Abstract
BackgroundOocyte donation has been associated to gestational diabetes, hypertensive disorders, placental abnormalities, preterm delivery and increased rate of caesarean delivery while simultaneously being characterized by high rates of primiparity, advanced maternal age and multiple gestation constituting the individual risk of mode of conception difficult to assess. This study aims to explore obstetrical outcomes among relatively young women with optimal health status conceiving singletons with donated versus autologous oocytes (via IVF and spontaneously).MethodsNational retrospective cohort case study involving 76 women conceiving with donated oocytes, 150 nulliparous women without infertility conceiving spontaneously and 63 women conceiving after non-donor IVF. Data on obstetric outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from the treating University Hospitals of Sweden. Demographic and logistic regression analysis were performed to examine the association of mode of conception and obstetric outcomes.ResultsWomen conceiving with donated oocytes (OD) had a higher risk of hypertensive disorders [adjusted Odds Ratio (aOR) 2.84, 95 % CI (1.04–7.81)], oligohydramnios [aOR 12.74, 95 % CI (1.24–130.49)], postpartum hemorrhage [aOR 7.11, 95 % CI (2.02–24.97)] and retained placenta [aOR 6.71, 95 % CI (1.58–28.40)] when compared to women who conceived spontaneously, after adjusting for relevant covariates. Similar trends, though not statistically significant, were noted when comparing OD pregnant women to women who had undergone non-donor IVF. Caesarean delivery [aOR 2.95, 95 % CI (1.52–5.71); aOR 5.20, 95 % CI (2.21–12.22)] and induction of labor [aOR 3.00, 95 % CI (1.39–6.44); aOR 2.80, 95 % CI (1.10–7.08)] occurred more frequently in the OD group, compared to the group conceiving spontaneously and through IVF respectively. No differences in gestational length were noted between the groups. With regard to the indication of OD treatment, higher intervention was observed in women with diminished ovarian reserve but the risk for hypertensive disorders did not differ after adjustment.ConclusionThe selection process of recipients for medically indicated oocyte donation treatment in Sweden seems to be effective in excluding women with severe comorbidities. Nevertheless, oocyte recipients-despite being relatively young and of optimal health status- need careful counseling preconceptionally and closer monitoring prenatally for the development of hypertensive disorders.
Highlights
Oocyte donation has been associated to gestational diabetes, hypertensive disorders, placental abnormalities, preterm delivery and increased rate of caesarean delivery while simultaneously being characterized by high rates of primiparity, advanced maternal age and multiple gestation constituting the individual risk of mode of conception difficult to assess
The median age differed between Index women and Control Group A, no significant differences were noted after stratification
It should be noted that the prevalence of these conditions did not differ between the groups with the exception of hypothyroidism (7 oocyte recipients vs 1 in Control Group A and 0 in Control Group B), 40 % of which could be attributed to women with Turner syndrome, possibly due to careful pre-pregnancy screening of Turner women in Sweden [25]
Summary
Oocyte donation has been associated to gestational diabetes, hypertensive disorders, placental abnormalities, preterm delivery and increased rate of caesarean delivery while simultaneously being characterized by high rates of primiparity, advanced maternal age and multiple gestation constituting the individual risk of mode of conception difficult to assess. Several studies have suggested that an increase in the incidence of gestational diabetes [2], hypertensive disorders [3,4,5,6,7,8], placental abnormalities [9], preterm delivery [9] and increased rate of caesarean delivery [9] may be related to this treatment. Pregnancies following oocyte donation are often characterized by high rates of primiparity and multiple gestation [6, 12], factors that might introduce a bias when assessing the association between OD and pregnancy complications
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