Trends and Outcomes for Donor Oocyte Cycles in the United States, 2000-2010

• Autores: Jennifer F. Kawwass, Michael Monsour, Sara Crawford, Dmitry Kissin, Donna R. Session, Aniket D. Kulkarni, Denise J. Jamieson
• Localización: JAMA: the journal of the American Medical Association, ISSN 0098-7484, Vol. 310, Nº. 22, 2013, págs. 2426-2434
• Idioma: inglés
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• Resumen

  • Importance The prevalence of oocyte donation for in vitro fertilization (IVF) has increased in the United States, but little information is available regarding maternal or infant outcomes to improve counseling and clinical decision making.

    Objectives To quantify trends in donor oocyte cycles in the United States and to determine predictors of a good perinatal outcome among IVF cycles using fresh (noncryopreserved) embryos derived from donor oocytes.

    Design, Setting, and Participants Analysis of data from the Centers for Disease Control and Prevention�s National ART Surveillance System, to which fertility centers are mandated to report and which includes data on more than 95% of all IVF cycles performed in the United States. Data from 2000 to 2010 described trends. Data from 2010 determined predictors.

    Main Outcomes and Measures Good perinatal outcome, defined as a singleton live-born infant delivered at 37 weeks or later and weighing 2500 g or more.

    Results From 2000 to 2010, data from 443 clinics (93% of all US fertility centers) were included. The annual number of donor oocyte cycles significantly increased, from 10?801 to 18?306. Among all donor oocyte cycles, an increasing trend was observed from 2000 to 2010 in the proportion of cycles using frozen (vs fresh) embryos (26.7% [95% CI, 25.8%-27.5%] to 40.3% [95% CI, 39.6%-41.1%]) and elective single-embryo transfers (vs 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?

    Conclusions and Relevance In the United States from 2000 to 2010, there was an increase in number of donor oocyte cycles, accompanied by an increase in good outcomes. Further studies are needed to understand the mechanisms underlying the factors associated with less successful outcomes.

    During the past several decades, mean maternal age at delivery of a first infant has increased steadily to 25.2 years in the United States and 30 years in Germany and Britain in 2009.1 The number of live births to women in their early 40s in the United States has also increased steadily, from 7.4 per 1000 women in 1999 to 10.3 per 1000 in 2011.2 Delay of childbearing may result from multiple factors, including technological advances in reproductive science, evolution of women�s societal roles, increased availability of effective contraception, and increased acceptance of divorce and delayed marriage.3 Reproductive potential declines with advancing female age, and current technology using autologous oocytes remains limited by the ovarian �biological clock.� Oocyte donation initially gained acceptance as treatment for premature ovarian insufficiency but has become more common for treatment of age-related diminished reserve. Among women of advanced age who conceive spontaneously, evidence demonstrates increased maternal and neonatal risk.4- 6 Small retrospective studies have attempted to quantify perinatal risk among older women undergoing donor oocyte in vitro fertilization (IVF) and have found that rates of pregnancy and miscarriage reflect donor rather than recipient age. However, these studies obtained conflicting results when comparing obstetric complications of donor oocyte IVF with spontaneously conceived, autologous oocyte IVF, or other-donor IVF pregnancies.7- 13 Evidence suggests increased risk of preterm delivery and low birth weight among singleton pregnancies conceived using autologous oocyte IVF,14 and race/ethnicity, infertility diagnosis, and embryo culture duration may decrease the likelihood of a good perinatal outcome.15 However, such predictors have not been affirmed in donor oocyte IVF. We investigated donor oocyte use from 2000 to 2010 using the United States� National ART Surveillance System (NASS) and determined predictors of good perinatal outcome (singleton live-born infant delivered at 37 weeks or later and weighing 2500 g or more) among donor oocyte IVF cycles performed in 2010 using fresh (noncryopreserved) embryos.