Objective: To determine the prevalence of placental complications in patients conceived through donor versus autologous oocytes.
Methods: This is a case control study including two groups of patients who conceived through in vitro fertilization using: 1) donor oocyte(n=105) and 2) autologous oocyte (n=87). Only singleton gestations were included .The rate of placental complications including preeclampsia, gestational hypertension and intra uterine growth restriction (IUGR) was compared between these two groups.
Results: The women who conceived using donor oocytes were older and delivered earlier compared to women who conceived using autologous oocytes (median maternal age 45 vs 40, p<0.01, median gestational age at delivery 38 vs 39, p<0.01). The rate of preeclampsia and IUGR was significantly higher in ovum donor recipients compared with women conceived with autologous oocytes (16% vs 3.4%, p<0.01, 11.4% vs 1.1%, p<0.01, respectively). When maternal age was restricted to ≤45 years, the rate of hypertensive diseases of pregnancy ( gestational hypertension and preeclampsia) as well as IUGR remained significantly higher among ovum donor compared to autologous oocyte recipients ( 22% vs 6.5%, p=0.016, 16% vs 1.1%, p<0.01 respectively). Binary logistic regression analysis was employed to examine the relationship between preeclampsia and the presence of donor oocytes vs autologous oocytes. Adjustment was conducted for maternal age, gravidity, parity and presence of gestational diabetes. The final regression model suggested that oocyte donation is independently associated with higher rate of preeclampsia (P=0.037).
Conclusions: Patients conceived through oocytes donation have an increased risk for placental complications of pregnancy. These findings support the “immunological theory” suggesting that immunological intolerance between the mother and the fetus may play an important role in the pathogenesis of preeclampsia. These finding have clinical implications for the management of pregnancies achieved through oocyte donation.
Michal Dviri, Inbar Segol, Shali Mazaki, Yacov Levron, Gil Yerushalmi, Ariel Hourvitz, Eyal Sivan, Eyal Schiff, Yoav Yinon
Department Of Obstetrics And Gynecology, Sheba Medical Center, Tel-aviv University