Oocyte donation in patients with Turner's syndrome: a successful technique but with an accompanying high risk of hypertensive disorders during pregnancy

BACKGROUND: Few data are available on pregnancy rate and obstetrical outcome after oocyte donation in Turner's syndrome patients. We conducted a retrospective analysis on the outcome of this subgroup. METHODS: Thirty oocyte donation cycles with fresh embryo transfer were performed in 21 patients between 2001 and 2004. RESULTS: The mean (+/-SD) age of the recipients was 33.1+/-1.8 years. The median (range) number of transferred embryos per cycle was two (1-4). Seventeen pregnancies were obtained (57%), of which 12 were clinical (40%). The implantation rate and the ongoing pregnancy rate were 22% (15 out of 68) and 30% (nine out of 30), respectively. Premature delivery was observed in 50% (four out of eight) of the pregnancies and intrauterine growth retardation in 55.5% (five out of nine) of the fetuses. Hypertensive disorders occurred in five out of eight pregnancies (three pre-eclampsias). CONCLUSIONS: Turner's syndrome patients achieve acceptable pregnancy rates after oocyte donation. A high rate of pregnancy-associated hypertensive disorders was observed which have led to a high rate of prematurity and intrauterine growth restriction. Although the number of cases in this study is limited, these results call for the need for intensive surveillance of such pregnancies. In order to reduce the risk of hypertensive disorders induced by multiple pregnancies, single embryo transfer should be proposed.     

Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome

A total of 811 intrauterine insemination (IUI) cycles in which clomiphene citrate/human menopausal gonadotrophin (HMG) was used for ovarian stimulation were analysed retrospectively to identify prognostic factors regarding treatment outcome. The overall pregnancy rate was 12.6% per cycle, the multiple pregnancy rate 13.7%, and the miscarriage rate 23.5%. Logistic regression analysis revealed five predictive variables as regards pregnancy: number of the treatment cycle (P = 0.009), duration of infertility (P = 0.017), age (P = 0.028), number of follicles (P = 0.031) and infertility aetiology (P = 0.045). The odds ratios for age < 40 years, unexplained infertility aetiology (versus endometriosis) and duration of infertility < or = 6 years were 3.24, 2.79 and 2.33, respectively. A multifollicular ovarian response to clomiphene citrate/HMG resulted in better treatment success than a monofollicular response, and 97% of the pregnancies were obtained in the first four treatment cycles. The results indicate that clomiphene citrate/HMG/IUI is a useful and cost-effective treatment option in women < 40 years of age with infertility duration < or = 6 years, who do not suffer from endometriosis.     

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.     

A report on 100 cycles of oocyte donation; factors affecting the outcome

Eighty-two patients had 100 cycles of oocyte donation from 68 donors resulting in 27 clinical pregnancies. The source of donated oocytes was 42 fertile volunteers and 26 patients from the assisted conception programme. The pregnancy rate was significantly higher when intra-Fallopian transfer was performed (36%; 21/59), compared with intrauterine transfer (15%; 6/41). The pregnancy rate following fresh gamete/embryo transfer (39%; 15/39) was slightly higher than for frozen embryo transfer (20%; 12/61). The age of the recipient significantly affected the pregnancy rate. The pregnancy rate was 50% in the 25-29 years age group and steadily dropped to 9.7% in the 45-49 age group. The pregnancy rate in patients with primary ovarian failure (50%; 8/16) was significantly higher than in patients with secondary ovarian failure (18%; 9/50). The pregnancy rate was significantly greater when parous donors (33%; 23/69) were used compared with non-parous donors (13%; 4/31). The number of gametes/embryos transferred significantly affected the pregnancy rate regardless of the treatment used. If one or two gametes/embryos were transferred, the pregnancy rate was 11% compared with 33% if three to four embryos were transferred. The age of the donors did not affect the pregnancy rate. The majority of the donors were under the age of 35 years. The best results (50% per cycle) were therefore achieved using gametes from parous donors and transferring three to four oocytes fresh to the Fallopian tubes of a young recipient.     

