Oocyte Donor Candidates Research Articles

P-714 Prevalence of chromosomal abnormalities in oocyte donor candidates: a French survey of over 8200 karyotypes

Abstract Study question Is karyotyping worth considering for fertile and childless oocyte donor candidates? Summary answer Karyotyping reduces the genetic risk of utilizing oocytes with balanced structural chromosomal rearrangements for recipient couples. What is known already While some countries including France consistently advocate for karyotype to be routinely performed, others suggest it as optional, specifically advising it for donors with a medical history indicating chromosomal rearrangements. Ravel et al. have demonstrated a higher incidence of balanced structural chromosomal rearrangements among 1196 french fertile oocyte donor candidates (FODC) compared to unselected newborns, raising the question whether oocyte donor recruitment could be biased towards chromosomally at-risk women. In 2016, France authorized childless oocyte donor candidates (CODC) to enhance recruitment, yet as of now, there is no reported study on their genetic status. Study design, size, duration A retrospective observational multicentric study conducted from January 2005 to October 2021. Participants/materials, setting, methods ODC were recruited within the French CECOS (Centre d’Etude et de Conservation des Œufs et du Sperme humain) network. Both FODC and CODC were compared to a control group composed of female newborns from literature. Quantitative and qualitative data were expressed as the median [25%–75%] or n (‰), respectively. Non-parametric Mann-Whitney tests were employed for quantitative parameters, while Chi-square tests or Fisher’s exact tests were used, as appropriate, to compare frequencies between groups. Main results and the role of chance A total of 8229 ODC from 22 CECOS centers were included in this study. FODC (n = 6339) and CODC (n = 1890) were compared to 8102 control female newborns. In total, 65 chromosomal abnormalities (7.9‰) were identified, leading to the exclusion of the ODC. This outcome was comparable to the 53 abnormalities observed in the control group (6.54‰, p = 0.3059). The occurrence of balanced structural chromosomal rearrangements was increased in ODC population (4.8‰) compared to controls (2.34‰, p = 0.0086). The occurance of reciprocal translocations was increased 5-fold in CODC (3.70‰) compared to the control group (0.74‰, p = 0.013). The number of gonosomal mosaics was notably increased in FOCD, with 17 cases (2.68‰) compared to the control group with six cases (0.74‰, p = 0.0052). Among chromosomal aberration carriers only two childless women (one reciprocal translocation and one gonosomal mosaïc) had fertility issues in their medical history with a diagnosis of premature ovarian failure. Limitations, reasons for caution This retrospective study was designed to examine ODC within the framework of French bioethics laws. ODC should adhered to specific criteria: being volunteers, anonymous, aged 18 to 38, and without any financial compensation. Since 2016, donors were permitted to retain around 50% of their gametes for personal oocyte cryopreservation. Wider implications of the findings Karyotyping is a straightforward and cost-effective approach to identify structurally balanced chromosomal abnormalities. Thus, chromosomal analysis limits genetic risks whithout resorting to the ethically debated expanded genetic screening in the ODC population. Nevertheless, it is crucial to communicate to gamete recipients the inherent genetic risks associated with any conception. Trial registration number not applicable

Evaluation of Psychiatric Disorders, Personality Characteristics and Intelligence Quotient Among Oocyte Donor Candidates: A Cross-Sectional Study in a Large Referral Hospital

Evaluation of Psychiatric Disorders, Personality Characteristics and Intelligence Quotient Among Oocyte Donor Candidates: A Cross-Sectional Study in a Large Referral Hospital

O-187 The combination of machine learning and pharmacogenetics for the prediction of sub-optimal ovarian response

