Oocyte Donation Pregnancies Research Articles

Oocyte Donation Pregnancies and the Risk of Preeclampsia or Gestational Hypertension

(Abstracted from Am J Obstet Gynecol 2016;214(3):328–339) The objective of this study was to conduct a systematic review and meta-analysis of published literature to establish whether the risk of preeclampsia or gestational hypertension was increased when pregnancies were achieved through oocyte donation rather than through other assisted reproductive technology methods or natural conception. Through literature review, specific eligibility criteria, and quality assessment using the Methodological Index for Non-Randomized Studies (MINORS), 19 of the 523 comparative studies were examined.

A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health.

The fetus is a semi-allograft for the maternal host in natural pregnancy, but the fetus is a complete allograft after oocyte donation (OD), and there is greater antigenic dissimilarity with the mother. Thus, OD pregnancy is a good model for understanding how the fetus is protected by the maternal immune system. Recent clinical data have revealed a higher risk of miscarriage, gestational hypertension, preterm birth, and low birth weight with OD pregnancy. There is also a higher incidence of chorionic deciduitis, dense fibrinoid deposits in the chorionic basal plate, inflammatory lesions in the chorionic plate, and C4d deposition on syncytiotrophoblasts in OD pregnancy. Impaired accumulation of T cells, regulatory T (Treg) cells, natural killer (NK) cells, and monocytes in the decidua basalis and poor remodeling of spiral arteries are observed in OD pregnancy irrespective of whether preeclampsia occurs. These findings may partly explain why OD pregnancy is associated with a high risk of gestational hypertension and preeclampsia. We need to clarify the immunological and pathological differences between uncomplicated and complicated OD pregnancy. In uncomplicated OD pregnancy, the level of HLA match between mother and baby is significantly higher than would be expected by chance, suggesting that miscarriage may be frequent with marked HLA mismatch. This review discusses the relationship between various aspects of the immune system and complications of OD pregnancy.

Maternal and fetal outcomes in oocyte donation pregnancies.

Since the first successful use of donated oocytes in 1984, the number of oocyte donationcycles in Europe and the USA has dramatically increased. Consequently, there has been increasing interest in the impact of oocyte donation on maternal and fetal outcomes. The aim of this review was to summarize the literature regarding maternal and fetal outcomes from pregnancies conceived through oocyte donation. Identification of relevant publications was through research within the Embase Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan. Oocyte donation seems to be independently associated with a higher rate of pregnancy-induced hypertension and pre-eclampsia. An explanatory hypothesis is that an immunological maladaptation causes placenta-mediated disorders in oocyte donation pregnancies. The risks are even higher in twin pregnancies. Oocyte donation also seems to be associated with lower fetal birthweight. However, after adjusting for obstetric complications, most studies report less pronounced differences in birthweight or no dissimilarities. The incidence of cesarean section is increased without clear clinical indications. Oocyte donation pregnancies are associated with a higher rate of placental disorders of pregnancy, such as gestational hypertension and pre-eclampsia. The risk of poorer neonatal outcomes is increased in oocyte donation pregnancies compared to otherin-vitro fertilization pregnancies. Poorer outcomes have been demonstrated especially for twin pregnancies and in association with previous chronic pathologies or the development of obstetrics complications.

Oocyte donation pregnancy, a major challenge for the maternal immune system

Oocyte donation pregnancy, a major challenge for the maternal immune system

Innate immune proteins, SP-A, SP-D and MBL-A, are expressed by murine testicular germ cells and are positively regulated by testosterone

Oocyte donation (OD) enables women with various causes of reproductive failure to conceive, but is accompanied with a high risk for certain pregnancy disorders. Possibly, the allogeneic nature of the fetus in OD pregnancies plays a role in the development of these disorders. In this study, we investigated whether there is a selection for some degree of HLA matching in successful and uncomplicated OD pregnancies. Mothers and children from OD pregnancies that made use of unrelated donors (n=75) were typed for HLA-A,-B,-C,-DR,-DQ and the observed number of HLA matches of the child was compared with the expected number of HLA matches. Moreover, we studied the possibility of a preferential selection for maternal KIR and fetal C combinations. We observed a significantly higher level of HLA matching betweenmother and child than expected by chance. Especially the incidenceof childrenwith5ormoreHLAmatches,which is the situation in autologous pregnancy, was higher than expected. A higher level of matching was shown especially for HLA class I, while no significant differences were observed for the individual HLA loci. With respect to maternal KIR and fetal HLA-C no selection for a favorable combination was found. Larger observational studies including uncomplicated, preeclamptic and aborted pregnancies are essential to determine to what extent HLA matching affects the outcome of OD pregnancies.