Pregnancy: Oocyte donation in menopausal women

Oocyte donation was performed by in-vitro fertilization andembryo transfer in 82 women. The average age of the patientswas 48 years (range 26–60), and 71 were over 40 yearsold, with an average follicle stimulating hormone (FSH) valueof 74±14 IU and oestradiol concentration of 30 ±9 pg/ml. Overall 32 clinical pregnancies were achieved, of which21 reached term, three are ongoing, and eight were lost (sixmiscarriages, one abruptio placentae, and one severe gestationalproteinuria hypertension in the second trimester). The 21 termpregnancies produced 26 newborns; one patient who had had threeembryos replaced delivered triplets and three patients had twins.Before the embryo transfer was performed, the endometrium thicknesswas accurately determined by vaginal ultrasound probe. The highestnumber of implanted embryos was reached when the endometriumthickness was 9–12 mm.     

Oocyte donation: the role of endometrial receptivity

Sixteen patients, 15 with primary ovarian failure and one carrier of chromosomal abnormality, received 21 embryo transfers following in-vitro fertilization of donated oocytes. Hormone replacement therapy was given to mimic a natural menstrual cycle. Five pregnancies were achieved (four infants delivered and one early pregnancy loss). All patients had endometrial biopsies taken in a preceding cycle of hormone replacement therapy. The majority (61%) showed delayed maturation compared with the expected appearances for the day of the cycle as assessed on light microscopy. Patients who conceived had a significantly better endometrial response than those who did not. Five out of seven patients (71%) conceived when the endometrium was 'in phase' (less than 2 days' delay). This suggests that endometrial receptivity is a key factor in conception. The implications for improving outcome from in-vitro fertilization treatment are discussed.     

Oocyte donation in patients without ovarian function

The clinical, hormonal and cytogenetic findings in 36 womenwith primary ovarian failure, referred for oocyte or embryodonations are reported. Fifteen women were suffering from ovariandysgenesis and 11 from premature menopause. Six of these 26patients showed X-chromosome abnormalities. One patient hada Noonan syndrome. The remaining 10 had surgical menopause.The mean duration of their infertility was 6.5 ± 3.2years (±SD). All patients had elevated serum gonadotrophinswithin the menopausal range. Hypothalamic, pituitary and thyroidfunction were found to be intact. In one of the 15 ovarian biopsieson the patients with chromosomal competent ovarian failure,primordial fofficles were found. Hysterosalpingograms revealeda normal uterine cavity in all patients. In view of oocyte donation,careful evaluation of the obstetric risk was mandatory in thesix patients with X-chromosome aberrations and in the patientwith the Noonan syndrome, because of their short stature andpossible concomitant cardiovascular and renal disease. Aftersub stitution therapy with oestradiol valerate and natural progesterone,13 pregnancies were established, seven patients delivered (oneset of twins), eight healthy children were born, three pregnanciesaborted and three pregnancies are progressing normally.     

Pregnancy: Oocyte donation in women with recurrent pregnancy loss

The prognosis of couples with recurrent miscarriage is controversialdespite efforts made during this century to learn about thephyslopathology and treatment of this troublesome condition.Here we present our experiences of employing oocyte donationin eight couples in whom the woman was a low responder to gonadotrophinstimulation and had a previous history of recurrent abortionwith negative routine infertility work-up for repeated pregnancyloss. Patients were desensitized with gonadotrophin-releas inghormone analogues and supplemented with oestradiol valeratefor a minimum of 15 days until oocytes were donated from in-vitrofertilization and fertile donors. Then, progesterone was addeduntil day 100 of pregnancy. A total of 12 oocyte donation cycleswere performed in these patients. Clinical pregnancy and deliveryrates per cycle were 75.0 and 66.6% respectively. The deliveryrate per patient was 85.7% in this series, and the miscarriagerate per cycle was 11.1%. The results of ovum donation comparedfavourably with low responders without a history of recurrentabortion undergoing this treatment during the study period.These results strongly suggest that the oocyte may be the originof infertility in women with idiopathic recurrent miscarriages.In addition, the results question the role of maternal localand systemic factors in early recurrent pregnancy loss, as wellas the paternal contribution to its aetiology.     