Abstract Study question Can an artificial intelligence (AI)-based model predict the risk of suboptimal ovarian response using patient genetic data? Summary answer AI-based predictive models can identify relevant predicting factors for suboptimal ovarian response, including several genetic variants. What is known already A substantial proportion of women classified as “normo-responders” may not reach the optimal range of oocytes retrieved after COS. Polyzos and Sunkara (2015) defined a new category of women (15-36%) with a worse prognosis and a “suboptimal” level of ovarian response in which the number of oocytes retrieved ranges between 4 and 9 oocytes. The explanation for this behavior has been suggested to be genetic and indeed variants in FSH receptor and LH subunit-B have been identified that predispose to lower ovarian sensitivity to stimulation. Therefore, these women might require higher doses of gonadotropins or longer stimulations. Study design, size, duration This observational study included a retrospective analysis of 1370 ovarian stimulations from egg donors performed between March 2018 and April 2022. The oocyte donor candidates were selected according to our clinic donation program requirements and ASRM and ESHRE guidelines for oocyte donation. They were stimulated following a progesterone-primed ovarian stimulation protocol. All donors started stimulation with 150-300 IU/day of FSH according to AFC and BMI. A GnRH agonist was used for final oocyte maturation. Participants/materials, setting, methods Oocyte donors were healthy women between 18 and 35 years old (n = 504). In order to establish the predictive machine learning models, patient characteristics and controlled ovarian stimulation data were recorded in a data frame. In addition, donors were genotyped for 31 variants corresponding to 16 genes associated with ovarian response. The association between the different variables and risk of suboptimal ovarian response was analysed using SPSS (v23.0) and R (v. 4.2.0) statistical software. Main results and the role of chance The oocyte donors had a mean age of 25.4±4.0 and a high ovarian reserve (AFC: 18.4±7). The mean number of oocytes retrieved after ovarian stimulation was 16.3±7.5, of which 13.1±6.4 were mature. Despite being young women with good ovarian reserve, 16.4% of the stimulations were suboptimal (4-9 oocytes retrieved). Classical statistical method (binary logistic regression) and 5 different supervised classification machine learning algorithms (multi-layer perceptron, support vector-machines, k-nearst neighbors, random forest and eXtreme Gradient Boosting (XGBoost)) were used to establish a prediction model for suboptimal ovarian response. The model with the highest AUC value was the XGBoost (0.876). The accuracy, sensitivity and specificity were 0.798, 0.809 and 0.787 respectively. The variables that had the greatest predictive power in the best machine learning algorithm (XGBoost) were: age, BMI, AFC and total gonadotrophin dose. In addition, four genetic variants were identified that modified the risk of a suboptimal ovarian response: -ESR2 (oestrogen receptor; c.*39G>A). -LHB (LH beta subunit; c.82T>C/p.Trp28Arg). -SOD2 (superoxide dismutase; c.47T>C/p.Val16Ala). A mitochondrial enzyme that catalyses the detoxification and protection against redox damage that can occur in COS. -and TP53 (tumour suppressor protein; c.215C>T/p.Pro72Leu) that exerts a protective effect on DNA damage in folliculogenesis. Limitations, reasons for caution Our investigation was performed with retrospectively collected data, and hence it will be of importance to collect data prospectively to confirm that the new identified variants are associated with suboptimal ovarian response also in the IVF population. Wider implications of the findings The combination of AI and pharmacogenetics has led to the identification of genetic variants that might predispose to suboptimal ovarian response. Women who carry these variants (erroneously considered as normo-responders) could be candidates for personalization of their ovarian stimulation treatment with higher doses of gonadotrophins and/or longer stimulations. Trial registration number Not applicable

Candidates selection for oocyte donation in a public gamete bank-Predictive value of the anti-Müllerian hormone.

Infertility treatments with oocyte donation are becoming frequent. Recruitment of oocyte donors is a demanding and costly process and therefore of crucial importance. The selection of the oocyte donors undergoes a rigorous evaluation process of the candidates with routine measurement of the anti-Müllerian hormone (AMH) levels (ovarian reserve test). Our aim was to assess whether AMH levels could act as a good marker as tool to select the donor candidates and correlate them with the ovarian response to stimulation with a gonadotropin-releasing hormone antagonist protocol as well as to identify and validate the appropriate AMH level threshold by correlating it with the number of oocytes retrieved. A retrospective analysis of the oocyte donors' clinical records was performed. The mean age of the participants was 27 years. The ovarian reserve evaluation showed a mean AMH of 5.20 ng/mL. An average number of 16 oocytes was retrieved (12 mature oocytes MII). AMH levels showed a statistically significant positive correlation with the number of total oocytes retrieved. A threshold value of AMH = 3.2 ng/mL predictive of the retrieval <12 oocytes (areas under the curve, 0.7364; 95% confidence interval: 0.529-0.944) was identified by receiver operating characteristic curve. Using this cutoff, the normal response (12 oocytes) was predicted with a sensitivity of 77% and a specificity of 60%. The measurement of AMH may be a determining factor in the choice of the oocyte donor candidates to maximize the response to requests from beneficiaries who require donor oocytes to perform assisted reproductive technique cycles.