Impairment of the accumulation of decidual T cells, NK cells, and monocytes, and the poor vascular remodeling of spiral arteries, were observed in oocyte donation cases, regardless of the presence or absence of preeclampsia

In oocyte donation (OD) pregnancies, a fetus is a complete allograft to the maternal host and OD pregnancies are an independent risk factor for preeclampsia. Immunocompetent cells contribute to spiral artery remodeling and the failure of this process could contribute to the pathophysiology of preeclampsia. Recent data have shown that impaired autophagy of extravillous trophoblasts (EVT) may induce poor vascular remodeling in preeclampsia. We have studied the distribution of T cells, NK cells and macrophages in the decidua basalis of 14 normotensive OD pregnancies, 5 preeclamptic OD cases, 16 normotensive pregnancy cases, and 13 preeclamptic cases in natural pregnancy or autologous oocyte IVF-ET (NP/IVF). The populations of decidual CD3+T cells, CD8+T cells, CD4+T cells, Foxp3+Treg cells, CD56+NK cells, and CD68+ macrophages in preeclampsia were significantly smaller than those in normal pregnancy in NP/IVF. Those frequencies in normotensive OD pregnancies or preeclamptic cases in OD pregnancies were similar to those in preeclamptic cases in NP/IVF. Impaired vascular remodeling was observed in OD pregnancies, regardless of the presence or absence of preeclampsia. The expression of p62, an impaired autophagy marker in EVT of normotensive or preeclamptic OD pregnancies, was significantly higher than that in normal pregnancies in NP/IVF. Immunological change in the decidua basalis and impairment of autophagy in EVT may induce impairment of spiral artery remodeling in OD pregnancies.

STA55. Pathophysiology of preeclampsia from the view point of immunology

Introduction The pathogenesis of preeclampsia remains largely unknown. However, many researches support the immune maladaptation hypothesis. Epidemiological findings show that first pregnancy, the use of barrier contraceptive method or short cohabitation, oocyte donation cases and obesity are the risks for preeclampsia. These factors seem to be independent. Objective We tried to explain the relationship between the epidemiological risks for preeclampsia and immune maladaptation. Method We have studied the immune system in preeclamptic cases and oocyte donation cases using flow cytometry and immunohistochemical examination. Results Human pregnancy represents a semiallograft to the maternal host, therefore tolerance system is required. In oocyte donation cases, all the MHC of the fetus are allograft to maternal host, therefore more strict tolerance system is needed. Nevertheless, our study showed the number of regulatory T (Treg) cells which induce tolerance were scare at fetomaternal interface. Moreover, macrophage, T cell and NK cells that play important roles for vascular remodeling were also scarce in placental bed biopsy samples. Importantly, vascular remodeling was inadequate in oocyte donation cases regardless of the presence or absence of preeclampsia. These findings suggest that macrophage, T cell and NK cells play an important role for vascular remodeling of spiral artery and poor placentation is present in oocyte donation pregnancy. We also showed that effector Treg cells decreased and exhausted Treg cells increased in peripheral blood of preeclampsia. Expression of Bcl-2 in Treg cells was decreased and expression of Bax in Treg cells was increased suggesting that Treg cells in preeclampsia are more likely to die by apoptosis. In our mice model, seminal plasma plays an important role for induction of paternal antigen specific Treg in the uterus. This finding explains barrier contraceptive method or short cohabitation are the risk of preeclampsia. We also showed the positive relationship between BMI and the frequencies of cytotoxic T cells and cytotoxic NK cells. Conclusion These findings support that immune maladaptation is one of the mechanisms of preeclampsia.

