1. Oocyte Donation; Factors Influencing The Outcome
Mustafa BAHÇECİ,M.D
Ulun ULUĞ, M.D.
German Hospital and Bahceci Women Health Care Center
Istanbul, Turkey

2. First pregnancy with donated oocyte (Lutjen et al, 1984)
Oocyte donation was performed in almost 10% of all ART cycles carried out in US (CDC report, 1999)

3. SART stats, 2005
Oocyte donated ET contributes 12.1 % of all ART cycles (over cycles)

4. Cumulative Pregnancy rates following Oocyte donated Embryo transfers (Remohi et al, Fertil Steril 1997)

5. Oocyte factor: Endometrial factor
Why oocyte donation programs are more successful in terms of achieving pregnancy; despite to advanced recipient age ?
Oocyte factor:
Younger oocytes
Capable for conception based on previous reproductive history
Endometrial factor
The recipient's endometrial receptivity is dissociated from folliculogenesis since it is artificially prepared to be more uniform and similar to that of a natural menstrual cycle

6. Indications for oocyte donation program
Premature ovarian failure
Poor responder
Menopause (surgical, radiotherapy, chemotherapy)
Advanced maternal age
Recurrent implantation failure
Poor oocyte quality
Genetic
Combined

7. Factors that can be detrimental for the outcome
Donor Age and ovarian reserve
COH for donor
Number of oocytes retrieved
Serum E2 levels of both donor and recipient
Recipient Age
Endometrial Thickness
Indication for oocyte donation
Embryo transfer timing and status
Luteal phase support
…..
Pregnancy follow up

8. Prenatal complications and dilemmas
Gestational diabetes (?)
Chronic Hypertension
Preeclampsia
Preterm delivery
Third trimester hemorrhage
Aortic dissection (Turner syndrome)
How to screen for aneuploides ?

9. Donor Selection Normal physical and gynecological examination
Uneventful medical history
No family history of hereditary or chromosomal diseases
Tested for STD
Normal ovarian reserve (BAF by USG)
Preferably uneventful (+) conception history ?

10. In a study of 257 ET oocyte donation cycles, neither the age of donors, nor the ovarian reserve or ovarian response variables were significantly related to implantation and pregnancy
(Mirkin et al, JARG, 2003)

11. Retrospective analysis of 109 cycles
Donor Age and Outcome
Yoon et al, ASRM, 2005
Retrospective analysis of 109 cycles
Pregnancy (+)
Pregnancy (-) p
Mean donor age
30.2 ±3.6
32.1 ± 4.3
0.01
Donor age
<30
>34 p
Pregnancy rate (%)
50.0
18.2
0.01

12. Long GnRH-agonist (mostly preferred) Multiple dose GnRH-antagonist
COH for Donors
Long GnRH-agonist (mostly preferred)
Multiple dose GnRH-antagonist
Although late onset OHSS is not considered, early onset
OHSS could be associated

13. Multiple Antagonist protocol
Time saving
Less injections
Less OHSS
Similar outcome compared to long agonist
Prapas et al, Hum Reprod, 2005

14. Alternative preparation of donors; a patient friendly approach
In vitro maturation of oocytes collected from unstimulated ovaries for oocyte donation
Holzer et al, Fertil Steril
8.7 mature oocytes per patient
18.2% implantation rate
50% clinical pregnancy rate

15. Number of Oocytes Retrieved and pregnancy (Letterie et al, JARG 2005)
<5
6-10
11-15
16-20
21-25
>25
PR (%)* 67 50 44 56 49 61
Cryopreservation (%) 51 55 42 60
* Not significant (ANOVA)

16. Estradiol Levels in donor and outcome (Pena et al, Hum Reprod, 2002)
Retrospective analysis of 330 consecutive fresh oocyte donation cycles
E2 pg/ml
1499 <
>3000
Clinical pregnancy rate per ET (%)
38.0
41.2
47.7
Ongoing/delivered rate per ET (%)
33.8
34.6
44.0
All not-significant (ANOVA)

17. Estradiol (pg/ml) Level in Recipient and Outcome (Remohi et al, Hum Reprod 1997)
E2 pg/ml
<100
>400
PR (%)
46.2
50.8
55.3 39
47.2
IR (%)
12.2 19 21
14.7
16.7
All not-significant (ANOVA)

18. Endometrial Thickness and Pregnancy (Remohi et al, Hum Rep 1997)
<7mm
7-9.9mm mm
>12mm
PR (%)*
46.7
45.3
42.5
54.8
IR (%)
13.4 14
15.4
26.1
*All not significant(ANOVA)

19. Endometrial Thickness and Implantation (2) Remohi et al
There was a weak but significant correlation between endometrial thickness

20. Endometrial Thickness and Pregnancy
Noyes et al, Fertil Steril, 2001

21. Recipient Age and Pregnancy (Soares et al, JCEM 2005)
Age (yrs)
<40
40-44
45-49
>49
PR (%)a
48.8 51
45.5
35.4
IR (%)
20.7
17.2
13.2b
a Not significant
b p=0.01
ANOVA

