During the past several decades, the mean maternal age at delivery of a first infant has risen. In older women undergoing donor oocyte in vitro fertilization, small studies have suggested that pregnancy and miscarriage rates reflect donor rather than recipient age. Race/ethnicity, infertility diagnosis, and embryo culture duration have been reported to decrease the likelihood of a good perinatal outcome. Such predictors have not been affirmed in donor oocyte in vitro fertilization. This study was undertaken to investigate donor oocyte use from 2000 to 2010 using the US National ART Surveillance System and to determine predictors of good perinatal outcome.
The National ART Surveillance System is a federally mandated reporting system that collects information about assisted reproductive technology (ART) cycles. All donor oocyte cycles using fresh and frozen embryos performed between 2000 and 2010 that did not use a gestational carrier were analyzed. The trend analysis reports the absolute number and percentage of all ART cycles using donor oocytes. Cycles using autologous oocytes and fresh embryos were chosen as the comparison group for characterization of donor and recipient traits. The primary measure was good perinatal outcome, defined as a singleton live birth at 37 weeks or later and birth weight of 2500 g or more. Unadjusted odds ratios (ORs), adjusted ORs, 95% confidence intervals [CIs], and P values were generated using logistic regression. A stepwise regression analysis was performed on the data limited to the first donation cycle in 2010. All analyses were conducted using SAS version 9.3 or SUDAAN version 11.0.
Data from 443 clinics (93% of all US fertility centers) were included. The annual number of donor oocyte cycles performed increased from 10,801 in 2000 to 18,306 in 2010, as did the percentage of cycles involving frozen oocytes or embryos versus fresh (26.7%, 95% CI, 25.8%–27.5%, to 40.3%, 95% CI, 39.6%–41.1%) and elective single-embryo transfer versus transfer of multiple embryos (0.8%, 95% CI, 0.7%–1.0%, to 14.5%, 95% CI, 14.0%–15.1%). Good perinatal outcomes increased from 18.5% (95% CI, 17.7%–19.3%) to 24.4% (95% CI, 23.8%–25.1%; P < 0.001 for all trends). The mean ± SD age of donors and recipients remained stable at 28 ± 2.8 y and 41 ± 5.3 y, respectively. Between 2000 and 2010, the mean number of oocytes retrieved increased from 17.2 to 19.6 in 2010 (P < 0.001). From 2004 to 2010, the absolute number of first donor cycles increased from 13,319 to 15,988 (P = 0.002 for trend), and repeat donor cycles increased from 1856 to 2318 (P = 0.004 for trend). In 2010, of 11,144 donor oocyte cycles using fresh embryos, 1279 (11.5%) were canceled before embryo retrieval or transfer; the mean ± SD donor and recipient ages were 28 ± 2.6 y and 41 ± 5.2 y, respectively. For patients using autologous oocytes, the mean ± SD age was 35 ± 4.7 y. In 2010, a total of 2713 (27.5%; 95% CI, 26.6%–28.4%) donor oocyte cycles performed using fresh embryos had a good perinatal outcome. Multivariable analysis suggested a significantly increased likelihood of a good perinatal outcome for embryo transfer on day 5 rather than day 3 (29.6% vs 23.3%; adjusted OR, 1.17; 95% CI, 1.04–1.32) and for elective single-embryo transfer compared with no elective single-embryo transfer (44.7% vs 24.9%; adjusted OR, 2.32; 95% CI, 1.92–2.80). Donor age; recipient age; obstetric or ART history; sharing of donor oocytes; number of oocytes retrieved; number of cryopreserved embryos; diagnosis of endometriosis, ovulatory disorder, or diminished ovarian reserve; and male fertility factor were not associated with good outcomes.
The use of donor oocytes with ART has increased and resulted in good perinatal outcomes, regardless of recipient age. Additional studies are necessary to evaluate the mechanisms by which underlying factors affect the outcomes.
Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA (J.F.K., D.M.K., D.R.S., D.J.J.); and Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (J.F.K., M.M., S.C., D.M.K., A.D.K., D.J.J.)