Selective advantage of HLA matching in successful uncomplicated oocyte donation pregnancies

Oocyte donation (OD) enables women with various causes of reproductive failure to conceive, but is accompanied by a high risk of certain pregnancy disorders. Possibly, the allogeneic nature of the fetus in OD pregnancies plays a role in the development of these disorders. In this study, we investigated whether there is a selection for some degree of HLA matching in successful and uncomplicated OD pregnancies. Mothers and children from OD pregnancies that used unrelated donors (n=75) were typed for HLA-A, -B, -C, -DR, and -DQ and the observed number of HLA matches of the child was compared with the expected number of HLA matches. Moreover, we studied the possibility of a preferential selection for maternal KIR and fetal C combinations. We observed a significantly higher level of HLA matching between mother and child than expected by chance. In particular, the incidence of children with 5 or more HLA matches, which is the situation in autologous pregnancy, was higher than expected. A higher level of matching was shown, especially for HLA class I, while no significant differences were observed for the individual HLA loci. With respect to maternal KIR and fetal HLA-C no selection for a favorable combination was found. Larger observational studies including uncomplicated, preeclamptic, and aborted pregnancies are essential to determine to what extent HLA matching affects the outcome of OD pregnancies.

First trimester placental markers in oocyte donation pregnancies

IntroductionThis study investigates the hypothesis that placenta works differently in oocyte donation (OD) compared to spontaneous pregnancies. To verify this hypothesis we examine the first trimester maternal serum levels of free β-hCG and pregnancy-associated plasma protein-A (PAPP-A). Then we evaluated for potential differences of Down syndrome screening between OD pregnancies, in vitro fertilization/intracytoplasmic sperm injection pregnancies with autologous oocytes (IVF/ICSI) and spontaneous pregnancies. MethodsWe analyze 13624 spontaneously conceived pregnancies (Controls), 171 oocyte donation pregnancies (OD IVF/ICSI) and 76 IVF pregnancies with autologous oocytes (Autologous IVF/ICSI). Furthermore, we collect a cohort of 802 spontaneously conceived age-matched pregnancies, in order to evaluate how older uteri contribute to explain the changes in markers concentrations (Age-matched controls We compare the multiples of the median (MoM) of free β-hCG and PAPP-A and nuchal translucency. ResultsFree β-hCG levels are significantly higher both in OD IVF/ICSI pregnancies (1.44 ± 1.06 MoM) and Autologous IVF/ICSI (1.48 ± 1.02 MoM) compared to Controls (1.15 ± 0.84 MoM; p < 0.05) and Age-matched Controls (1.18 ± 0.98 MoM; p < 0.05). PAPP-A levels do not significantly differ among the four groups. Significantly lower nuchal translucency is detected in Controls (1.41 ± 0.36 mm) compared to OD IVF/ICSI (1.46 ± 0.44 mm; p < 0.05), in Autologous IVF/ICSI (1.51 ± 0.34 mm; p < 0.05) and Age-matched Controls (1.44 ± 0.42 mm; p < 0.05). DiscussionOocyte donation pregnancies (OD IVF/ICSI) are significantly related to altered maternal serum placenta marker levels. These alterations might be due to the IVF technique.

Preeclampsia in autologous and oocyte donation pregnancy: is there a different pathophysiology?

Oocyte donation (OD) is a specific method of artificial reproductive technology that is accompanied by a higher risk of preeclampsia during pregnancy. The pathophysiological mechanism underlying preeclampsia in OD pregnancies is thought to differ from preeclampsia in autologous pregnancies. As preeclampsia in autologous pregnancies is suggested to be associated with complement activation, we studied C4d deposition, circulating complement components and placental complement regulatory proteins in preeclamptic OD pregnancies. Women with uncomplicated and preeclamptic pregnancies after OD or spontaneous conception were selected. We stained the placentas for C4d, marker for complement activation, measured complement factors C1q, C3 and C4 in maternal sera and quantified the placental mRNA expression of complement regulatory proteins CD46, CD55 and CD59. A significantly (p<0.03) higher incidence of C4d deposition was observed in placentas from women with preeclampsia compared with uncomplicated pregnancies, both OD and autologous. The level of complement factors in serum did not differ between the groups. Children born in the autologous preeclampsia group were significantly lower in birth weight (p<10th percentile) compared with the preeclamptic OD group. In addition, the placental mRNA expression level of complement regulatory proteins was significantly lower in uncomplicated and preeclamptic OD compared with the autologous pregnancies. In line with autologous preeclampsia pregnancies, there is excessive activation of complement in preeclamptic OD pregnancies. However, in contrast to autologous pregnancies this is not associated with counterbalancing upregulation of complement regulatory proteins. Furthermore, C4d deposition in OD pregnancies is not related to the severity of preeclampsia, suggesting another trigger or regulatory mechanism of placental C4d deposition in preeclamptic OD pregnancies.

