro fertilization (IVF) program provides a unique opportunity to evaluate influences of hormonal milieu on pregnancy outcome, by using a shared pool of oocytes obtained by donors (in exchange for financial assistance). The study presented herein evaluated 38 retrieval cycles (28 oocyte donors/22 recipients). No difference in mean number of embryos transferred was seen (2.7 in the donors vs 2.8 in the recipients). However, a statistically significant difference was seen in the pregnancy rates per retrieval (10.5% donors vs 29% recipients) and per transfer (4/35, 11.1%, vs 11/34, 32.3%). Abortion rates were similar (25% donor, 27.2% recipients). These data suggest that other reports of higher pregnancy rates from donor oocyte programs may not be due exclusively to better-quality oocytes. Possibly a negative effect of hyperstimulation or adverse endometrial environment of the donor (possible chronic endometritis) may explain these data.     

The effect of the age of the recipients on pregnancy rates following donor-oocyte replacement

Purpose Besides waning ovarian function with advancing age, the question of a uterine senescence factor has been proposed as a cause of decreased fecundity. The replacement of oocytes from younger donors into older recipients allows further investigation into the aging endometrium.Results The pregnancy rate was considerably lower, 8.5% in recipients in ovarian failure who were 40 years old (n =23) compared to younger recipients, <40 years of age (n =55), who were also in ovarian failure, which would support the uterine senescence theory. Conclusion The endometrial factor may be manifested by failure to generate a critical endometrial thickness of 10 mm by sonography in 61% of the older group, compared to only 29% of the younger group. Future studies should address methods of improving the endometrial thickness in the older group, to determine if improved pregnancy rates will occur and to evaluate whether increasing luteal support with extra progesterone may also improve pregnancy rates.     

Low-dose human chorionic gonadotropin during the proliferative phase may adversely affect endometrial receptivity in oocyte recipients

The effect of low-dose human chorionic gonadotropin (hCG) administration in the proliferative phase of oocyte recipients was investigated in a prospective randomized trial. Sibling oocytes from the same donor were shared at random among two different recipients. In group I oocyte recipients received 750 IU of hCG every three days concomitant to endometrial preparation with estradiol until hCG injection to the donor, whereas in group II recipients received no hCG during endometrial priming with estradiol. Endometrial thickness was significantly lower in group I compared with group II, although similar endometrial thickness was detected during the mock cycle. Pregnancy rates were significantly lower in group I than in group II (13.6% vs. 45.4%, p<0.05). Implantation rates were also significantly lower in group I (1.7% vs. 22.4%, p<0.01). The study was discontinued prematurely for ethical reasons when 22 cycles were completed, as pregnancy rates were very low in group I. In conclusion, hCG administration in the proliferative phase might directly affect endometrial proliferation and receptivity.     

The relationship of clinical response,oocyte number,and success in oocyte donor cycles

Purpose: The purpose of the study was to determine if there is a threshold of clinical response to ovarian stimulation below which pregnancy rates diminish in oocyte donation cycles.Methods: Two hundred and seventy-six oocyte donor cycles were reviewed. Data were stratified by number of oocytes retrieved and divided into pregnant versus non-pregnant outcomes.Results: There were no differences in fertilization rates or clinical pregnancy rates regardless of the number of oocytes retrieved ranging from 3 to > 25. There was no difference in the mean age of the donors in pregnant versus non-pregnant cycles.Conclusions: These data suggest that a lower threshold below which cycle cancellation should be considered donation cycles is different than standard IVF.Presented at the 59th Annual Meeting of the American Society for Reproductive Medicine 2003, San Antonio, Texas.     

Low-dose aspirin for oocyte donation recipients with a thin endometrium: prospective, randomized study

Objective: To evaluate the effect of low-dose aspirin use in oocyte donation recipients with an endometrial thickness of <8 mm.Design: A prospective, randomized study.Setting: An oocyte donation program in a private infertility practice.Patient(s): Twenty-eight recipients undergoing oocyte donation who failed to develop an endometrial thickness of at least 8 mm in a previous evaluation cycle.Intervention(s): Fifteen recipients received low-dose aspirin (81 mg/d) in addition to standard hormone replacement for an oocyte donation cycle. The remaining 13 recipients did not receive aspirin.Main Outcome Measure(s): Clinical pregnancy rates, delivery rates, implantation rates, and change in endometrial thickness were compared in the aspirin and nonaspirin groups.Result(s): There was no demonstrable increase in endometrial thickness in the aspirin-treated group. However, there was a statistically significant increase in implantation rates in the aspirin-treated group (24% versus 9%) and in implantation rates and clinical pregnancy rates in the aspirin-treated group when the final endometrial thickness was <8 mm.Conclusion(s): Low-dose aspirin therapy improves implantation rates in oocyte donation recipients with a thin endometrium.     

