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Donor Egg Cycles Improve Chances of Successful Pregnancy

October 21, 2013

After the age of 35, your chances of healthy pregnancy decrease, due to a decrease in spontaneous conception and an increase in the chance of miscarriage and late obstetric and perinatal complications according to a recent article published in the Journal of American Medical Association on October 17, 2013. While assisted reproductive technology (ART) allows many women to challenge their biological clock, age-related biological barriers are still difficult to overcome, even with the transfer of multiple embryos. Transferring multiple embryos can increase the chance of pregnancy, but also increases adverse pregnancy outcomes, specifically preterm delivery. Autologous oocyctes, a woman’s own eggs, are associated with ART failure because of age related declines in ovarian reserve, while the use of donor oocytes (donor eggs) from a younger woman increases the probability of conception and live birth in older women. Studies have been inconclusive on the risks of adverse perinatal outcomes with donor eggs.

Infertility clinic outcomes are reported using the National ART Surveillance System (NASS), which is a partnership between the Center for Disease Control and Prevention (CDC), the American Society for Reproductive Medicine (ASRM), and the Society for Assisted Reproductive Technology. Collectively, they report a significant number of donor egg cycles between 2000 (10801) and 2010 (18306). The increase appears to correlate with the number of overall cycles, because the number of cycles in which donor eggs were used only increased from 10.8% in 2000 to 11.5% in 2010. The report did not include the age-specific rate of donor eggs vs. a woman’s own eggs.

An improvement in the proportion of donor cycles resulting in a good perinatal outcome changed from 18.5% in 2000 to 24.4% in 2010. This was associated with an increase in the proportion of donor eggs using frozen embryos (FET) (26.7% to 40.3%) and elective single-embryo transfers (eSet) (0.8% to 14.5%). Single embryo transfers may require more cycles to achieve a pregnancy; however, this is now an option with the increased reliability of FET. Day 5 embryo transfers were noted to have a higher percentage of perinatal outcomes than day 3 transfers (29.6% vs. 23.3%) and eSet transfers were noted to have an even higher percentage than multiple embryo transfers (44.7% vs. 24.9%). Negative influences were associated with tubal or uterine factors or with non-Hispanic black race/ ethnicity of the recipient.

Donor egg cycles with donors younger than 35 are recommended to have a single embryo transfer by the ASRM, yet 85% of recipients disregard that suggestion. This reflected in a higher twin rate using donor eggs vs. a woman’s own eggs (37% vs. 29%). This may be influenced by the fact that only 34% of all ASRM members discuss the benefits of a single embryo transfer with their patients. Of interest is the increased risk of adverse perinatal outcomes in black women using donor eggs, suggesting factors such as poverty and health care do not explain racial disparities in birth outcomes.

With this data, donor egg cycles are likely to remain at a constant rate and possibly even increase.

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