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Oocyte donation outcomes at Alpha International Fertility Centre

Introduction Results Conclusions

References1. Lutjen P, Trounson A, Leeton J, Findlay J, et al. The

establishment and maintenance of pregnancy using in vitro fertilization and embryo donation in a patient with primary ovarian failure. Nature 1984; 307: 174.

2. Steiner AZ, Paulson RJ. Oocyte Donation: State of the Art. Gardner DK, ed. IVF: A Practical Approach, Informa Healthcare USA, 2007.

3. The American Society for Reproductive Medicine. Guidelines for oocyte donation. Fertil Steril 2004; 82 (suppl 1): S13.

4. The American Society for Reproductive Medicine. Psychological assessment of gamete donor and recipients. Fertil Steril 2004; 82 (suppl 1): S18.

5. Sauer MV, Paulson RJ, Lobo RA. Comparing the clinical utility of GnRH antagonist to GnRH agonist in an oocyte donation program. Gynecol Obstet Invest 1997; 43: 215.

6. Navot D, Scott RT, Droesch K, Veeck LL, et al. The window of embryo transfer and the efficiency of human conception in vitro. Fertil Steril 1991; 55: 114.

The first use of standard in vitro fertilization (IVF) methodology for oocyte donation, which led to a successful pregnancy in a woman with ovarian failure was reported by Lutjen et al. back in 19841. Oocyte donation is now an integral part of the armamentarium of the infertility specialist. At its inception, it was intended as therapy for women with premature ovarian failure, or those with heritable genetic defects2. However, as experience accumulates, oocyte donation as a treatment has been extended to women with a variety of defects in oocyte production or function, notably those with age-related decline in fertility. Our Centre administers oocyte donation therapy to women with low ovarian reserves and/ or function. The group consist of women with premature ovarian failure, those with poor oocyte quality inferred by multiple failed cycles of conventional IVF, and women with advanced reproductive age with associated diminished ovarian reserve. 

Oocyte donation is a logical extension of the technology of IVF, designed to overcome the conundrum caused by oocyte problems. The details of an oocyte donation cycle are very similar to those of standard IVF protocol, and yet may be simpler because poor responder protocols are mitigated, as with concerns about hyperstimulation as donors do not become pregnant. Therefore, oocyte donation therapy offers an effective treatment option for women with low ovarian reserve and function. 

Materials & MethodsA retrospective analysis of all oocyte donation treatment cycles in Alpha International Fertility Centre was reviewed from July 2011 until December 2011. Oocyte donors were assessed according to American Society for Reproductive Medicine (ASRM) guidelines3. Screening guidelines include a personal and sexual history, and serum screening for syphilis, hepatitis B, HIV-1, and HIV-2, as well as vaginal/ cervical cultures. The counselor confirms that the donor has been informed on the medical treatment and discusses the psychological risks of oocyte donation4. The oocyte donors remain anonymous. Oocyte donors undergo ovarian hyperstimulation in a manner similar to that of conventional IVF. Our Centre commonly utilizes the short protocol using gonadotropin releasing hormone (GnRH) antagonist during the late follicular phase of the stimulation cycle5.  Endometrial preparation in recipients was mainly through down regulation with intra-muscular depot GnRH agonist, and endometrial priming with escalating doses of oral estradiol valerate. Luteinization of the endometrium was achieved via progesterone pessary initiated one day prior to oocyte retrieval6. Embryo transfer is performed in the same manner as in conventional IVF.     

The mean age of oocyte donors and recipients was 24.0 and 40.8 respectively. During that 6-month duration, 36 oocyte retrievals were performed. All these cycles led to embryo transfers. In all, eighty-eight embryos were transferred, resulting in 42 intra-uterine gestational sacs. The mean number of embryos transferred was 2.4 and the implantation rate was 47.7%. There were 26 clinical pregnancies, resulting in a clinical pregnancy rate per embryo transfer of 72.2%. Of the 20 on going pregnancies, 7 are singleton (35%), 11 sets are twins (55%) and 2 sets are triplets (10%).

Leong WY, Lee SS, Low SY- Alpha International Fertility Centre, MalaysiaAlpha Fertility CentreMalaysia