影响脑梗死功能结局的危险因素

目的 探索影响脑梗死功能结局的危险因素。 方法 回顾性分析594例脑梗死患者的临床资料,并与年龄、性别相匹配的351例健康者相对照。比较两组人口统计学、既往史和临床实验室指标,并采用非条件 logistic 回归进行多因素分析,了解影响脑梗死功能结局的危险因素。 结果 同型半胱氨酸、脂蛋白a、空腹血糖、入院时的收缩压和高血压史是影响脑梗死功能结局的独立危险因素。 结论 临床应及早控制引起脑梗死预后不良的危险因素,以减轻、防止不良的功能结局和预防脑梗死的再发。     

临沂地区62例Turner综合征患者的细胞遗传学分析

目的 探讨临沂地区Turner综合征患者的染色体类型及与临床症状间的关系.方法 用1640培养基培养淋巴细胞,常规收获制片,G带显色(必要时加做C带显色),按人类细胞遗传学国际命名体制2005(ISCN2005)进行染色体核型分析.结果 62例Turner综合征患者检出染色体异常核型16种,包括:45,X、46,X,i(X)(q10)、45,X/46,XX、45,X/46,XY等,发现世界首报染色体异常核型1例.结论 临沂地区Turner综合征患者染色体的类型较多,临床表现差异较大.     

Pedal hemangioma (venous malformation) occurring in Turner's syndrome: an additional manifestation of the syndrome

Two infants with Turner's syndrome and an unusual vascular tumor or malformation of the feet are described. In one child, the lesion developed in the dorsal metacarpal area, whereas in the other, the lesion was located in a bilaterally symmetrical distribution over the dorsum of the feet. Both lesions were characterized by a proliferation of tortuous, thick-walled veins with imperfectly formed muscular walls. Redundancy of the endothelial lining leading to intimal "webs" and intraluminal vascular channels was prominent. The similarity of these two lesions clinically and histologically suggests that they do not represent a fortuitous occurrence, but an additional manifestation of Turner's syndrome. Furthermore, their existence indicates that the vascular abnormality in Turner's syndrome may be more generalized than previously recognized and may include abnormalities of peripheral blood vessels in addition to those of the heart and aorta.     

Oocyte donation in Israel: a study of 1001 initiated treatment cycles

There are numerous studies concerning pregnancy rates in oocyte donation, yet only a handful report the obstetric outcome in such pregnancies. The purpose of this study was to assess factors that influence pregnancy rates, to determine the incidence of complications, and to evaluate obstetric outcome in pregnancies resulting from oocyte donation. This study included 423 oocyte recipients who underwent 1001 oocyte donation cycles at the Oocyte Donation Programme, In-Vitro Fertilization (IVF)-Embryo Transfer Unit, Herzlia Medical Center, Israel. Donors were all healthy women < 34 years old who underwent IVF themselves. In 873 cycles, fertilization occurred and embryo transfer was performed, resulting in 194 clinical pregnancies. Pregnancy rates (PR) significantly declined with the increase in number of previous attempts, and with increasing age of recipient (36.8%/embryo transfer in patients < or = 30 compared to 17.8% in patients > 40 years old). A significant increment in PR was noted with the increasing number of embryos transferred. The overall PR was 22.2%/embryo transfer. However, in young amenorrhoeic patients with normal karyotypes undergoing their first cycle, PR was 52.2%; the 'take home baby' rate was 38.3% per patient undergoing embryo transfer and 17.8% per embryo transfer cycle. A significant increase in the incidence of pregnancy-induced hypertension and a higher proportion of abortions were noted in older patients. A significantly higher incidence of prematurity and low birthweight was observed in multiple pregnancies.      

Oocyte donation in menopausal women aged over 40 years

In order to investigate the pregnancy potential of menopausalwomen over 40 years of age by use of donor eggs, we retrospectivelyanalysed the results of our ovum donation programme. Forty-oneclinical pregnancies were established in 134 recipient cycles.The recipients were divided into three age groups (40–43,44–47 and 48 years) in order to investigate the implantationrate with respect to age. The 30.6% pregnancy rate per embryotransfer cycle and 9.7% implantation rate per embryo appearedto be constant in all age groups studied. Fourteen pregnanciesended in miscarriage, there was one ectopic pregnancy and 25healthy babies have been delivered. The oldest woman to deliverwas 54 years of age. This report highlights the question ofage limit for application of the new reproductive technologies,and especially of oocyte donation.     

