Oocyte donation (OD) is being increasingly advised, especially in couples or individuals with inheritable diseases, repeated IVF failures, and advanced maternal age. However, IVF cycles using donor oocytes have been associated with a high risk for obstetric complications, such as preterm labor, postpartum hemorrhage, and pregnancy induced hypertension (PIH). A new retrospective matched cohort study validates the increased risk of developing gestational hypertension and preeclampsia in pregnancies conceived using donor oocytes and donor cryopreserved-thawed embryos.
Peter C Klatsky from the Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, and coworkers, compared the risk of gestational hypertension and preeclampsia in women who underwent IVF cycles using autologous and donor oocytes. Donor oocyte recipients (n=77) with live births were matched with those undergoing autologous IVF (n=81) for age and plurality (singleton or twin).
The groups did not differ with respect to parity, age, and gestational type. In comparison to women undergoing autologous IVF, the ovum-donor recipients had
• substantially higher occurrence of preeclampsia (16.9% vs. 4.9%; P=0.02) and gestational hypertension (24.7% vs. 7.4%; P<0.01)
• greater probability for premature delivery (34% vs.19%) even after controlling for multiple gestation (OR=2.6; 95% CI=1.04-6.3)
It was also observed that pregnancies derived from cryopreserved embryos (n=16) were more vulnerable for hypertensive disorders (OR=5.0; 95% CI=1.2-20.5).
Earlier, Keegan et al (Fertility Sterility, 2007) conducted a retrospective anonymous questionnaire study to analyze and compare the rates of obstetric outcomes between OD recipients and IVF patients in the age group of either <35 or ≥40 years. They found that PIH rates were significantly higher in women using donated oocytes (<35 years, 42%; ≥40 years, 26%), when compared to those undergoing IVF (<35 years, 12%; ≥40 years, 14%). It was also seen that PIH rates among the twin pregnancies was higher in OD recipients than the IVF group.
In contrast, a more recent retrospective cohort study by Krieg et al (Fertility Sterility, 2008) found that rates of obstetric complications, such as gestational diabetes, hypertensive disorders in pregnancy, prematurity, and placental abnormalities, were comparable between women who conceived using donated and autologous oocytes in IVF. It was also demonstrated that the two groups did not show any significant difference with respect to infant birth weight and gestational age at the time of delivery.
Although the exact etiology of preeclampsia in oocyte donor cycles is yet to be established, altered or insufficient immunoprotective capability of the fetoplacental unit due to the brief exposure to non-maternal antigens is hypothesized as one of the reasons for its development.
A 2008 report by The Society of Obstetricians and Gynaecologists of Canada suggested the use of donated gametes in ART to be one of the first trimester risk markers for preeclampsia. With the current study results reaffirming the higher chances of hypertensive disorders in donor oocyte pregnancies, it is important to counsel such patients on the potential risks prior to treatment initiation.
References
1. Klatsky PC, Delaney SS, Caughey AB, et al. The Role of Embryonic Origin in Preeclampsia: A Comparison of Autologous In Vitro Fertilization and Ovum Donor Pregnancies. Obstet Gynecol. 2010 Dec;116(6):1387-1392.
2. Keegan DA, Krey LC, Chang HC, Noyes N. Increased risk of pregnancy-induced hypertension in young recipients of donated oocytes. Fertil Steril. 2007 Apr;87(4):776-781.
3. Krieg SA, Henne MB, Westphal LM. Obstetric outcomes in donor oocyte pregnancies compared with advanced maternal age in in vitro fertilization pregnancies. Fertil Steril. 2008 Jul;90(1):65-70.
4. Magee LA, Helewa M, Moutquin JM, et al. SOGC clinical practice guideline: diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. JOGC. 2008 Mar;30(suppl 1):S1-S48.
