No abstract
This study was performed to evaluate the relative contribution of oocyte and uterine factors to the age-related reduction in fecundity. The pregnancy and miscarriage rates in women receiving donated oocytes were compared to those in women using their own oocytes in in-vitro fertilization (IVF) and gamete intra-Fallopian transfer (GIFT) procedures. Oocyte donation with embryo transfer was performed on 241 women in 371 cycles; 116 of these women became pregnant (48% per patient and 31.5% per cycle) of whom 40 (35%) miscarried, giving a live birth rate of 20.5%. Assisted conception, in the form of IVF/GIFT procedures, was performed on 1331 women using their own oocytes in 2194 cycles; 627 of these women became pregnant (47% per patient and 28.7% per cycle), of whom 228 (36%) miscarried, giving a live birth rate of 18.2%. Neither the age of the donor nor the age of the recipient was related to pregnancy rate. The age of the donor, however, was directly related to the miscarriage rate. On the other hand, the age of patients undergoing IVF/GIFT was inversely related to the pregnancy rate and directly related to the miscarriage rate. In women of 40 years or over, the overall pregnancy and live birth rates were significantly higher and the miscarriage rate was significantly lower in the group receiving donated oocytes compared to the group using their own oocytes. In summary, we suggest that the age-related decline in fecundity is associated with the age of the oocytes rather than the age of the uterus.
The attitudes of volunteer donors and recipients undergoing treatment in an ovum donation programme were studied in order to assess both the psychological and psycho-social aspects of the procedure. A questionnaire was sent to 35 donors and 60 recipients. All donations were unpaid. Fifty-eight were anonymous donations and three were known. Eighty-six per cent of recipients and 74% of donors had told at least one person other than their partner. Eighty per cent of donors and 66% of recipients agreed that donors should not be paid. Sixty-three per cent of donors would donate if the recipient was told their name but only 26% of recipients would accept if the donor was given their name. Seventy per cent of the donors would donate to someone they knew but would rather donate anonymously. Ninety per cent of recipients were strongly against the donor contacting the child later in life but 54% of donors had no objection to the child contacting them. Eighty-six per cent of recipients and 56% of donors felt that if they had been born from a donated oocyte, they would not want to know.
A case is reported of the velamentous insertion of the umbilical cord into the membranes of the placenta, unsuspected until delivery, in an in vitro fertilization pregnancy. Abnormal placental development adds a new dimension of risk to these pregnancies. The Australian Register of in vitro fertilization (IVF) pregnancies has shown (1) an increase in perinatal mortality rates but there are many possible causes for such an increase. A recent report (2) has suggested a higher incidence of velamentous and marginal insertions of the umbilical cord in IVF pregnancies. We wish to report a case of marked velamentous insertion of the cord which was associated with an uncomplicated vaginal delivery, but highlights the possible increased risks of vasa praevia in IVF pregnancies.
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