Health and development of children born after oocyte donation compared with that of those born after in-vitro fertilization, and parents' attitudes regarding secrecy

The health, growth and development of a cohort of children (n = 59) aged 6 months to 4 years and born after oocyte donation (OD) was compared with that from a group of children born after in-vitro fertilization (IVF) (n = 126). The study was performed by questionnaire, and the response rate was 100% in the OD group and 95% in the IVF group. All OD children were healthy. Three IVF children had a neurological disorder. Surgical intervention had been carried out in 8% of the OD and 13% of the IVF children. Height and weight development were normal, and eating and sleeping disorders were uncommon in both groups of children. The IVF mothers more often expressed concern about the child's behaviour than did the OD mothers. Thirty-eight percent of the OD parents and 60% of the IVF parents intended to tell the child about the nature of its conception (P < 0.01). Although oocyte recipients appear to have more complications during their pregnancies than conventional IVF patients, the general health status of OD children aged <5 years is at least as good as that of IVF children. Growth and development in both groups of children is similar to that of the general population.      

Low-dose aspirin in prevention of miscarriage in women with unexplained or autoimmune related recurrent miscarriage: effect on prostacyclin and thromboxane A2 production

Early pregnancies in women with a history of recurrent spontaneous abortion (RSA) are accompanied by a deficiency in vasodilatory and anti- aggregatory prostacyclin (PGI2) and/or overproduction of its endogenous antagonist thromboxane A2 (TXA2). We evaluated the effect of a low-dose aspirin (LDA) on PGI2 and TXA2 production and on pregnancy outcome in RSA women with and without detectable anticardiolipin antibodies (ACA). Of 82 RSA women studied, 66 became pregnant, and of them, 33 (six with elevated and 27 with normal ACA concentrations) were randomized to receive LDA (50 mg/day) and 33 (six with elevated and 27 with normal ACA concentrations) to receive placebo (PLA) from a mean of 6.6 days after the missed period to delivery. Treatment with LDA inhibited platelet TXA2 production similarly in RSA women with and without detectable ACA and with continuing pregnancies (7.0 +/- 0.7 ng/ml, LDA group versus 254.5 +/- 37.8 ng/ml, PLA group, mean +/- SEM, P < 0.0001) or miscarrying pregnancies (13.8 +/- 3.8 ng/ml compared with 233.6 +/- 59.8 ng/ml, P < 0.0001 respectively). Furthermore, LDA decreased urinary excretion of the TXA2 metabolite (2,3-dinor-TXB2) both in pregnancies which went to term (6.1 +/- 0.6 ng/mmol creatinine, LDA group versus 19.3 +/- 3.0 ng/mmol creatinine, PLA group, P < 0.0001) or again ended in miscarriage (4.7 +/- 0.8 ng/mmol creatinine versus 17.3 +/- 4.4 ng/mmol creatinine, P < 0.0001 respectively), but did not affect the excretion of the prostacyclin metabolite (2,3-dinor-6-keto- PGF1alpha). Early pregnancy ultrasound examination revealed a living fetus in 58 women. Of these, seven in the LDA group (23.3%, four with elevated and three with normal ACA concentrations) and five in the PLA group (17.9%, two with elevated and three with normal ACA concentrations; not significant) experienced a miscarriage. All infants were healthy, and the frequency of growth retardation was similar in both groups (13.0%). One woman in the LDA group (4.3%) and three women receiving PLA (13.0%) developed pre-eclampsia (not significant). Therefore, although treatment with LDA caused a desirable biochemical effect, it did not improve pregnancy outcome in RSA women with or without detectable ACA.      

Levonorgestrel-releasing intrauterine device can be used in oocyte donors during ovarian stimulation

Seven oocyte donors with a levonorgestrel-releasing intrauterine device (LNG-IUD) in situ (group A) underwent ovarian stimulation with human menopausal gonadotrophin (HMG) after goserelin down-regulation, in eight treatment cycles. The donors in a control group (group B, n = 16) were comparable in age, body mass index and parity characteristics. There were no statistically significant differences in response to ovarian hyperstimulation between the two groups. The number of oocytes recovered was 12.4 +/- 5.1 (SD) following stimulation with 27.9 +/- 9.3 ampoules of HMG over 11.2 +/- 1.3 days in group A. Following stimulation with 26.2 +/- 6.3 ampoules of HMG over 11.0 +/- 1.0 days, the number of oocytes collected was 13.9 +/- 10.4 in group B. The fertilization rate (2PN/cell) of cells in group A was 63% (62/99) and in group B, 53% (117/220, not significant). The cleavage rate of cells in group A (60%, 59/99) was significantly higher than in group B (47%, 104/220) (P <0.05). On average, two embryos were transferred per cycle. In group A, the pregnancy rate per transfer was 40% (4/10) and in group B, 29% (6/21; not significant). In conclusion, LNG-IUD can be used as a contraceptive method during ovarian stimulation of volunteer oocyte donors.      

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.     

Obstetric and perinatal outcome after oocyte donation: comparison with in-vitro fertilization pregnancies

The obstetric and perinatal outcome in 51 oocyte donation pregnancies (61 infants) was compared with that of a control group of standard in- vitro fertilization (IVF) patients (97 pregnancies, 126 infants). The oocyte recipients (mean +/- SD age 33.5+/-4.7 years) included 39 women with ovarian failure and 12 women with functioning ovaries. In oocyte recipients, first trimester bleeding (53%) occurred significantly more often than in IVF mothers (31%, P < 0.01). Pregnancy-induced hypertension was observed in 31% of oocyte recipients compared with 14% in IVF mothers (P < 0.05). There was no difference in the duration of pregnancies or in the preterm delivery rate between the two groups. When restricting analysis to singleton pregnancies, 63% of oocyte recipients were hospitalized in the antenatal period compared with 29% in the IVF group (P < 0.001). The Caesarean section rate was 57% in the oocyte donation group and 37% in the IVF group (P < 0.05). Birthweight in singleton pregnancies was similar in both groups. The perinatal mortality rate was 3.3% in the oocyte donation group and 0% in the IVF group. In conclusion, oocyte donation pregnancies are associated with an increased risk compared with IVF pregnancies, but the complications are usually manageable and most oocyte recipients experience a good pregnancy outcome.