160-POS

Objectives Allograft pregnancy such as oocyte donation and embryo donation has higher risks of placental complications including preeclampsia. Altered spiral arterial remodeling and the regional T, NK cells and monocyte population characteristics were studied in oocyte donation. Methods Decidua basalis were collected during scheduled cesarean sections from 19 women who conceived by oocyte donation (OD) and 18 women with normal gestation (CTR). Spiral arterial remodeling was studied using extra-villous trophoblastic (EVT) marker CK7 and vascular endothelium marker CD31 by immunohistochemistry. The regional T cell population was studied using CD3, CD8, Foxp3, and CD56 for T cells, cytotoxic T cells, regulatory T cells and NK cells, respectively. Macrophages were stained with CD68. The staining of P62 immunohistochemistry was also included to detect impaired response to oxidative stress by autophagy. The helper T cell count was estimated by subtracting CD8+ cells counts from CD3+ cells counts. Quantitation was done by counting immunopositive cells in 4 high power fields (×100). This study was reviewed and approved by the institutional review boards of Aiiku hospital and University of Toyama. Results When OD is compared to CTR, the vascular endothelium was incompletely replaced by EVT, indicating attenuated remodeling. The regional T cell analysis showed decreased CD3+ (8.83 vs 25.5: median), CD8+ (4.17 vs 12.0), CD4+ (4.63 vs 13.5), Foxp3+ (0.63 vs 2.00) CD56+ (4.00 vs 15.3) and CD68+ (6.25 vs 16.5). P62/CK7 ratio was four times higher in OD than CTR. Conclusions OD pregnancies have inappropriate remodeling of the spiral arteries and decreased regulatory T cell expression, macrophage, NK cells accumulation in the region. The characteristic difference coincided with a decreased autophagy, thus impaired response to oxidative stress. Our novel findings may at least in part be the etiology of the clinically well-known higher incidence of preeclampsia in the oocyte donation gestation. Disclosures Y. Nakabayashi: None. A. Nakashima: None. T. Shima: None. H. Sakamoto: None. T. Adachi: None. T. Okai: None. M. Nakabayashi: None. S. Saito: None.

Recent Developments in Diagnosis and Care for Girls in Turner Syndrome

The past decade produced important advances in molecular genetic techniques potentially supplanting the traditional cytogenetic diagnosis of Turner syndrome (TS). Rapidly evolving genomic technology is used to screen 1st trimester pregnancies for sex chromosomal anomalies including TS, and genomic approaches are suggested for the postnatal diagnosis of TS. Understanding the interpretation and limitations of new molecular tests is essential for clinicians to provide effective counseling to parents or patients impacted by these tests. Recent studies have advanced the concept that X chromosome genomic imprinting influences expression of the Turner phenotype and contributes to gender differences in brain size and coronary disease. Progress in cardiovascular MRI over the past decade has dramatically changed our view of the scope and criticality of congenital heart disease in TS. Cardiac MRI is far more effective than transthoracic echocardiography in detecting aortic valve abnormalities, descending aortic aneurysm, and partial anomalous pulmonary venous return; recent technical advances allow adequate imaging in girls as young as seven without breath holding or sedation. Finally, important developments in the area of gynecological management of girls and young women with TS are reviewed, including prognostic factors that predict spontaneous puberty and potential fertility and recent practice guidelines aimed at reducing cardiovascular risk for oocyte donation pregnancies in TS.

Pregnancy outcome of non-anonymous oocyte donation: a case-control study

ObjectiveTo evaluate the maternal and neonatal outcome of non-anonymous oocyte donation compared to in vitro fertilization.Study design We compared 84 oocyte donation pregnancies with a 251 matched in vitro fertilization cohort. Maternal and neonatal outcomes were retrieved from a nationwide perinatal registry. Oocyte donation and in vitro fertilization pregnancies were matched for maternal age, study center, ZIP code and embryo transfer date. Both maternal and neonatal complications and outcome were compared between oocyte donation and in vitro fertilization with univariate and multivariate logistic regression analyses, adjusting for maternal age, donor age, socio-economic status, ethnicity, and parity. ResultsIn total, 277 women underwent 541 oocyte donation cycles. The median recipient age was 34.9 years (IQR: 31.5–38.5), while the median donor age was 34.4 years (IQR: 31.7–37.0). Clinical pregnancy rate was 26.6%, which is comparable to standard in vitro fertilization treatment. Donor age in years (OR 0.93, 95% CI 0.88–0.99) and a previous pregnancy of the recipient (OR 1.69, 95% CI 1.02–2.78) were significantly associated with clinical pregnancy rate. Both singleton and multiple oocyte donation pregnancies were associated with pregnancy-induced hypertension compared with in vitro fertilization singleton and multiple pregnancies (OR 1.99, 95%CI 1.02–3.89, OR 6.43, 95% CI 1.67–24.72, respectively). No significant differences in neonatal outcome were observed. ConclusionOocyte donation pregnancies are associated with an increased incidence of pregnancy-induced hypertension compared with age-matched in vitro fertilization controls. However, no significant differences in neonatal outcome were observed between oocyte donation and in vitro fertilization.