Endometriosis is not detrimental to embryo implantation in oocyte recipients

Purpose: Our purpose was to determine the effects of endometriosis on implantation and pregnancy rates in ovum recipients. Methods: The medical records of 239 consecutive oocyte recipient patients who were treated between January 1, 1991, and June 30, 1995, were analyzed retrospectively. Recipients with endometriosis (group I; n=55) were compared to recipients without endometriosis (group II; n=184). Patients in group I had active endometriotic disease confirmed by laparoscopy and were subdivided into mild (Stages I and II; n=18) and moderate to severe (Stages III and IV; n=37) endometriosis. Results: No difference was found in recipient age, endometrial thickness, donor age, and embryos transferred. The pregnancy rates (28 versus 29%) and implantation rates (12 and 13%) were also comparable between group I and group II, as well as between patients with mild and patients with moderate to severe endometriosis. Conclusions: The presence of endometriosis in oocyte recipients does not lower implantation or pregnancy rates. We conclude that the adverse effect of endometriosis on reproductive outcome is not related to implantation but, in fact, is most likely an effect on oocyte or embryo quality. Presented at the 43rd Annual Meeting of the Society for Gynecological Investigations, Philadelphia, Pennsylvania, March 21–22, 1996.     

闭经患者子宫内膜厚度和雌激素水平与孕激素撤退性出血的关系

目的评价闭经患者子宫内膜厚度（EM）和雌激素水平（E2）与其应用孕激素引起撤退性出血的关系。方法选择继发性闭经患者53例，利用阴道超声测量其EM和放射性核素测量E2后观察用甲羟孕酮引起撤退性出血的效果。结果33例有撤退性出血者为阳性组，20例无撤退性出血者为阴性组，阳性组的EM和E2均高于阴性组，且差异均有显著性。结论测量继发性闭经患者EM和E2对预测孕激素引起撤退性出血是有价值的。     

Artificial endometrial preparation for oocyte donation: The effect of estrogen stimulation on clinical outcome

Morphologic studies of the endometrium have demonstrated that varying the duration of an artificial follicular phase (AFP) in women with ovarian failure did not adversely affect its developmental capacity. The aim of this study was to evaluate whether such manipulations of endometrial stimulation could influence the pregnancy rate in women undergoing oocyte donation (OD). Twenty-nine women were investigated in 51 cycles of OD. Endometrial preparation was performed with a fixed dose of micronized estradiol, 4 mg/day, administered for 5–35 days in accordance with oocyte availability. On the day of donation progesterone in oil, 50 mg/day, was added to the regimen. Oocytes were donated anonymously by patients undergoing routine in vitro fertilization. Fifteen clinical pregnancies were achieved, for a success rate of 29.4%. Using logistic regression analysis the success rate was found to be closely associated with the duration of estrogen stimulation. The pregnancy rate was 7.7, 52, and 7.7% after an AFP of 4–11, 12–19, and 20–29 days, respectively. It seems that for optimal results in an OD program, estrogen stimulation should be kept at between 12 and 19 days. These results also imply that, contrary to endometrial morphology, which seems to be tolerant to extreme AFP durations, functional receptivity is less permissive and is adversely affected by such manipulations.     

Transfer and uterine factors are the major recipient-related determinants of success with donor eggs

OBJECTIVE: To define the recipient-related determinants of outcome with donor eggs. DESIGN: Case-control study. SETTING: Community hospital-based assisted reproductive technology (ART) program. PATIENT(S): One hundred thirty-four embryo transfers (ETs) in which two recipients were matched to one donor. INTERVENTION(S): Controlled ovarian hyperstimulation (COH) and ovum retrieval in donors; IVF and ET to recipients. MAIN OUTCOME MEASURE(S): Recipients' age, body mass index (BMI), medical conditions, endometriosis, gravidity, uterine pathology, endometrial thickness, egg number, total motile sperm count, intracytoplasmic sperm injection (ICSI), zygote number, fertilization rate, embryos per ET, embryos frozen, embryo quality, difficulty with transfer, and ongoing pregnancies per ET. RESULT(S): Forty-one recipient pairs had discordant outcomes. Pregnant patients had a lower frequency (9.7% vs. 31.7%, P=.04) and lesser severity of uterine pathology. Endometrium <8 mm was found solely in failed cycles. Pregnant women had fewer moderate or difficult ETs (9.7% vs. 31.7%, P=.04) and more good embryos (1.8 vs. 1.3, P=.03) than the nonpregnant group. CONCLUSION(S): Analysis of recipient pairs with discordant outcomes identifies the recipient-related predictors of success by keeping oocyte quality and the laboratory component constant. Uterine pathology, thin endometrium, transfer difficulty, and number of high-grade embryos are the principal recipient-related determinants of outcome with donor eggs.     