O-144 Adverse pregnancy and neonatal outcomes in an oocyte donation program. Expanded Carrier Screening can substantially decrease the risk of recessive conditions

Abstract Study question How frequent are adverse outcomes in oocyte donation (OD) programs and how many recessive conditions can be prevented with the implementation of expanded carrier screening(ECS)? Summary answer Adverse outcomes were reported only in 1.55% of cases. ECS prevented 2.66% autosomal recessive and X-linked-conditions, interpreted in a 63% decrease in adverse outcomes. What is known already Nowadays, oocyte donors undergo a rigorous selection process, including the evaluation of genetic risks. ECS has been widely implemented in the screening of gamete donors. Nevertheless, pregnancies conceived after OD cycles are still at risk for genetic adverse outcomes. There are very few reports in the literature regarding children born with an inherited genetic condition from a gamete donor, and they are reported in sperm donation-conceived offspring. To our knowledge, there is no published review of genetic adverse outcomes in oocyte donation offspring so far. Study design, size, duration This is a retrospective observational study that analyses the adverse events reported in 4573 OD cycles carried out between January 2014 and December 2021 in the Reproductive Medicine Unit of Dexeus University Hospital. The study also reviews the number of high-risk assignations that has been identified in the OD program where ECS was applied to the oocyte donors and the recipient’s male partner to avoid high-risk assignations. Participants/materials, setting, methods The study includes patients who underwent OD cycles and reported an adverse outcome with a potential genetic aetiology from 2014 to 2021. Moreover, genetic matchings were revised in the OD program and high-risk assignations were defined as matchings where oocyte donors and recipients’ male partners were carriers of the same autosomal recessive condition or as matchings where oocyte donor candidates were found to be carriers of X-linked conditions. Main results and the role of chance A total of 4.573 OD cycles were performed, including 1696 oocyte donors. Seventy-one recipients (1.55%) reported an adverse outcome of the pregnancy or children born from the OD. A confirmed genetic aetiology was reported in 23 (32.4%) cases including chromosomal abnormalities, microduplications and monogenic disorders. The reported remaining cases were due to congenital malformations, stillbirth, neurodevelopmental disorders, and other conditions for which a genetic aetiology has not been established to our knowledge. Moreover, we identified 211 (4.6%) high-risk assignations due to oocyte donors and recipient’s male partners being carriers of the same autosomal recessive condition when initially assigned, which would have led to an additional 1,15% of children born with an autosomal recessive conditions (25% of 4.6% high-risk assignations). Additionally, we rejected 52 (3.07%) oocyte donor candidates that were carriers of X-linked conditions, which would have led to an additional 1.5% of children born with an X-linked disorder. Based on our results, implementation of ECS, resulted in 63% risk reduction in adverse outcomes observed in our oocyte donation program from a potential adverse event rate of 4.2% to an actual 1.55% incidence of adverse outcomes. Limitations, reasons for caution The actual number of adverse outcomes and high-risk assignations in an OD program could be underestimated given that not all patients report the adverse outcome or in some cases adverse events have not yet developed. Additionally, the number of rejected/avoided high-risk assignations in ECS is not always collected. Wider implications of the findings This study provides evidence that ECS reduces the probability that children born from OD could inherit some autosomal recessive or X-linked conditions. However, there are still several genetic adverse events that cannot be avoided by implementing ECS, mostly caused by de novo monogenic changes, chromosomal abnormalities, or congenital malformations. Trial registration number Not applicable

Evaluation of oocyte donor candidates by genetic counselor

Evaluation of oocyte donor candidates by genetic counselor

Effect of follicle-stimulating hormone receptor N680S polymorphism on the efficacy of follicle-stimulating hormone stimulation on donor ovarian response

