Oocyte Donation: State of the Art doc

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Oocyte Donation: State of the Art

Anne Z. Steiner and Richard J. Paulson

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics

and Gynecology, Women’s and Children’s Hospital, Keck School of Medicine,

University of Southern California, Los Angeles, California, U.S.A.

INTRODUCTION

Oocyte donation is now an integral part of the armamentarium of the infer￾tility specialist. At its inception, it was intended as therapy for women with

premature ovarian failure, or those with heritable genetic defects. However,

as experience accumulated, oocyte donation as a treatment has been

extended to women with a variety of defects in oocyte production or func￾tion. The largest group of women now undergoing treatment with oocyte

donation consists of those with age-related decline in fertility. Additionally,

techniques learned from oocyte donation, including endometrial prep￾aration and embryo-endometrial synchrony, have been applied to other

infertility treatments, including frozen embryo transfer and in vitro matu￾ration of immature oocytes.

HISTORY

The first successful human oocyte donation was reported in 1983. At the

time of ovulation, a fertile donor was inseminated with the recipient

partner’s sperm. Uterine lavage was performed on the fifth day after the

luteinizing hormone (LH) peak. The recovered embryo was then transferred

to the uterus of the infertile patient. After several attempts, a pregnancy was

successfully initiated and a singleton birth at term was achieved (1,2).

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Unfortunately, this method, known as ‘‘ovum transfer,’’ was inefficient (3).

Attempts to enhance the efficiency of the process by administering fertility

medications to the donors were unsuccessful and led to retained pregnancies

in the donors (4).

The first use of standard in vitro fertilization (IVF) methodology for

oocyte donation was also reported in 1983; however, this pregnancy ended

as a miscarriage (5). Subsequently, Lutjen et al. reported a successful preg￾nancy in a woman with ovarian failure. Donated oocytes were fertilized in

vitro and the resulting embryos were transferred to the recipient’s uterus,

which was prepared with a combination of oral estradiol and intramuscular

progesterone (6). This landmark event substantiated the observation that

exogenous estrogen and progesterone could reliably produce a receptive

endometrium rather than relying on natural ovulatory cycles. In women

with residual ovarian function, donor and recipient cycles could thus be syn￾chronized with gonadotropin-releasing hormone (GnRH) agonists (7), and

the recipient endometrium stimulated with exogenous steroids (8,9). These

essential principles have remained the key components of the current prac￾tice of oocyte donation.

INDICATIONS

Oocyte donation is a therapy which allows women to conceive when their

own oocytes are either not capable of producing a pregnancy or carry a heri￾table defect that the patient does not want to pass on to their children.

Common indications for oocyte donation thus include premature ovarian

failure secondary to chemotherapy in healthy cancer survivors (10), follicle￾stimulating hormone (FSH) receptor defects (11), or other causes. Patients

with gonadal dysgenesis are also appropriate candidates for oocyte donation.

Those with Turner’s syndrome may conceive; this group may be at some

risk of obstetrical complications (12). Oocyte donation is also indicated in

the cases of poor oocyte quality inferred by multiple failed cycles of con￾ventional IVF or in women of advanced reproductive age with associated

diminished ovarian reserve. Other patients may choose oocyte donation in

an attempt to avoid passing heritable genetic diseases to their children,

although pre-implantation genetic diagnosis is increasingly being applied

in these situations.

FACTORS INFLUENCING SUCCESS

Donor Age

It has been established that female fertility hinges on the age of the oocyte

provider. Thus, the chronological age of the oocyte donor would seem to

play an intuitive role in the overall success of the process. Remarkably, most

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