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R J Paulson

Publications and source records attributed to R J Paulson.

At least 37 records · Page 2Linked to original sources
PubMed1997

Assessing the importance of endometrial biopsy prior to oocyte donation.

The importance of performing an endometrial biopsy in women preparing for oocyte donation goes beyond confirming the histologic response to hormone replacement therapy. Additional information related to uterine architecture, ease of embryo transfer, status of the ovaries, and patient compliance is also gained. Finally, the return visit provides an opportunity to discuss plans for the upcoming cycle. Whereas this report does not specifically address the question as to how many pregnancies were contingent upon the satisfactory performance of the mock cycle, we estimate that due to a combination of factors (i.e., lack of endometrial response, patient noncompliance, difficult embryo transfer), the likelihood of pregnancy in many cases would have been substantially reduced had the preliminary cycle not been attempted.

Adult↗
PubMed1997

The luteal phase of cycles utilizing controlled ovarian hyperstimulation and the possible impact of this hyperstimulation on embryo implantation.

OBJECTIVE: Our purpose was to evaluate the early luteal phase of assisted reproductive cycles utilizing controlled ovarian hyperstimulation and to compare these results with those obtained in unstimulated cycles. STUDY DESIGN: We undertook a descriptive study analyzing luteal phase serum progesterone levels, endometrial histologic features, and endometrial surface ultrastructure by scanning electron microscopy of cycles utilizing controlled ovarian hyperstimulation. Study samples were obtained from 7 oocyte donors undergoing controlled ovarian hyperstimulation for the purpose of follicle aspiration in oocyte donation. Control (unstimulated) serum progesterone samples were obtained from 19 patients undergoing in vitro fertilization in unstimulated cycles. Prospective recipients of oocyte donation (n = 20) undergoing mock cycles of exogenous estradiol and progesterone acted as controls for the endometrial biopsies. RESULTS: Serum progesterone levels on the day of human chorionic gonadotropin administration were twofold higher in the study group than in the unstimulated group (1.1 +/- 0.6 vs 0.5 +/- 0.2 ng/ml, mean +/- SD, p < 0.01). On the day of follicle aspiration, progesterone levels were much higher in the study group (8.5 +/- 2.2 vs 0.5 +/- 0.1 ng/ml, p < 0.001). Histologic dating of endometrial biopsies revealed that the study group was advanced by nearly 2 days as compared with the group having artificial cycles. Pinopods, ultrastructural markers of the implantation window, were present in only one of seven study cycles as compared with all of the four artificial cycles. CONCLUSIONS: The early luteal phase of cycles undergoing controlled ovarian hyperstimulation is characterized by markedly elevated serum progesterone levels during the periovulatory period, advanced endometrial histologic features, and an absence of endometrial pinopods at the time of embryo implantation. We speculate that these high levels of progesterone in the early luteal phase cause premature endometrial luteinization and a premature appearance of the implantation window, thus providing an explanation for the observed decrease in endometrial receptivity.

Biopsy↗
PubMed1997

Follicle aspiration, sperm injection, and assisted rupture (FASIAR): a simple new assisted reproductive technique.

OBJECTIVE: To describe the first successful application of a new fertility-enhancing technique. DESIGN: Case report. SETTING: Academic fertility program. PATIENT(S): A 36-year-old nulligravid woman undergoing inseminations with frozen-thawed donor sperm. INTERVENTION(S): Ovarian superovulation, follicle aspiration, sperm injection, and assisted follicular rupture. MAIN OUTCOME MEASURE(S): Assessment of feasibility of technique and pregnancy outcome. RESULT(S): After failing to conceive during 16 cycles of IUI, the patient successfully achieved an ongoing pregnancy during the second follicle aspiration, sperm injection, and assisted rupture (FASIAR) attempt. CONCLUSION(S): Follicle aspiration, sperm injection, and assisted rupture combines the concepts of superovulation, IUI, and peritoneal oocyte and sperm transfer to obviate the possibility of luteinized unruptured follicle syndrome, assist oocyte release, and ensure gamete intermixing. It also can be used to reduce the number of ovulating oocytes and thus to reduce the risk of multiple gestations. Follicle aspiration, sperm injection, and assisted rupture is a new, simple, office-based procedure that does not require embryologic expertise beyond sperm preparation as for IUI, yet promises to be more successful than IUI.

