Indexed on: 01 Jul '12Published on: 01 Jul '12Published in: Pregnancy Hypertension
The history of oocyte donation is relatively new in the framework of in vitro fertilization (IVF) techniques, and little has been discussed about the obstetric outcomes of such pregnancies.The aim of this study is to assess the obstetric outcomes of pregnancy following in vitro fertilization with embryo transfer (IVF-ET) using donor oocytes and compare them to the outcomes from autologous IVF-ET and to spontaneous pregnancy in women with advanced age (AMA) to identify possible criticalities and help in counseling women and their doctors.The study included a total of 70 delivered pregnancies. The study group included 14 oocyte donors IVF-ET (d-IVF-ET) from women aged 32-52years. The results from the study group were compared to the next two consecutive deliveries from the autologous IVF-ET (IVF-ET group) (n=28; age 30-46years) and with two more consecutive deliveries from women older than 40years (Advanced Maternal Age: AMA) (n=28, age 40-45years). We evaluated the occurrence of pregnancy-induced hypertension (PIH), preeclampsia (PE), fetal growth restriction (IUGR), the gestational age at birth, placental anomalies, the mode of delivery, birth weight and the neonatal Apgar score. The fetal weight was corrected with the gestational age at the time of delivery according to Gardosi. Statistical analysis was performed with the Chi-squared test.Oocyte donor pregnancies had significantly higher rates of PE (d-IVF-ET 21.4%, IVF-ET 0%, AMA 0%, p<0.011). They also had higher rates of PIH and IUGR (d- IVF-ET 21.4%, IVF-ET 0%, AMA 3.6% p<0.011) (d- IVF-ET 21.4%, IVF-ET 7.1%, AMA 3.6% p<0.011 respectively). We found placental anomalies only in the d-IVF-ET group; the incidence of placental accretism was 28.6%, (p<0.003). There are not significant differences in the gestational age at birth, placental anomalies, the mode of delivery, birth weight and the neonatal Apgar score between the groups.This is the first study that compares the obstetric outcomes of donor pregnancies to the outcomes of autologous IVF-ET pregnancies and to advanced maternal age. The advanced maternal age criterion assumes that most women requiring oocyte donation are older. Hypertensive disorders were surprisingly not related to maternal age or to the in vitro fertilization technique. Obstetricians that deal with pregnancies from oocyte donation need to be aware of the more severe obstetric outcomes, especially placenta accrete and pregnancy-related hypertensive disorders. This warrants close blood pressure monitoring and an accurate placenta ultrasound. All women who conceive through oocyte donation should be counselled as early as the pre-conception period and referred to specific centres for high-risk pregnancies.
Indexed on: 21 Feb '13
Published on: 21 Feb '13 in The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians