Newsletter – March 24, 2012
Since the Monash IVF team’s announcement of the birth of the first healthy baby conceived by oocyte donation in 1983 (Trounson et al., Br Med J 1983), the use of oocyte donation has spread exponentially. Today, oocyte donation is widely used throughout the world, except in countries where it is legally prohibited (Italy, for example). It is impossible to give a true estimate of the number of oocyte donation cycles performed annually worldwide. In the US alone, the latest CDC data (from 2009) reveals that 17,697 oocyte donation cycles (frozen oocytes: 6,659 cycles, fresh oocytes: 11,038 cycles) were performed ( http://www.cdc.gov/art/ART2009/section4.htm), representing approximately 12% of all ART cycles performed in 2009. While the success rates of oocyte donation cycles have been consistently high, usually higher than those of non-donor cycles, practices regarding the evaluation and preparation of both donors and recipients vary considerably among countries and clinics. Very few interventions related to oocyte donation are evidence-based. The purpose of the oocyte donation survey was to analyze clinical and laboratory practices, as reflected by clinicians from five continents.
One of the most important aspects of a safe and successful oocyte donation program is the screening for genetic disease. As there are no uniform guidelines available, there is great variability in genetic testing requirements, as reflected by the survey. In 18% of the cycles represented in the survey, no genetic testing was performed, and 60% performed genetic testing regularly, of which 40% performed both karyotyping and testing for genetic disease.
In the US, new ASRM Practice Committee guidelines for oocyte donation suggest that cystic fibrosis testing should be performed on all donors. Consideration should be given to performing chromosome analysis and fragile X testing on donors, but is not required.
It is noteworthy that in 52% of the cycles represented in the survey, a GnRH antagonist protocol was used for donor stimulation. Most likely, this had not been the case until several years ago. Clinicians and scientists now recognize that compared to GnRH agonist-based protocols, there is a lower statistically significant incidence of ovarian hyperstimulation syndrome (OHSS) in GnRH antagonist cycles (Al Inany et al., Cochrane Database Syst Rev 2011). In a recent meta-analysis, no signiﬁcant differences were observed in pregnancy rates or in the number of retrieved oocytes after donor stimulation with GnRH agonist or antagonist protocols (Dodri et al., Fertil Steril 2011).
TO READ MORE ABOUT THE REAULTS OF THE SURVEY