Adult↗
PubMed1997

Ultrastructural characteristics of the luteal phase endometrium in patients undergoing controlled ovarian hyperstimulation.

OBJECTIVE: To provide a descriptive analysis of the ultrastructure of the endometrial surface epithelium during the luteal phase from patients undergoing controlled ovarian hyperstimulation (COH). DESIGN: Prospective, observational study. SETTING: Tertiary care academic IVF center. PATIENT(S): Twelve oocyte donors undergoing COH. INTERVENTION(S): After oocyte aspiration, patients underwent two endometrial biopsies 2 to 7 days after hCG administration. MAIN OUTCOME MEASURE(S): Appearance of the endometrial epithelial surface as evaluated by scanning electron microscopy. RESULT(S): Endometrial maturation proceeded in an orderly manner. The ciliated cells remained unchanged, both in regards to cell density, cilia density, and ratio of ciliated cells to nonciliated cells. The microvilli became more uniformly distributed as the luteal phase progressed. The central aspect of the cells also appeared to protrude more into the endometrial lumen as the cycle progressed. Elongation the glandular orifices also was noted with progression of the luteal phase. Apical protrusions, pinopods, were noted to develop and regress during a short period during the midluteal phase spanning days 4 to 7 after hCG administration. Initial pinopod development began in the region of the glandular orifices, with substantially fewer occurring outside this region. CONCLUSION(S): Although the development of the endometrial ultrastructural characteristics during the luteal phase progresses in an orderly manner that is comparable to that of endometrium obtained in unstimulated cycles, pinopod expression was noted at an earlier phase of endometrial maturation. This advanced development may result in an alteration the window of implantation and affect pregnancy rates in women undergoing COH.

Biopsy↗
PubMed1997

The significance of polycystic-appearing ovaries versus normal-appearing ovaries in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate what hormonal or biochemical parameters are most highly associated with the finding of polycystic-appearing ovaries as compared with normal-appearing ovaries in women with polycystic ovary syndrome (PCOS). DESIGN: Prospective randomized study. SETTING: Academic medical center. PATIENTS: Ten women with PCOS-five with normal-appearing ovaries and five with polycystic-appearing ovaries-were matched for age and body mass index. All had serum T levels between 80 and 150 ng/dL (conversion factor to SI unit, 3.467). INTERVENTION(S): Insulin infusion for the purpose of performing insulin tolerance testing to evaluate insulin resistance or sensitivity. MAIN OUTCOME MEASURE(S): We measured serum T, DHEAS, androstenedione, sex-hormone binding globulin, 5 alpha-androstane-3 alpha-17 beta-androstenediol glucuronide, FSH, LH, insulin-like growth factor-I, insulin-like growth factor binding protein-1, and insulin-like growth factor binding protein-3. Insulin resistance, measured by insulin tolerance testing, also was done on the same day after the patient had fasted for at least 8 hours. RESULT(S): Serum androgens and binding proteins were not significantly different in both groups. Insulin tolerance testing demonstrated a slower glucose disappearance in the polycystic appearing ovary group (Kitt glucose was 4.58% +/- 1.4%/min in the normal-appearing ovaries group versus 2.07% +/- 1.07%/min in the polycystic-appearing ovaries group). CONCLUSION(S): Women with PCOS and polycystic-appearing ovaries do not demonstrate any definitive serum hormonal differences compared with women with PCOS and normal-appearing ovaries. The presence of polycystic-appearing ovaries correlates significantly with the presence of insulin resistance.

Adult↗
PubMed1997

The impact of the woman's age on the success of standard and donor in vitro fertilization.