The aim of this study was to investigate whether N680S FSHR polymorphism has a predictive value for the ovarian response to stimulation with gonadotropins and cycle outcome in our egg donor program. The oocyte donor candidates were selected according to the Instituto Bernabeu egg donation program requirements and ASRM and ESHRE guidelines for oocyte donation. The FSHR polymorphism N680S was studied in 145 oocyte donors. All donors underwent controlled ovarian hyperstimulation (COH) (n=355) using urinary follicle-stimulating hormone in a GnRH antagonist protocol and receiving a GnRH agonist triggering. The main outcome measures were oocyte yield, days of stimulation, gonadotropin doses, biochemical pregnancy, ongoing pregnancy, and miscarriage rates. Significant differences were reported in the antral follicle count (16.5 ± 5.0 for NN, 14.5 ± 4.7 for NS, and 14.1 ± 3.8 for SS), number of eggs retrieved (21.5 ± 9.2 for NN, 18.5 ± 8.2 for NS, and 19.8 ± 8.9 for SS), and gonadotropin doses (2098.5 ± 639.4 IU for NN, 2023 ± 490.1 IU for NS, and 2149.5 ± 552.3 IU for SS) between the genotypes. The clinical outcome was not affected by the N680S polymorphism of the FSHR gene in the egg donors. In a population of fertile egg donors, the FSHR gene polymorphism at position 680 is associated with different ovarian responses to COH. The genotype of the FSHR gene is an important factor for determining the prognosis of the COH cycles in normo-ovulatory fertile women.

FMR1-dependent variability of ovarian aging patterns is already apparent in young oocyte donors

BackgroundHypothesizing that redundant functional ovarian reserve (FOR) at young ages may clinically obfuscate prematurely diminished FOR (PDFOR), we investigated in young oocyte donors genotypes and sub-genotypes of the FMR1 gene, in prior studies associated with specific ovarian aging patterns, and determined whether they already at such young age were associated with variations in ovarian reserve (OR). We also investigated racial as well as FMR1 associations with menarcheal age in these donors.MethodsIn a cohort study we investigated 157 oocyte donor candidates and, based on the 95% CI of AMH, divided them into normal age-specific (AMH greater or equal to 2.1 ng/mL; n = 121) and PDFOR (AMH < 2.1 ng/mL; n = 36). We then assessed associations between numbers of trinucleotide repeat (CGGn) on the FMR1 gene and FOR (based on anti-Müllerian hormone, AMH).ResultsFMR1 did not associate with AMH overall. Amongst 36 donors with PDFOR, 17 (42%) presented with at least one low (CGGn < 26 ) allele. Remaining donors with normal FOR presented with significantly more CGGn greater or equal to 26 (73.6% vs. 26.4%; P = 0.024) and higher AMH (P = 0.012). This finding was mostly the consequence of interaction between FMR1 (CGGn < 26 vs. CGGn greater or equal to 26) and race (P = 0.013), with Asians most responsible (P = 0.009). Menarcheal age was in donors with normal FOR neither associated with race nor with FMR1 status. In donors with PDFOR race was statistically associated with CGGn (P = 0.018), an association primarily based on significantly delayed age of menarche in African donors with CGGn < 26 in comparison to African donors with CGGn greater or equal to 26 (P = 0.019), and Caucasian (P = 0.017) and Asian donors (P = 0.025) with CGGn < 26.ConclusionsCGGn on FMR1 already at young ages affects FOR, but is clinically apparent only in cases of PDFOR. Screening for low FMR1 CGGn < 26 at young age, thus, appears predictive of later PDFOR.

Comparison of ovarian FMR1 genotypes and sub-genotypes in oocyte donors and infertile women

We recently described ovarian genotypes and sub-genotypes of the FMR1 gene with distinctly associated ovarian aging patterns, which in infertile women follow a typical X-linked distribution pattern. Whether normally fertile women, however, also demonstrate the same distribution, is unknown. We, therefore, investigated ovarian FMR1 genotype and sub-genotype distribution in 182 oocyte donor candidates in comparison to 339 infertile controls. As previously reported, genotype designation was made, based on a normal range of CGG ( n = 26-34) (median 30), defining women as normal (norm), heterozygous (het) or homozygous (hom). Het and hom genotypes were further subdivided into sub-genotypes, based on whether abnormal alleles were above (high) or below normal range (low). Oocyte donors presented with 47.8% norm, 45.1% het and 7.1% hom genotypes, confirming a typical X-linked distribution pattern. They, however, still subtly differed from infertility patients, especially in het sub-genotypes. These findings validate recently newly described ovarian genotypes and sub-genotypes, reaffirming their relevance to female fertility/infertility.