22. Recipient Age and Outcome (2) (Soares et al)
Age Groups (yrs)
<45
≥45 p
Implantation Rate (%)
20.7
16.8
0.02
Pregnancy Rate (%)
49.8
44.4
0.04
Miscarriage Rate (%)
23.3
0.03

23. Recipient Age and Outcome (3) (Toner et al, Fertil Steril, 2002) Analysis of SART stats between ’96-’ cycles
1. Older recipient age was associated with statistically reduced implantation,
clinical pregnancy and delivery rates.
2. This effect appeared among recipients in their late 40s, and become more
pronounced at age ≥50 years

24. Does Ovarian function of Recipient have any impact on the outcome ?
The use of GnRH-a in women receiving oocyte donation does not affect implantation rates (Remohi et al, 1994)
No differences were found according to whether ovarian function was present or absent in the recipient (Moomjy et al, 2000)

25. Multivariate Analysis Soares et al, JCEM 2005 (over 3000 ET cycles)
Dependent variables
Independent Variables PR IR
Miscarriage
Age
0.79
0.58
0.24
Endometrial Thickness
0.65
0.96
Days of Estradiol therapy*
0.01
0.02
0.38
Serum Estradiol
0.80
0.53
0.12
Good quality Embryos
0.008
0.2
* 7 weeks or more

26. Number of Embryos Transferred and Pregnancy (Mirkin et al, JARG 2003)*
PR, non significant
* p<0.05

27. Clinical pregnancy rate (%)
Almost 40% of all conceptions from oocyte donation were
twin or high order pregnancies
(ASRM/SART, Fertil Steril, 2004)
Single Embryo transfer in Recipients (Soderstrom-Antilla et al, Hum Reprod, 2003) Retrospective analysis of 127 oocyte donation cycles
No. of ETs
Age of recipient woman
Clinical pregnancy rate (%)
Delivery rate (%)
eSET 49
33.4 ± 5.3
40.8
32.6
DET 78
35.5 ± 4.4
41.0
32.1

28. a variety of reproductive disorders and recurrent miscarriages
Indications for Oocyte donation and Pregnancy Garcia-Velasco et al, Fertil Steril 2003 (shared oocytes study)
Pregnancy (+)*
(n=365)
Pregnancy (-)
POF (%)
44.5
44.3
Genetic (%)
1.5
1.9
RIF (%)
29.1
27.2
Poor responder (%)
17.6
19.7
RPR (%)
2.2
2.5
Others (%)
5.1
4.4
p: not significant
Oocyte donation provides similar success rates when applied to women with
a variety of reproductive disorders and recurrent miscarriages
Budak et al, Fertil Steril (in press)

29. Male Factor and Pregnancy (Garcia-Velasco et al)
Normozoospermic (%)
35.1
38.6 NS
Asthenospermic (%)
32.9 26
Oligozoospermic (%)
1.4
3.3
Teratozoospermic (%)
0.5
0.6
OAT (%)
6.8
4.4
Azoospermia
Non ejaculated (%)
(epid/test) 32 33
Totally 12 patients

30. Intra and Interdonor Variabilities
(Mirkin et al, JARG 2003)
There was no impact of additional stimulations on the donors’ ovarian responses
CPR was not significantly different when comparing results of consecutive cycles
Donors who achieved a pregnancy were more consistent in demonstrating success in subsequent cycles

31. Cleavage state vs blastocyst ET Budak et al, Fertil Steril 2007 (over 7000 ET cycles)
IR (%)
PR (%)
Ongoing PR (%)
Day 2-3
34.8
50.5
45.9
Day 5-6
49.9
63.4
58.7
*Statistical comparisons were not performed

32. Effect of day of transfer on implantation and pregnancy outcome in oocyte donors (Schoolcraft and Gardner, Fertil Steril, 2000)
Day 3
Day 5
No. of patients
116
113
Age
39.9 ± 0.43
41.3 ± 0.41 NS
Implantation rate (fetal sac) (%)
47.1
65.8
<0.01
Clinical pregnancy rate per retrieval (%)
75.0
87.6
<0.05
Multiples (%)
40.5
44,2

33. Does Recipient’s body habitus have adverse impact on outcome ?
Body mass index and uterine receptivity in the oocyte donation model
(Wattankumtornkul et al, Fertil Steril 2003)
Patients were segregated to 4 groups according to BMI (<19, 20-24, 25-30, >30)
Pregnancy rates did not differ
between groups
The area under the curve, 0.51 (95% CI 0.41–0.62) suggests
no relationship between BMI and implantation

34. Conclusion
Prognostic factors can differ in oocyte donation programs than homologues IVF programs

35. IVF Oocyte Donation Age important not as much Infertility etiology not
COH protocol
Oocyte number
Estradiol levels
Duration of treatment
to some extent
Embryo quality
Ovarian Response