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Egg Donation and PGS
Oocyte donation offers women in menopause, women with premature ovarian failure and women with diminished ovarian reserve the opportunity to not only become parents but also to carry a pregnancy. Oocyte quality and quantity decline substantially as a woman ages (and in some instances even before a woman ages); this decline is often the cause of many women’s fertility struggles. Despite marked improvements in IVF techniques, we are often unable to fix diminished egg quality and quantity, and therefore in order to achieve a pregnancy, oocyte donation is required.
With this technology, oocytes are obtained from a younger woman (the donor) and donated to another woman (recipient) to allow the recipient to have a child. To obtain oocytes, the donor is given medications to stimulate her ovaries to produce multiple oocytes; these oocytes are then extracted and fertilized. Increased awareness surrounding oocyte donation and infertility combined with increased success with the technique has led to a significant and steady increase in the number of oocyte donation cycles performed in the United States. According to The Society of Assisted Reproductive Technologies (SART), in 2013, there were 8,921 fresh oocyte donation cycles and 10,399 frozen oocyte donation cycles performed in the United States; in nearly 53% of these cycles, babies were born. In our center, success rates were greater than 60% for fresh oocyte donation cycles…simply stated this technique works!
Historically, when using donor eggs to achieve a pregnancy, multiple embryos were transferred into the uterus of a recipient. While this practice improved success rates, it often resulted in a substantial incidence of high order multiple gestations (twins, triplets and sometimes more!) Although “multiples” are often seen as a “two-fer” or “two for the price of one”, they can be quite risky and fraught with complications to both the mother and the babies. Multiple gestations are at increased risk for preterm labor/preterm delivery (NICU admissions), neonatal morbidity/mortality, gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, anemia, hemorrhage, and post-partum depression.
Recently, there has been a strong push in to reduce the incidence of multiple gestations by limiting the number of embryos transferred, particularly in oocyte donation cycles. Single embryo transfers, in appropriate candidates, are often met with only a modest reduction in pregnancy rate, but a significant reduction in multiple gestations.
To further enhance the success of single embryo transfer oocyte donation cycles, PGD/PGS (comprehensive chromosomal screening) can be performed and the genetic status of the embryo evaluated. While an embryo’s appearance (how it looks to the embryologist under the microscope) can provide a great deal of information about its ability to achieve a pregnancy, we are limited in our ability to differentiate between a euploid (chromosomally normal; 46XX or 46XY) and an aneuploid (chromosomally abnormal; ex. 47XY or 45X0) . Aneuploid embryos (embryos with the incorrect number of chromosomes) will often result in embryo transfers that either do not result in a pregnancy or result in a pregnancy that goes on to miscarry. Failed cycles can be both emotionally and physically taxing and therefore any technique to enhance success and reduce miscarriage is highly desirable. PGD/PGS appears to be a viable solution to this problem. A single screened “normal” embryo has a very high chance of achieving a health singleton pregnancy for a recipient. Without sacrificing success rates, we can “deliver” one healthy baby at a time!