Intermediate and normal sized CGG repeat on the FMR1 gene does not negatively affect donor ovarian response

Fragile X syndrome is associated with low ovarian reserve and poor ovarian response. The aim of this study was to investigate whether CGG repeats on the fragile X mental retardation 1 (FMR1) gene have predictive value for ovarian response to stimulation with gonadotrophins and for clinical outcome in our oocyte donation program. Oocyte donor candidates were selected according to Instituto Bernabeu oocyte donation program requirements. Fragile X genetic screening was performed in 204 oocyte donors, defining 141 controls and 63 cases: 35-39 repeats (n = 34), 40-45 (n = 12) and >45 (n = 17). All the patients underwent ovarian stimulation using a GnRH antagonist protocol and received a GnRH agonist trigger. The main factors used to measure outcome were oocyte yields, days of stimulation, gonadotrophin dosages, biochemical pregnancy, ongoing pregnancy and miscarriage rates. No differences between the study group and controls were reported in oocyte yields (17.5 versus 18.9) or days of stimulation (11.40 versus 9.82). The control group used significantly more gonadotrophin (2212 versus 1850 IU) than the study group. Clinical outcome was not affected by the CGG repeats on the FMR1 gene in oocyte donors. No negative effect was observed for intermediate-sized CGG repeats on ovarian stimulation and clinical outcome using a non-confounding model of oocyte donation. These results disagree with previous studies performed on infertility patients. Owing to the present study, fragile X genetic screening should not be considered for prediction of response to ovarian stimulation.

Mood disorders in oocyte donor candidates: brief report and implications for future research

BACKGROUND IVF, using donor oocytes, has become increasingly common. The donation procedure carries psychiatric risks, including depression, anxiety and rarely, psychosis, and this risk increases when there is a past history of psychiatric illness. We report on the psychiatric status, at intake assessment, of a group of candidate oocyte donors. METHODS The authors reviewed clinical records of 63 women continuously presenting to a University medical center for psychiatric evaluation as part of the screening process for oocyte donation. A board certified psychiatrist administered a structured clinical interview to candidate donors, and self-report measures were obtained from 28 women. RESULTS There was a significant discrepancy between psychiatric history of depression and current mood status, as measured by both clinical interview and psychometric self-report data. Nearly one-quarter of candidate donors (22%) reported a history of major depressive disorder; however, all candidate donors denied current mood disturbance on clinical interview, and mean Beck depression inventory and profile of mood states scores were lower than expected compared with psychometric norms (P < 0.0005), epidemiological data and the recurrent nature of depressive disorders. CONCLUSIONS Candidate donors may minimize psychiatric symptoms. Given the potential for ovarian stimulation protocols to induce or exacerbate mood symptoms, and the moderate heritability of mood disorders, careful evaluation of candidate donor affective disorder history is recommended. This evaluation should focus on sensitivity to mood destabilization during times of hormonal change. Measures that examine whether a candidate donor may have a tendency to present herself in an overly favorable manner, and/or a tendency to minimize symptoms, are recommended.

Evaluating the necessity for universal screening of prospective oocyte donors using enhanced genetic and psychological testing

To minimize the potential for harmful inheritable conditions, donors are rigorously screened according to standard guidelines, yet such guidelines may not be sufficient to exclude egg donors with certain known inheritable conditions. We compared universal screening of oocyte donors with Tay-Sachs, Fragile X, karyotype and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) versus standard American Society of Reproductive Medicine (ASRM) guidelines that do not include such testing. In this 12 year retrospective cohort study, results of enhanced universal screening of all anonymous oocyte donor candidates from 1997 to 2008 at a university hospital oocyte donation program were reviewed. Primary outcomes were the frequency of oocyte donor candidates excluded as a result of enhanced universal screening (Tay-Sachs, Fragile X, karyotypic analysis and MMPI-2) versus basic screening according to ASRM guidelines. Of 1303 candidates who underwent on-site evaluation, 47% passed the screening process, 23% were lost to follow-up and 31% were excluded. Genetic and psychological factors accounted for the most common reasons for candidate exclusion. Enhanced genetic screening excluded an additional 25 candidates (19% of all genetic exclusions) and enhanced psychological screening excluded an additional 15 candidates (12% of all psychological exclusions). Altogether enhanced screening accounted for 40 candidates (10%) of the total pool of excluded candidates. Although our study is limited by its retrospective nature and center-specific conclusions, we show that enhanced comprehensive screening can exclude a significant number of candidates from an oocyte donor program and should be encouraged to assure optimal short-term and long-term outcomes for pregnancies achieved through oocyte donation.

