Evaluation of Uterine Artery Doppler and Estrogen Milieu in Oocyte Donation Pregnancies—A Pilot Study

Abstract

Oocyte donations (OD) represent 4.5% of all in vitro fertilization (IVF) cycles. While OD pregnancies face increased risks of obstetrical complications, especially pregnancy-induced hypertension and pre-eclampsia (PE), little is known about the physiology and the physiopathology of placentation. We performed a prospective case-control study to analyze uterine artery Doppler pulsatility index (UtA-PI) and serum maternal 17β-estradiol (17β-E) at 11 + 0 to 13 + 6 weeks’ gestation in singleton pregnancies with different modes of conception. Study groups were: 55 OD, 48 IVF with autologous oocytes from fresh cycles (Autologous-Fresh IVF), 10 IVF with autologous oocytes from frozen cycles (Autologous-Frozen IVF) and 122 spontaneously conceived pregnancies (SC). The mean UtA-PI and serum maternal 17β-E at 11 to 13 + 6 weeks were significantly lower in OD as compared to SC and autologous IVF, either from fresh or frozen cycles. Oocyte donation presents lower UtA-PI and lower serum 17β-E in the first trimester of pregnancy. The etiology of these particularr differences is likely multifactorial and deserves further investigation.

Novel association between FOXO3 rs2232365 polymorphism and late-onset preeclampsia: a case-control candidate genetic study

“…Aberrant human lymphocyte antigen (HLA) allogenicity can alter the function of uterine natural killer cells (uNK) and lead to the abnormal maternal blood supply to the placenta, which is the predominant cause of facilitates disorders such as PE and fetal growth restriction [26]. A recent study also showed abnormally low uterine arteries pulsatility index and serum maternal 17 β -E at 11 to 13 + 6 weeks in oocyte donations as compared to natural conceptions [27,28]. The authors of this study described this new phenomenon as increasing placental perfusion to compensate for maternal or placental dysfunction [27].…”

The pathophysiological role of estrogens in the initial stages of pregnancy: molecular mechanisms and clinical implications for pregnancy outcome from the periconceptional period to end of the first trimester

“…Owing to the lack of evidence, this result could be variously explained: first, we could hypothesize that the smaller placental volumes detected in OD placentas could imply a lower estrogen release compared to natural and autologous IVF pregnancies ( Rizzo et al , 2016 ; Mandia et al , 2020 ); and second, we could speculate that oral estrogen administration might inhibit placental production, in a sort of feedback mechanism that is common in many endocrine systems. Undoubtedly, placental function in OD is reduced compared to naturally conceived and autologous IVF pregnancies: as observed by Savasi et al (2015) , first trimester placental markers, such as free β-hCG and PAPP-A, are significantly altered, suggesting a reduced crosstalk at the fetal–maternal interface ( Savasi et al , 2015 ).…”

“…A review of the literature has highlighted only a few studies, mainly from our study group. Mandia et al (2020) compared serum E2 levels in four different groups (55 OD pregnancies, 48 autologous fresh IVF/ET pregnancies, 10 autologous FET pregnancies and 122 naturally conceived pregnancies) during the late first trimester of pregnancy (from 11 + 0 to 13 + 6 gestational weeks). Unexpectedly, significantly lower E2 concentrations were detected in OD pregnancies compared to natural conception or autologous IVF pregnancies.…”

“…Unexpectedly, significantly lower E2 concentrations were detected in OD pregnancies compared to natural conception or autologous IVF pregnancies. However, no difference in pregnancy outcomes and complications emerged ( Mandia et al , 2020 ).…”

“…Moreover, exogenous steroid supplementation may not replace the total absence of a corpus luteum during the very early stages of an OD pregnancy, as well as playing a part in a negative feedback regulation on placental function. Eventually, altered serum estrogen levels during the late first trimester may induce improper modelling of uterine arteries, resulting in pregnancy complications, such as pre-eclampsia and fetal growth restriction ( Jauniaux et al , 1992 ; Mandia et al , 2020 ). As for periconceptional stages, further investigation is needed to find an optimal range for estrogenic concentrations during the first trimester.…”