OBJECTIVE: To study the effect of the age of the woman who provides the oocytes or who receives the embryos on results of IVF-ET. DESIGN: Historical cohort study. Multivariate regression analysis was used to study the age effect continuously and after adjustment for confounding. SETTING: Patients of the University of Southern California, Los Angeles, California. PATIENT(S): Couples who underwent standard (n = 277) or donor IVF-ET (n = 294) between January 1991 and July 1995. INTERVENTION(S): One cycle of standard or donor IVF-ET. MAIN OUTCOME MEASURE(S): Successive IVF outcomes from number of oocytes to ongoing pregnancy and several measures of pregnancy loss. RESULT(S): The number of oocytes decreased with aging of the oocyte provider. More women who received oocytes from donors aged 20 to 23 years had at least one good embryo transferred than women who received oocytes from older donors. The age of the woman who received the embryos had no effect on IVF outcomes. In women > 40 years who underwent standard IVF, the probability of pregnancy decreased. No such relationships were observed for donor IVF, but all the oocyte donors were younger. CONCLUSION(S): An age effect for ongoing pregnancy was only found in women > 40 years who underwent standard IVF independent of the lower number of oocytes and suggests decreasing oocyte quality.

Adult↗
PubMed1997

Successful pregnancy in a 63-year-old woman.

OBJECTIVE: To report the occurrence of an unusual case of successful pregnancy achieved by oocyte donation in a woman > 60 years of age. DESIGN: Case report. SETTING: University-based assisted reproductive technology program. PATIENT(S): Sixty-three-year old nulligravida, married for 16 years to her 60-year-old husband. Throughout her infertility treatment, the patient was believed to be 10 years younger, as she claimed. She revealed her true age of 63 only upon being referred for obstetric care at 13 weeks of gestational age. INTERVENTION(S): Oocyte donation, IVF, embryo cryopreservation, and ET. MAIN OUTCOME MEASURE(S): Attainment of pregnancy and subsequent delivery. RESULT(S): The patient underwent two cycles of oocyte donation. During the second attempt, the fresh transfer resulted in a clinical miscarriage at approximately 8 weeks of gestational age. A subsequent transfer of three frozen-thawed embryos resulted in an ongoing singleton gestation. The pregnancy was complicated by gestational diabetes (controlled by diet) and mild pregnancy-induced hypertension. Delivery by cesarean section at 38 weeks of gestational age resulted in the birth of a healthy female infant weighing 2,844 g with Apgar scores of 9 and 9. CONCLUSION(S): This case demonstrates that the uterus is capable of supporting nidation and subsequent gestation for many years beyond natural menopause. It shows that other aspects of human physiology are capable of adapting to the stresses and changes of pregnancy sufficiently well to achieve a normal birth at the age of 63 years. This case also exemplifies the difficulty in attempting to regulate the age of recipients in oocyte donation. As in other aspects of human life, when age limits are applied to the provision of certain services, human beings whose age falls outside of these limits become motivated to deceive the providers of those services to avail themselves of the services.

Breast Feeding↗
PubMed1997

Potential enhancement of endometrial receptivity in cycles using controlled ovarian hyperstimulation with antiprogestins: a hypothesis.

OBJECTIVE: To manipulate the luteal endometrial progression by the use of antiprogestins. DESIGN: Prospective controlled clinical trial. SETTING: The IVF program of the University of Southern California School of Medicine, Los Angeles, California. PATIENT(S): Thirteen oocyte donors and 20 oocyte recipients. INTERVENTION(S): Controlled ovarian hyperstimulation of oocyte donors, administration of two doses of 2.5 mg of RU486 to the study group, and endometrial biopsies. MAIN OUTCOME MEASURE(S): Serum E2 and P levels, histologic dating of the endometrium, endometrial ultrastructure by scanning electron microscopy. RESULT(S): No difference in serum E2 or P levels was noted after RU486 administration. The histologic dating was advanced in oocyte donors as compared with recipients undergoing artificial cycles but returned to normal (in phase) after RU486. Pinopods were noted in all recipient biopsies and in donors treated with RU486 but in only one of four biopsies in donor controls. CONCLUSION(S): Cycles with controlled ovarian hyperstimulation are associated with high early luteal P levels and advanced endometrial histology. Low doses of RU486 may correct the precocious luteinization and restore endometrial receptivity.