Classical complement activation in oocyte donation pregnancies complicated by preeclampsia

Classical complement activation in oocyte donation pregnancies complicated by preeclampsia

Uncomplicated oocyte donation pregnancies are associated with a higher incidence of human leukocyte antigen alloantibodies

Downscaled freeze-drying was demonstrated to be a valuable alternative for formulation development and optimization. Although the pore structure is known to exert a major influence on the freeze-drying cycle, little is known about the ones of microscale preparations. This study describes morphology evaluation methods for lysozyme formulations prepared in one microscale processing option and the assessment of fundamental product quality criteria. Scanning electron microscopy (SEM) revealed cooling rate dependent pore size variations at the nucleation site which diminished as the rate increased. Micro-X-ray computed tomography (μ-CT) showed that porosity generally increased in the sample from bottom to top, the pore size fractions shifted toward larger pores in elevated sample levels, and horizontal homogeneity was found throughout each sample with minor deviations in the bottom region. Furthermore, the event of microcollapse could be identified and quantified. Low residual moisture was achieved repeatedly and the procedure did not influence the post freeze-drying bioactivity. This microscale heating stage is a valuable option to reduce overall cycle times and cost, and to prepare freeze-drying formulations with high reproducibility. The mapping tools permit a quick but detailed insight into the structural features resulting from the process environment and processing conditions.

Uncomplicated oocyte donation pregnancies are associated with a higher incidence of human leukocyte antigen alloantibodies

BackgroundFetuses in pregnancies conceived after oocyte donation (OD) have a higher degree of antigeneic dissimilarity with the mother compared to semi-allogeneic fetuses after natural conception. We questioned whether this leads to higher level of HLA antibody formation in OD pregnancies. MethodUncomplicated pregnancies after OD were compared with pregnancies conceived either spontaneously or by IVF. We calculated the number of HLA- and epitope mismatches. Maternal sera were screened for HLA antibodies with ELISA; child HLA specific antibody production was determined using CDC and Luminex with single antigen beads for class I and II. ResultsA significantly (p<0.0001) higher incidence of HLA antibody production was observed in women conceiving after OD (69%) compared to non-donor pregnancies (24–25%). The antibody formation was positively correlated with the number of fetomaternal antigen (Spearman’s rho 0.95, p<0.0001) and epitope mismatches (Spearman’s rho 0.91, p<0.0001). The number of HLA-DR mismatches between women and child was an independent risk factor for the production of HLA class I specific alloantibodies. ConclusionWomen conceiving after OD have a higher risk of developing child-specific HLA antibodies; the higher the number of immunogenetic differences, the higher the chance these antibodies are formed. The high incidence of antibody production also strongly depends upon the number of HLA-DR mismatches. Despite the stronger antibody response, OD was associated with uncomplicated pregnancy in cases included in this study.

Differential immunoregulation in successful oocyte donation pregnancies compared with naturally conceived pregnancies