Oocyte and embryo donation: evaluation of 412 consecutive trials.

A total of 199 patients (412 consecutive cycles) were treated by oocyte-embryo donation in 336 replacement cycles. Of these, 296 involved intra-uterine embryo transfers, 38 zygote intra-Fallopian transfers (ZIFT) and two gamete intra-Fallopian transfers (GIFT). Of the 336 replacements, 244 (73%) constituted transfers of fresh concepti and 92 (27%) of frozen-thawed ones. A total of 85 pregnancies were achieved of which 16 ended in preclinical abortions, giving a clinical pregnancy rate of 34.7% per patient, 20.5% per transfer and a take-home baby rate of 29.1% per patient. The pregnancy rate was significantly higher (P less than 0.05) following fresh gamete or embryo replacement (23%; 56/244) than following that of frozen-thawed embryos (14.1%; 13/92). No significant difference was observed when intra-Fallopian replacement was applied (27.5%; 11/40) as opposed to intra-uterine (19.6%; 58/296). Ovarian function was not found to be of significant importance to the achievement of pregnancies after oocyte donation since comparable pregnancy rates per replacement and per started cycle were obtained in patients with ovarian failure and in those with functional ovaries (19% and 15.4%; 24.2% and 20.2% respectively). Comparison of the implantation and abortion rates between these two groups did not reveal any significant difference (11.1% and 11.1% versus 14.8% and 16.6%). The highest pregnancy rate among patients with ovarian failure was observed in those with primary ovarian failure (26.4%; 14/53), while the lowest was among women who had received chemotherapy and/or radiotherapy (9%; 1/11).(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Oocyte and semen donation: a survey of UK licensed centres

In view of the difficulties encountered by licensed clinics in the recruitment of oocyte and semen donors, the present survey was commissioned by the National Gamete Donation Trust (NGDT) to provide systematic information on current practice as a basis for planning future recruitment strategies. Sixty-four clinics agreed to participate in the survey, of which 55 recruited oocyte donors, 30 recruited semen donors, and 24 recruited both oocyte and semen donors. Almost all of the clinics had experienced difficulty in obtaining a sufficient supply of donated oocytes, and many patients requiring treatment with donated oocytes were placed on a waiting list for more than one year. Three-quarters of potential donors changed their mind about donating after receiving information on the procedures involved. The difficulties in recruiting semen donors were generally less acute. In this case, the greatest problem was the high proportion of potential semen donors who were deemed unsuitable after completing the screening process. Clinics also reported a shortage of both oocyte and semen donors from specific ethnic groups.     

Pattern and factors affecting the outcome of pregnancy in hypertensive patients

The pattern and factors affecting the outcome of pregnancy in hypertensive patients at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between January 1997 and December 2002 were studied. There were 2,393 deliveries, with 127 (5.3%) patients fulfilling the criteria for hypertensive disorder of pregnancy. 26.2% had de-novo (gestational) hypertension, 19.7% had pre-eclampsia (PET) superimposed on chronic hypertension and 54.1% had PET/eclampsia. All patients with prepregnancy chronic hypertension had superimposed PET or eclampsia in this study. The PET/eclampsia group had the worst maternal and fetal outcomes as demonstrated by maternal mortality (6.1%), fetal mortality (36.4%), fetal respiratory distress (66.7%) and abruptio (6.1%). They also had more target organ damage (18.2%). 50.8% of these were categorized as high risk. Furthermore, patients in the PET/eclampsia group tended to be illiterate, attended antenatal clinic (ANC) less regularly and had more maternal and fetal adverse outcomes. Twenty percent of the patients had poorly controlled blood pressures (BP) at discharge, and only one out of five of the chronic hypertensive patients attended the medical hypertension clinic on discharge. These poor outcomes further emphasize the need for patient education; regular antenatal clinic attendance; prompt treatment of elevated BP; compliance with postnatal clinic follow-up, including medical outpatient care in these patients.     

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.