Biopsy↗
PubMed1997

Cumulative conception and live birth rates after oocyte donation: implications regarding endometrial receptivity.

The purpose of the present study was to determine the cumulative likelihood of pregnancy success after repetitive cycles of oocyte donation and specifically to examine the influence of recipient age and diagnosis upon the cumulative likelihood of pregnancy in an effort to identify any potential subgroup of recipients who might have diminished endometrial receptivity. We retrospectively analysed the outcome of 418 consecutive embryo transfer cycles among 276 recipients of oocyte donation in our institution. We analysed clinical pregnancy and delivery rates in the recipients divided by age groups and diagnostic groups. For the purpose of life-table analysis, only cycles prior to and including the first cycle producing a successful pregnancy were included. Frozen-thawed embryo transfers were not included in the analysis. The overall clinical pregnancy rate was 36.2% (95% CI 31-41%) and the cumulative pregnancy rate after four cycles was 87.9%. The overall delivery rate was 29.3% (95% CI 25-33%) and the cumulative delivery rate after four cycles was 86.1%. There were no statistically significant differences in any of the rates attributable to recipient age or diagnosis. No decline in per cycle success was noted over consecutive cycles. We conclude that neither recipient age nor diagnosis plays a substantial role in the success of oocyte donation, implying that endometrial receptivity is unaltered by age or diagnosis. Furthermore, up to four successive cycles of oocyte donation are associated with the same probability of success.

Adult↗
PubMed1997

Endocrine abnormalities in ovulatory women with polycystic ovaries on ultrasound.

Polycystic-appearing ovaries (PAO) on ultrasound have been described in a variety of endocrinopathies and also occur in ovulatory women. By some investigators this is merely referred to as 'PCO' (polycystic ovaries). Although there is controversy in this regard, we do not consider women with PAO/PCO who have no known endocrine disturbance to have polycystic ovary syndrome (PCOS) and therefore prefer not to use the term 'PCO' which is often equated with PCOS. We studied 15 ovulatory women with normal-appearing (NAO) ovaries on ultrasound and 15 matched ovulatory women with PAO/PCO. Compared to ovulatory women, 25 other women were studied who were considered to have PCOS. Of these, 15 were overweight and 10 were of normal weight. All the PCOS women had serum concentrations of luteinizing hormone (LH), testosterone, unbound testosterone, androstenedione and dihydroepiandrosterone sulphate (DHEAS) which were significantly higher (P < 0.01) than values in the normal women, regardless of ovarian morphology. These values were similar in the two groups of ovulatory women with NAO and PAO/PCO. Fasting insulin was elevated in women with PCOS with increased body weight (P < 0.01) and was higher than in ovulatory women with NAO and PAO/PCO and than in women of normal weight with PCOS. Serum insulin-like growth factor (IGF)-I and binding protein (BP)-3 were similar in all groups but serum IGFBP-1 was significantly (P < 0.01) lower in those women with PCOS with increased body weight, compared to all other groups. Compared to values in ovulatory women with NAO, serum IGFBP-1 was also significantly (P < 0.05) lower in women with PAO/PCO and those women with PCOS of normal weight. These lower values were similar in women with PAO/PCO and in normal weight women with PCOS. On an individual basis, an elevation of at least one serum androgen value was found in 33% of women with PAO/PCO. These data confirm that increased body weight accentuates the metabolic alterations in PCOS, but suggest that subtle endocrine disturbances, similar to those that are found in PCOS, may be uncovered in up to a third of ovulatory women with PAO/PCO. It appears that a disturbance of the IGF/IGFBP-1 axis is common and apparently closely associated with alterations in ovarian morphology.