In oocyte donation (OD) pregnancies, there is a higher level of antigenic dissimilarity between mother and fetus compared with naturally conceived (NC) pregnancies. We hypothesize that a higher degree and/or a different type of immunoregulation is necessary to maintain an uncomplicated OD pregnancy. Different immunological aspects of successful OD pregnancies (n=28) were compared with those of NC pregnancies (n=51), and non-donor IVF (n=20) pregnancies. Maternal peripheral blood mononuclear cells (mPBMCs) were characterized by flow cytometry; the outcome correlated with the number of mother–child HLA mismatches. The fetus-specific alloreactivity of mPBMCs was measured in a mixed lymphocyte reaction. The percentages of CD4+CD25bright and CD4+CD25dim cells were higher in mPBMCs of OD and IVF pregnancies compared with NC pregnancies. The percentage of CD4+CD25dim cells in mPBMCs of OD pregnancies correlated positively with the number of HLA mismatches. Functional studies showed a lower proliferative response to umbilical cord blood by mPBMCs in OD pregnancies. In conclusion, we found a higher degree of peripheral immunoregulation in OD and IVF pregnancies compared with NC pregnancies. A higher number of HLA mismatches in successful OD pregnancies leads to increased percentages of activated T cells in peripheral blood, but not to a higher alloreactivity to the fetus. These studies show that immunoregulation in OD pregnancy is different from that in NC pregnancies. The antigenic dissimilarity in OD pregnancies may play a role in the pathophysiology of preeclampsia.

Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study

What are the obstetric and neonatal outcomes of deliveries after oocyte donation (OD) in women with Turner syndrome (TS)? Pregnancies among women with TS carry a substantial risk, particularly for hypertensive disorders. Potentially life-threatening complications occurred in 3.3% of pregnancies. The neonatal outcomes were generally reassuring, with similar rates of preterm birth and low birthweight (LBW) as after conventional IVF and better than previously reported in deliveries after OD in women with TS. OD pregnancies in women with TS are known to be high-risk pregnancies. This retrospective cohort study included 106 women with TS who delivered after OD (n = 122 deliveries, n = 131 newborns) in three Nordic countries (Finland, Denmark, Sweden) between 1992 and 2011. Women with TS who delivered after OD in three Nordic countries were identified (n = 110). Four women declined to participate or were lost to follow-up, thus 106 women were included in the study. The medical data from fertility clinics, antenatal clinics and the hospitals where the women had been treated and/or delivered were scrutinized. In this cohort, the karyotype was 45,X in 44% of the women with TS. Ten women (9.4%) had a known cardiac defect before pregnancy. Single embryo transfer was performed in 70.3% of the cases and the multiple birth rate was 7.4%. In total, 35.0% of the pregnancies were associated with a hypertensive disorder including pre-eclampsia in 20.5%. Potentially life-threatening complications occurred in four pregnancies (3.3%), including one woman with aortic dissection, one with mild regurgitation of the tricuspid and mitral valve, one with a mechanical heart valve who developed HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) and one who underwent a post-partum hysterectomy due to severe haemorrhaging. Neonatal outcomes were reassuring, with a preterm birth rate of 8.0% and LBW rate of 8.8% in singletons. Major birth defects were found in 3.8% of the children. The perinatal mortality was 2.3% (3/131), including a set of extremely preterm twins. Although this study was performed over a period of almost 20 years in three different countries, with a low drop-out rate and little missing data, much larger series are needed to assess rare events. This study also lacks an appropriate control group. This study suggests that cardiovascular evaluation before and during pregnancy may contribute to favourable obstetric outcomes in many cases. Maternal outcomes were in agreement with the literature while neonatal outcomes were generally better than previously reported. The outcomes were consistent across the three countries, supporting generalizability to similar populations.

Perinatal outcomes in 375 children born after oocyte donation: a Danish national cohort study

To describe perinatal outcomes in children born after oocyte donation (OD) compared with in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and spontaneous conception (SC). National cohort study. Fertility clinics. Three hundred seventy-five children born after OD during the period 1995-2010. None. Mean birth weight, mean gestational age, risks of low birth weight (LBW), preterm birth (PTB), congenital malformations, cesarean delivery, preeclampsia, and admittance to neonatal intensive care unit. We found an increased risk of PTB in OD pregnancies. The adjusted odds ratio (AOR) of PTB in OD singletons was 1.8 (95% CI, 1.2-2.69), 2.5 (95% CI, 1.7-3.6), and 3.4 (95% CI, 2.3-4.9) compared with IVF, ICSI, and SC, respectively. The risk of LBW was also increased. The AOR of LBW was 1.4 (95% CI, 0.9-2.2), 1.8 (95% CI, 1.2-2.8), and 2.6 (95% CI, 1.7-4.0) compared with IVF, ICSI, and SC. The risk of preeclampsia was increased in OD pregnancies with an AOR of 2.9 (95% CI, 1.8-4.6), 2.8 (95% CI, 1.7-4.5), and 3.1 (95% CI, 1.9-4.9) compared with IVF, ICSI, and SC. After additional adjustment for preeclampsia, perinatal outcome improved. Among the twins, the difference between the groups was less pronounced. Pregnancies after OD have a poorer perinatal outcome than those after standard IVF and ICSI mainly because of the high prevalence of preeclampsia.

