Oocyte donation.

Use of donor oocytes is becoming an increasingly important facet of assisted reproductive technology programs. Candidates for donor oocytes include women with premature ovarian failure or severe genetic disorders, women who respond poorly to human menopausal gonadotropin, and women older than 40 years who do not conceive with used of other therapies. The coordination of donor and recipient of oocytes is facilitated by pituitary desensitization of both parties using gonadotropin-releasing-hormone agonists. Pregnancy rates are much higher than that achieved with traditional in vitro fertilization and embryo transfer, possibly because of the young age of the donors and better endometrial receptivity.     

Oocyte donation: a review

Summary. Oocyte donation provides an option for achieving pregnancy in women lacking functioning gonads, or in whom IVF techniques have failed to harvest adequate oocytes, or those who do not wish to use their own gametes because of hereditary disease. In agonadal women, artificial menstrual cycles are required before proceeding to gamete donation. A fixed cyclical steroid replacement schedule of oestradiol (E₂) valerate and progesterone (P₄) pessaries was initially used, but the need for synchrony between donor and recipient cycles, and the narrow window for implantation limited the transfer of fresh embryos. Donorrecipient cycle asynchrony can be overcome by using frozen-thawed embryos, or by extending the follicular phase in the recipient to widen the transfer window. Twenty-two pregnancies have now been achieved by the Monash/Epworth group, resulting in the birth of 13 healthy Infants. There were no statistically significant differences in pregnancy rates (per transfer) between transfers in natural cycles (14%, four pregnancies) and steroid replacement cycles (24%, 16 pregnancies). Five pregnancies (36%) were established in women treated with 2 mg of E₂ daily 13–18 days before embryo transfer with P, starting on the day of or the day tollowing oocyte retrieval. E₂ was continued for a median of 85 days (range 49–110) and P₄ for a median of 86 days (range 49–133) after the supposed last menstrual period. All but one delivery was by caesarean section. There were no perinatal deaths and no ectopic pregnancies.     

Oocyte donation: a review

Oocyte donation provides an option for achieving pregnancy in women lacking functioning gonads, or in whom IVF techniques have failed to harvest adequate oocytes, or those who do not wish to use their own gametes because of hereditary disease. In agonadal women, artificial menstrual cycles are required before proceeding to gamete donation. A fixed cyclical steroid replacement schedule of oestradiol (E2) valerate and progesterone (P4) pessaries was initially used, but the need for synchrony between donor and recipient cycles, and the narrow window for implantation limited the transfer of fresh embryos. Donor-recipient cycle asynchrony can be overcome by using frozen-thawed embryos, or by extending the follicular phase in the recipient to widen the transfer window. Twenty-two pregnancies have now been achieved by the Monash/Epworth group, resulting in the birth of 13 healthy infants. There were no statistically significant differences in pregnancy rates (per transfer) between transfers in natural cycles (14%, four pregnancies) and steroid replacement cycles (24%, 16 pregnancies). Five pregnancies (36%) were established in women treated with 2 mg of E2 daily 13-18 days before embryo transfer with P4 starting on the day of or the day following oocyte retrieval. E2 was continued for a median of 85 days (range 49-110) and P4 for a median of 86 days (range 49-133) after the supposed last menstrual period. All but one delivery was by caesarean section. There were no perinatal deaths and no ectopic pregnancies.     

Oocyte donation in Turner syndrome

Turner syndrome represents about 10% of the indications of oocyte donation. Pregnancy rates are as satisfactory as for other indications when endometrial preparation is sufficient. Unfortunately patients with Turner syndrome present somatic abnormalities inducing obstetrical complications and even an elevated mortality rate, in particular by aortic dissection. So, it is absolutely necessary to define with extreme precision the elements of medical check up previous to oocyte donation as well as the forms of medical care during pregnancy which would protect the patients from severe complications.     

Oocyte and embryo donation in IVF programmes

We have described a cyclic steroid replacement regimen of oestradiol and progesterone which is able to produce physiological concentrations of these steroids in plasma indicative of a normal menstrual cycle. The stimulation of a secretory endometrium at the appropriate time in this artificial menstrual cycle bears testament to the suitability of the treatment and has led to the establishment of pregnancy in three women with complete ovarian failure or ovarian agenesis when used in combination with the established techniques of in vitro fertilization and embryo transfer. The steroid replacement regimen can easily be adjusted to maintain pregnancy until the time of luteoplacental shift, based on the close monitoring of the plasma steroid and hCG levels in the pregnant individual. The implications of this form of treatment for other disease states and for our understanding of the mechanisms involved in ovarian hormone action, pregnancy maintenance and parturition are immense.     

Oocyte vitrification technology has made egg-sharing donation easier in China

When infertile women undergoing IVF or intracytoplasmic sperm injection (ICSI) have more than 20 mature oocytes retrieved, at least 15 oocytes are inseminated by their husband's spermatozoa. The extra oocytes are cryopreserved by vitrification. If the patients became pregnant and have healthy live births, the patients are encouraged to donate their remaining cryopreserved oocytes. Forty-seven egg-sharing donors were recruited after having normal deliveries and they donated their remaining oocytes, totalling 395 cryopreserved oocytes, to 75 recipients. The survival rate of vitrified-warmed oocytes was 83.0%. Following insemination by ICSI, the fertilization and cleavage rates were 83.8% and 89.8%, respectively. Out of 75 recipients, 71 recipients completed the treatment cycles and 30 of them became pregnant with clinical pregnancy and implantation rates of 42.3% and 25.5%, respectively. The birthweight of the new-born infants (22 from singleton and two from one set of twins) were 3344.5 ± 669.1g and 2425.0 ± 742.5 g, respectively. No birth defects were observed for the live births. These results indicate that oocyte vitrification is an effective methodology for an egg-sharing donation programme, with acceptable pregnancy and implantation rates.     

Oocyte donation in postmenopausal women: medical and ethical considerations

Although maternal morbidity is increased, reported perinatal outcomes from peri- and postmenopausal pregnancy are generally good. Ethical considerations, in particular those relating to long term wellbeing of the child, constitute the primary reason to restrict the use of donated eggs in postmenopausal women.     

Oocyte and embryo donation 2006: reviewing two decades of innovation and controversy

For over 21 years, oocyte and embryo donation have been used to treat infertility caused by a variety of conditions affecting the ovary. Many disorders, including premature ovarian failure, advanced reproductive age, unexplained recurrent implantation failure and inherited conditions, are amenable to gamete donation, with high pregnancy rates and good obstetrical outcomes observed in recipients. Protocols for the medical screening of recipients and donors, as well as infectious disease and genetic testing, have become relatively uniform and well accepted. Established guidelines allow synchronization of the menstrual cycles of both women to ensure that embryos are transferred to a receptive endometrium. The high demand for donor services has led to escalating costs and long waiting lists. American programmes bid against each other to secure the participation of young women often motivated as much by financial reward as altruism. In the United States, where the majority of oocyte donation is practised, more than 100,000 treatment cycles have occurred. However, to date no meaningful longitudinal studies detailing the long term effects of treatment on donors, recipients, children born, or families created have been published. Throughout its history, oocyte and embryo donation has proven to be both efficacious and clinically innovative, yet remains highly controversial.     

Oocyte morphology does not affect post-warming survival rate in an egg-cryobanking donation program

Purpose  

To evaluate whether oocyte dysmorphisms affect oocyte survival rates in an egg-cryobanking donation program.