Adult↗
PubMed1997

The utility of a midcycle follicle-stimulating hormone boost in addition to human chorionic gonadotropin for timing of follicle aspiration in unstimulated in vitro fertilization cycles.

PURPOSE: To analyze the effects and potential benefits of a single midcycle dose of follicle-stimulating hormone (FSH) prior to human chorionic gonadotropin (hCG) administration during unstimulated in vitro fertilization (IVF) cycles. METHODS: Twenty-five cycles from 20 patients receiving 150 IU of FSH 42-44 h and 10,000 IU of hCG 34-36 h prior to follicle aspiration were compared to 110 cycles triggered with hCG alone. RESULTS: Serum E2 levels were significantly lower on the day of hCG treatment in the FSH-treated group (266 vs. 297 pg/ml). On the day after hCG administration, serum E2 was similar in both groups. Maximum follicular diameters the day of and the day after hCG treatment were similar as were the number of oocytes aspirated and embryos transferred, and clinical pregnancy rates in both groups. The number of cycles dropped due to premature luteinizing-hormone (LH) surge was 8% in the FSH group compared to 20% in the group treated with hCG alone. CONCLUSIONS: A midcycle FSH boost does not increase pregnancy success of unstimulated IVF cycles but does enhance the increase in serum E2 levels after hCG, thereby potentially allowing earlier hCG administration while incurring decreased cycle cancellation rates due to premature LH surges.

Adult↗
PubMed1997

Comparing the clinical utility of GnRH antagonist to GnRH agonist in an oocyte donation program.

A potent gonadotropin-releasing hormone (GnRH) antagonist (Nal-Glu) was administered to downregulate the pituitaries of oocyte donors (n = 15) and block their midcycle luteinizing hormone surges. Donors received Nal-Glu at a dose of 50 microg/kg/day i.m., beginning when lead follicles reached a mean diameter of 14 mm. All donors had previously undergone controlled ovarian hyperstimulation cycles using GnRH agonist (leuprolide acetate) administered subcutaneously beginning during the midluteal phase. Ovarian stimulation was performed using human menopausal gonadotropin (hMG). Compared to previous stimulated cycles using agonist and hMG, cycles with antagonist and hMG demonstrated a significant decrease in the amount of hMG required for follicle stimulation (24.7 +/- 1.8 vs. 31.3 +/- 2.5 ampules; p < 0.05). There was also a significant reduction in the number of patient visits necessary per cycle (5.1 +/- 1.4 vs. 9.3 +/- 1.1; p < 0.05) and the required duration of treatment to accomplish a cycle (27.1 +/- 5.3 vs. 11.3 +/- 1.3 days; p < 0.05). However, there were no differences noted in the number of oocytes retrieved (10.7 +/- 4.5 vs. 13.0 +/- 6.3), the fertilization rate of oocytes (60.3 +/- 10.2 vs. 53.9 +/- 11.6%), or the number of embryos obtained per recipient (5.5 +/- 3.2 vs. 7.6 +/- 5.3). Clinical pregnancies occurred in 7 of 15 transfer cycles to recipients. There were no serious adverse side effects experienced by donors using antagonist. We conclude that the use of GnRH antagonist significantly reduces the amount of medication and the time required for ovarian hyperstimulation and that is a useful adjunct in cycling oocyte donors.

Adult↗
PubMed1996

The significance of elevated early follicular-phase follicle stimulating hormone (FSH) levels: observations in unstimulated in vitro fertilization cycles.