The effect of paternal age on shared recipient oocyte donation (OD) cycles

ObjectiveShared OD cycles are an ideal model to study the effect of paternal age, since one woman's oocytes are distributed between two couples, each with distinct male partner ages. This study's objective is to determine whether paternal age affects OD outcomes.DesignRetrospective cohort study.Materials and methods332 pairs of recipient couples undergoing shared OD cycles were studied. All 664 couples were initially individually stratified by paternal age (<40, 40-49, ≥50), to compare OD cycle characteristics, semen parameters, implantation rates (IR), and pregnancy rates. Paired analysis was then performed in a subset of shared OD cycles with one male partner ≥50 years old and the other <50, and with one male partner ≥ 50 and the other ≤40. Statistical analyses included one-way ANOVA, Kruskal-Wallis, Wilcoxon, and Chi-square tests.ResultsTabled 1OD Cycle Characteristics by Paternal Age<4040-49≥50P-valueN=17639593Recipient age39.3±5.343.3±2.844.8±2.6<.001# oocytes10.7±4.110.2±4.310.1±3.9NS2PN7.4±3.56.9±3.46.6±2.6NSDay 3 IR0.39±0.40.4±0.40.4±0.4NSDay 5 IR0.57±0.40.6±0.40.67±0.4NSTPR (%)73.170.172.2NSLBR (%)50.553.456.3NS Open table in a new tab ConclusionIn shared OD cycles, increased male age is associated with impaired semen parameters. However, this unique study design, which utilizes a paired analysis of younger and older men that share the same oocyte donor, demonstrates that paternal age does not appear to significantly affect pregnancy outcomes. ObjectiveShared OD cycles are an ideal model to study the effect of paternal age, since one woman's oocytes are distributed between two couples, each with distinct male partner ages. This study's objective is to determine whether paternal age affects OD outcomes. Shared OD cycles are an ideal model to study the effect of paternal age, since one woman's oocytes are distributed between two couples, each with distinct male partner ages. This study's objective is to determine whether paternal age affects OD outcomes. DesignRetrospective cohort study. Retrospective cohort study. Materials and methods332 pairs of recipient couples undergoing shared OD cycles were studied. All 664 couples were initially individually stratified by paternal age (<40, 40-49, ≥50), to compare OD cycle characteristics, semen parameters, implantation rates (IR), and pregnancy rates. Paired analysis was then performed in a subset of shared OD cycles with one male partner ≥50 years old and the other <50, and with one male partner ≥ 50 and the other ≤40. Statistical analyses included one-way ANOVA, Kruskal-Wallis, Wilcoxon, and Chi-square tests. 332 pairs of recipient couples undergoing shared OD cycles were studied. All 664 couples were initially individually stratified by paternal age (<40, 40-49, ≥50), to compare OD cycle characteristics, semen parameters, implantation rates (IR), and pregnancy rates. Paired analysis was then performed in a subset of shared OD cycles with one male partner ≥50 years old and the other <50, and with one male partner ≥ 50 and the other ≤40. Statistical analyses included one-way ANOVA, Kruskal-Wallis, Wilcoxon, and Chi-square tests. ResultsTabled 1OD Cycle Characteristics by Paternal Age<4040-49≥50P-valueN=17639593Recipient age39.3±5.343.3±2.844.8±2.6<.001# oocytes10.7±4.110.2±4.310.1±3.9NS2PN7.4±3.56.9±3.46.6±2.6NSDay 3 IR0.39±0.40.4±0.40.4±0.4NSDay 5 IR0.57±0.40.6±0.40.67±0.4NSTPR (%)73.170.172.2NSLBR (%)50.553.456.3NS Open table in a new tab ConclusionIn shared OD cycles, increased male age is associated with impaired semen parameters. However, this unique study design, which utilizes a paired analysis of younger and older men that share the same oocyte donor, demonstrates that paternal age does not appear to significantly affect pregnancy outcomes. In shared OD cycles, increased male age is associated with impaired semen parameters. However, this unique study design, which utilizes a paired analysis of younger and older men that share the same oocyte donor, demonstrates that paternal age does not appear to significantly affect pregnancy outcomes.