Follow‐up assessment of excluded oocyte donor candidates

In 2005 16,161 fresh and frozen egg donation embryo transfer cycles were performed in the U.S.A. Use of egg donation continues to increase and, as such, the number of women who apply to be egg donors will also increase. Up to 44% of women who apply to be egg donors will ultimately be rejected. We suggest that women pursuing egg donation may not anticipate that they may be excluded from the program. Further, we suggest that many of them are unprepared to receive the information that they have been rejected from an egg donor program based on either medical or psychological grounds. In this brief report, we share our clinical experiences with women who were rejected from our egg donation program. We suggest that egg donation programs have an ethical obligation to follow up with women they have rejected from their program. This paper reports on the experiences of the excluded donors from our clinic and reveals that being excluded creates a negative emotional impact which can include disappointment, fear, anger, and sadness. For most excluded donors this reaction is short-term but for some it is more long-lasting and more seriously upsetting. The scope of this paper is limited in that it reports on clinical experiences rather than results of a controlled study. This paper suggests that researchers and clinicians have an ethical obligation to follow up with rejected donors to assess and address the emotional impact of being excluded from a donor program.

The potential applicability of neuropsychological evaluation for oocyte donors

The aim of this study was to investigate the applicability of neuropsychological testing identifying cognitive factors of candidates for the anonymous oocyte sharing donation program. Prospective study evaluating testing applicability 24 subfertile women applied for IVF treatment (group A) and were willing to share their oocytes as part of the compensation agreement for assisted conception treatment. Besides good health and women's chronology (<32 yr), all volunteers suffered from either tubal or male factor infertility. Neuropsychological tests focused on the investigation of attention, learning abilities, memory, visual-spatial organization, mental flexibility, and intelligence (IQ). Neuropsychological results of these women were compared to a sample of 25 healthy fertile female volunteers (group B) using Student's t test and p<0.05 was considered significant. There were no significant differences between group responses regarding learning abilities, memory and visual-spatial organization. Women who were candidates for oocyte donation exhibited a significantly higher incidence of attention deficits (12.6 ± 2.4 vs 16.5 ± 2.2; p<0.02), although they had significantly greater scores on mental flexibility (3.2 ± 1.1 vs 2.1 ± 0.7; p<0.02) and IQ (111.05 ± 10.5 vs 98.3 ± 9.4; p<0.01). Two patients were considered not suitable for oocyte donation because neuropsychological testing revealed signs of attention-deficit hyperactivity disorder (ADHD) and epilepsy, which were latter confirmed. None of these diagnoses had been previously informed by the patients to the infertility specialist during the history and work-up procedures. The attention deficit presented in the oocyte donor candidates could be resulting from the interference of circumstantial anxiety. These prospective patients depend upon the results of an infertility treatment to remain in the program which is in itself highly stressful. The findings regarding greater mental flexibility in this sample suggest that this could be an essential feature for these women to endure this combined treatment (infertility treatment and the simultaneous oocyte donation). These findings reveal that neuropsychological testing can be a useful complementary instrument in the evaluation of candidates for oocyte donation and third-party assisted reproduction. Additional data should provide evidence to make neuropsychological testing as an integral part of the evaluation protocol to third-party reproductive candidates.

Psychological characteristics of sister oocyte donor candidates: A comparison against anonymous donor candidates using the MMPI-2

Psychological characteristics of sister oocyte donor candidates: A comparison against anonymous donor candidates using the MMPI-2

Psychological characteristics of egg donors: MMPI-2 profiles of 436 anonymous oocyte donor candidates

Most ART clinics routinely offer oocyte donation for women who are unable to use their own eggs to achieve a pregnancy. However, because previous research studies utilized small sample sizes, little is really known at present about the psychological and psychosocial characteristics of potential ovum donors. In recent years, protocols have been established to screen and counsel donor candidates. Psychological assessment of potential donors is recommended by The American Society of Reproductive Medicine (ASRM) and is an important aspect of the mental health professional’s role in the infertility setting. Research into the personality profiles of ovum donor candidates using The Minnesota Multiphasic Personality Inventory (MMPI) has been limited and inconsistent. Early research concluded that potential donors tended to be psychologically conflicted while subsequent research revealed that donor profiles fell soundly within normal limits.