Luteinizing hormone supplementation increases pregnancy rates in gonadotropin-releasing hormone antagonist donor cycles

OBJECTIVE: To determine whether LH supplementation improved pregnancy and implantation rates in GnRH antagonist donor cycles. DESIGN: Donors were randomly assigned to a protocol using GnRH antagonist (GnRH-a) alone or GnRH-a + recombinant LH. Analysis of variance, Student's t-test and Fisher's exact test were used where appropriate. SETTING: Private clinical setting. PATIENT(S): Young voluntary donors with antagonist (n = 20) and antagonist + LH (n = 22). Fifty-five patients received oocytes. INTERVENTION(S): Donors received the GnRH-a (Cetrorelix, 0.25 mg/day) alone or in combination with recombinant LH (75 IU/day). Ovulation induction was carried out with recombinant FSH in a step-down protocol. The endometrial tissue of recipient patients was prepared with oral E(2) and P. MAIN OUTCOME MEASURE(S): Pregnancy and implantation rates in a donor program. RESULT(S): A significant increase in MII oocyte (80% vs. 71%), fertilization rates (83% vs. 71%), G1 embryos (17% vs. 3%), and implantation rates (35% vs. 15%), were found in recipients whose embryos originated from donors receiving GnRH-a + recombinant LH as compared to donors receiving GnRH-a alone. Estradiol levels, pregnancy/transfer and clinical pregnancies were lower (not significant) in donors treated with the GnRH-a alone vs. those receiving the recombinant LH-supplemented GnRH-a. CONCLUSION(S): The LH supplementation improved the possibilities of gestation for recipients whose embryos originated from GnRH-a-treated donors.     

厚度偏薄的子宫内膜对体外受精-胚胎移植及冻融胚胎移植妊娠率的影响

目的探讨厚度偏薄的子宫内膜对体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)及冻融胚胎移植(freezing-thawing embryo transfer,FET)临床妊娠率的影响。方法 2008年12月至2010年4月在河南省人民医院对218周期子宫内膜厚度在6～7.9mm之间的IVF-ET及FET患者进行回顾性分析,比较子宫内膜厚度在6～7.9mm之间的IVF-ET及FET患者的临床妊娠率有无差异。结果子宫内膜厚度在6～7.9mm之间的IVF-ET组与FET组患者的临床妊娠率分别为35.6%和50.7%,差异有统计学意义(P﹤0.05)。结论子宫内膜偏薄患者FET的临床妊娠率高于IVF-ET的临床妊娠率。     

Perinatal outcomes in oocyte donor pregnancies

Abstract

Objective: To assess the obstetric outcomes of pregnancy following intracytoplasmic sperm injection (ICSI) using donor oocytes.

Methods: Twenty-six deliveries from oocyte donor ICSI (d-ICSI) were compared to the next two consecutive deliveries from homologous ICSI (h-ICSI group) (n?=?52) and with the two consecutive deliveries from women older than 40 years (Advanced Maternal Age: AMA) (n?=?52). We evaluated the occurrence of gestational hypertension (GH), preeclampsia (PE), fetal growth restriction (IUGR), gestational diabetes mellitus (GDM), preterm premature rupture of membranes (pPROM), preterm birth, placental anomalies, mode of delivery, hemorrhage, gestational age at birth and birth weight.

Results: d-ICSI had significantly more PE (d-ICSI 19.2%, h-ICSI 0%, AMA 0%, p?<?0.001); higher rates of IUGR than AMA pregnancies (d-ICSI 19.2%, AMA 3.8%, p?<?0.025). Placental accretism was found only in the d-ICSI group (15.4%, p?<?0.043). No postpartum bleeding was observed.

Conclusions: This is the first study that compares the obstetric outcomes of donor pregnancies to the outcomes of h-ICSI and AMA. Obstetricians who deal with pregnancies from oocyte donation need to be aware of the more severe obstetric outcomes, especially placenta accreta and preeclampsia. All women who conceive through oocyte donation should be counseled as early as the pre-conception period and referred to specific centers for high-risk pregnancies.