OBJECTIVE: Our objective was to determine the effect of elevated early follicular-phase serum follicle stimulating hormone (FSH) levels on follicle growth and oocyte maturity in unstimulated in vitro fertilization (IVF) cycles. STUDY DESIGN: We compared cycles with elevated day 3 FSH levels (> 20 mIU/ml) to subsequent cycles in the same patients when day 3 FSH returned to normal and to cycles among women with normal day 3 FSH levels. PATIENTS: Seven cycles in seven patients had an elevated day 3 FSH (high-FSH group). These were compared to 11 subsequent cycles in which there was a return to a normal baseline FSH and to 13 cycles in 13 patients that entered the unstimulated protocol with a normal baseline day 3 FSH. RESULTS: The day of human chorionic gonadotropin (hCG) administration was similar in all groups as were the serum estradiol (E2) levels. Although the high-FSH group tended to have smaller maximum follicular diameters, the difference was not statistically significant. The highest FSH level on cycle day 3 in a completed cycle was 56.2 mIU/ml. The total number of oocytes aspirated and the number of embryos obtained was similar in all groups. Whereas there were no pregnancies in the high-FSH group, 2 of the subsequent 11 normal day 3 FSH cycles resulted in clinical pregnancies. Two of the 13 patients in the normal day 3 FSH values also achieved pregnancies. CONCLUSIONS: We conclude that cycle day 3 serum FSH levels as high as 56.2 mIU/ml may be associated with apparently normal follicular growth, oocyte fertilization, and embryo cleavage in unstimulated cycles. However, pregnancies are not observed. In addition, FSH levels vary widely from cycle to cycle and elevated levels in one cycle do not necessarily imply that pregnancy may not occur in a subsequent cycle when FSH levels return to normal.

Blastocyst↗
PubMed1996

Rare occurrence of ovarian hyperstimulation syndrome in oocyte donors.

OBJECTIVES: To define the incidence and severity of ovarian hyperstimulation syndrome (OHSS) occurring in oocyte donors. METHODS: Women (n = 149) aged 31.3 +/- 4.8 years (mean +/- S.D., range 21-41 years) participated as designated oocyte donors and underwent 400 consecutive cycles of controlled ovarian stimulation using human menopausal gonadotropin following pituitary downregulation with gonadotropin-releasing agonist. Patients were monitored by serial transvaginal ultrasound examinations and serum estradiol (E2) determinations. Oocytes (15.6 +/- 7.5 per aspiration; range 2-57) were harvested by ultrasound-directed transvaginal follicle aspiration 36 h following the intramuscular injection of human chorionic gonadotropin (hCG). Follow-up examination occurred 1 and 2 weeks post-aspiration. RESULTS: On the day of hCG injection E2 levels ranged from 512 to 13,502 pg/ml (mean 2902.7 +/- 1486.9 pg/ml). Over the next few weeks the degree of hyperstimulation in donors was staged: mild 65% (grade I, n = 98; grade II, n = 162); moderate 33.5% (grade III, n = 120; grade IV, n = 14); severe 1.5% (grade V, n = 6; grade VI, n = 0). Associated preaspiration E2 levels were: grade I, 1120 +/- 424 pg/ml; grade II, 2084 +/- 613 pg/ml; grade III, 3785 +/- 1713 pg/ml; grade IV, 5370 +/- 1264 pg/ml; grade V, 4286 +/- 1100 pg/ml. Worsening OHSS was associated with increasing levels of E2. There were no serious complications and hospitalization was not required. All symptoms resolved within 30 days of aspiration, disappearing by the time of the first menstrual flow in women of grade-III or lower stage. CONCLUSION: Although oocyte donors commonly experienced exaggerated levels of serum E2 they rarely (< 2%) developed severe OHSS. This may be attributable to their lack of embryo transfer which avoids exacerbating the illness.

Adult↗
PubMed1996

Oocyte donation to women of advanced reproductive age: pregnancy results and obstetrical outcomes in patients 45 years and older.

