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Obstetric Complications of Donor Egg Conception Pregnancies

Ovum donation (OD) is a significant and important treat-ment option, not only for older women (as more than half of women aged over 45 years undergoing in vitro fertili-sation (IVF) treatment will use donor oocytes), but also for younger women. Reasons for women using donor ovum are many and include primary ovarian failure, surgi- cal oophorectomy, after radiotherapy or chemotherapy, poor oocyte quality, multiple failures of IVF, genetic disorders, Turners syndrome and advanced maternal age. Modern society where child bearing is delayed will only see this method becoming more prevalent.

Obstetric complications with IVF pregnancies are well documented. However, until recently OD had not previously been investigated as a separate subtype of this. It could be postulated that there may be more complications with OD pregnancies as the embryo is immunologically different to the mother. The subsequent allograft reactions can cause problems with placental development and function leading to pathol- ogy. Initial studies investigating OD pregnancies were inadequate due to small sample size and inappropriate control groups. Studies specifically comparing to spontaneous pregnancies alone are not suitable when we already know that IVF in itself increases the risk to both mother and baby. Recent research has optimised the control group by using women undergoing IVF with autologous ovum. Ovum donation has now been shown to be an independent risk factor for hypertensive disease in pregnancy, post-partum haemorrhage and increased risk of caesarean section. Neonatal outcomes are less clear-cut, although there is some evidence to suggest there is increased risk of small for gestational age babies and preterm delivery. It is now clear that OD pregnancies are higher risk than IVF pregnancies with autologous ovum and they should be treated as such. Women with ovum donation pregnancies should have obstetric-led care, in a unit which has ready access to both blood transfusion and cell salvage. Future research should investigate how to reduce the risk of ovum donation to these women.

If you are considering ovum donation, discuss the risks and complications with your fertility expert of for further information please contact Fertility Plus.

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