Psychological screening of prospective oocyte donors

Objective: To report our experience with psychological screening of potential oocyte donor candidates and to assess the frequency with which psychological issues resulted in the exclusion of donor candidates.Design: Retrospective analysis of the psychological screening outcomes for anonymous oocyte donor candidates from 1997 to 2001 at a large university-based oocyte donation program.Materials/Methods: Psychological evaluation of potential oocyte donation candidates included testing with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as well as a clinical interview with a staff psychologist.Results: Of 607 potential donor candidates, 63 were rejected based on psychological testing results and a clinical interview. Candidates could be excluded based on their family’s histories or their own personal history. Eighteen candidates were excluded because of a significant family history of mental illness, suicide, substance abuse, criminal arrest, or learning disabilities. Alcohol abuse or learning disabilities evident in two or more family members including grandparents, aunts, uncles, first cousins and immediate family members was necessary for exclusion. Forty-five candidates were excluded based on their personal histories for the above criteria. Other reasons for exclusion in these cases included unresolved issues as a result of physical or sexual abuse, misrepresentation in the clinical interview, immaturity, or marital dispute about ovum donation. Of the 63 cancelled donors, only 6 donors were eliminated based on MMPI-2 findings alone, and in each case the clinical interview validated the test results. An additional five candidates who would have been excluded by the psychological screening were cancelled for genetic or medical reasons. Thus, 68 (11%) of the oocyte donor applicants had psychological findings that excluded them from proceeding with the donation.Conclusions: Psychological testing and a clinical interview may exclude a significant number of donor candidates in an ovum donor program. Screening should be encouraged to optimize the donor’s experience and safety and to minimize negative outcomes in pregnancies achieved through oocyte donation.Supported by: None. Objective: To report our experience with psychological screening of potential oocyte donor candidates and to assess the frequency with which psychological issues resulted in the exclusion of donor candidates. Design: Retrospective analysis of the psychological screening outcomes for anonymous oocyte donor candidates from 1997 to 2001 at a large university-based oocyte donation program. Materials/Methods: Psychological evaluation of potential oocyte donation candidates included testing with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as well as a clinical interview with a staff psychologist. Results: Of 607 potential donor candidates, 63 were rejected based on psychological testing results and a clinical interview. Candidates could be excluded based on their family’s histories or their own personal history. Eighteen candidates were excluded because of a significant family history of mental illness, suicide, substance abuse, criminal arrest, or learning disabilities. Alcohol abuse or learning disabilities evident in two or more family members including grandparents, aunts, uncles, first cousins and immediate family members was necessary for exclusion. Forty-five candidates were excluded based on their personal histories for the above criteria. Other reasons for exclusion in these cases included unresolved issues as a result of physical or sexual abuse, misrepresentation in the clinical interview, immaturity, or marital dispute about ovum donation. Of the 63 cancelled donors, only 6 donors were eliminated based on MMPI-2 findings alone, and in each case the clinical interview validated the test results. An additional five candidates who would have been excluded by the psychological screening were cancelled for genetic or medical reasons. Thus, 68 (11%) of the oocyte donor applicants had psychological findings that excluded them from proceeding with the donation. Conclusions: Psychological testing and a clinical interview may exclude a significant number of donor candidates in an ovum donor program. Screening should be encouraged to optimize the donor’s experience and safety and to minimize negative outcomes in pregnancies achieved through oocyte donation. Supported by: None.

Genetic screening of prospective oocyte donors

Objective: To report our experience with genetic screening of oocyte donor candidates and to determine the frequency with which significant genetic issues are identified. Design: Prospective genetic screening of oocyte donor candidates. Setting: University hospital oocyte donation program. Patient(s): Women presenting consecutively as volunteer oocyte donors. Intervention(s): Genetic screening was performed by pedigree analysis and laboratory studies. Main Outcome Measure(s): Inclusion in the oocyte donor pool based on the results of clinical evaluation and laboratory tests consisting of polymerase chain reaction–based mutational analysis for cystic fibrosis carrier status, cytogenetic analysis for karyotype, enzymatic assay for Tay-Sachs disease carrier status, and complete blood count and hemoglobin electrophoresis. Result(s): Eight (11%) of 73 oocyte donor candidates were excluded from the donor pool because of a potentially serious genetic finding. Cystic fibrosis mutations were identified in 5 candidates (7%), abnormal karyotypes were found in 2 (3.5%), and an autosomal dominant skeletal dysplasia was identified in 1 (1.4%). Conclusion(s): A significant proportion of women who present as candidates for oocyte donation are inappropriate for donation because of their genetic history or genetic testing results. A thorough genetic evaluation, including a history and laboratory screening, is essential to any oocyte donation program to maximize positive outcomes in pregnancies achieved through assisted means.