We analysed the results of oocyte donation to women of advanced reproductive age (> or = 45 years old) and followed their pregnancies through to delivery in order to assess obstetrical outcomes. Patients (n = 162) aged 45-59 years (mean +/- SD; 47.3 +/- 3.4 years) underwent 218 consecutive attempts to achieve pregnancy. Oocytes (16.2 +/- 7.2 per retrieval) were provided by donors < or = 35 years old. Cleaving embryos (8.2 +/- 4.8 zygotes/couple) were transferred transcervically (4.5 +/- 1.1 per embryo transfer) to recipients prescribed oral micronized oestradiol and intramuscular progesterone. Following oocyte aspiration there were six instances of non-fertilization (2.8%) and 212 embryo transfers. A total of 103 pregnancies was established for an overall pregnancy rate (PR) of 48.6%, which included 17 preclinical pregnancies, 12 spontaneous abortions, and 74 delivered pregnancies (clinical PR 40.6%; delivered PR 34.9%). Multiple gestations were frequent (n = 29; 39.2% of pregnancies) and included 20 twins, seven triplets, and two quadruplets. Two of the triplet and both of the quadruplet pregnancies underwent selective reduction to twins. Antenatal complications occurred in 28 women (37.8% of deliveries) and included preterm labour (n = 9), gestational hypertension (n = 8), gestational diabetes (n = 6), carpel tunnel syndrome (n = 2), pre-eclampsia (n = 2), HELLP syndrome (n = 2), and fetal growth retardation (n = 2). 48 (64.8%) deliveries were by Caesarean section. The gestational age at delivery for singletons was 38.3 +/- 1.3 weeks (range 35-41 weeks), with birth weight 3218 +/- 513 g (range 1870-4775 g); twins 35.9 +/- 2.0 weeks (range 32-39 weeks), birth weight 2558 +/- 497 g (range 1700-3450 g); and triplets 33.5 +/- 0.7 weeks (range 32-34 weeks), birth weight 1775 +/- 190 g (range 1550-2100 g). Neonatal complications (4.6% of babies born) included growth retardation (n = 2), trisomy 21 (n = 1), ventricular septal defect (n = 1), and small bowel obstruction (n = 1). There were no maternal or neonatal deaths. We conclude that oocyte donation to women of advanced reproductive age is highly successful in establishing pregnancy. However, despite careful antenatal screening, obstetrical complications are common, often secondary to multiple gestation.

Abortion, Spontaneous↗
PubMed1996

Efficacy of oocytes donated by older women in an oocyte donation programme.

Population and insemination studies indicate that women experience declining fertility with ageing. The question therefore arises whether older women are suitable oocyte donors. This study addresses this issue by examining the relationship between oocyte donor age and clinical outcome in a large oocyte donation programme. We retrospectively reviewed data from 458 consecutive oocyte donation cycles completed by 164 different designated oocyte donors. Data were divided into two groups: group A, cycles with donors aged 21-30 years at the time of follicular aspiration (193 cycles, 88 donors); and group B, cycles with donors aged 31-40 years at the time of follicular aspiration (265 cycles, 86 donors). Five donors, because of ageing during repetitive donations, contributed data to groups A and B. In a given cycle, all oocytes for a recipient came from only one designated donor. Comparing the two donor groups, there was no difference in the amount of gonadotrophin used to achieve optimal stimulation; however, more oocytes were obtained from group A than group B donors (16.8 +/- 6.9 and 15.1 +/- 8.1 respectively, P < 0.05). Similar percentages of oocytes were fertilized in each group, resulting in the transfer of comparable numbers of embryos (4.5 +/- 1.1 and 4.4 +/- 1.3 respectively). Comparable clinical pregnancy rates were achieved (group A, 36%; group B, 37%). The spontaneous abortion rates were also similar (group A, 20%; group B, 12%), resulting in comparable ongoing and delivered pregnancy rates per cycle (group A, 29%; group B, 32%) and per embryo transferred (group A, 6.4%; group B, 7.3%). In conclusion, women of proven fertility should not be excluded from donating oocytes simply because of their age. There exists a cohort of fertile women who resist the decreasing fecundity and increasing spontaneous abortion rates associated with ageing. With careful screening, many women of proven fertility can donate oocytes until the age of 40 years with an efficacy equal to that of younger women. Given the relative shortage of suitable oocyte donors, and increasing requests from recipients with previous donor oocyte babies to obtain oocytes from the same, now older, donor, the findings of this study are of practical clinical importance.

Adult↗