With advances in Assisted Reproductive Technologies (ART) a greater number of women are deciding to have a child and become a mother in their later years. Natural fertility rates decline with age, becoming dramatically apparent in women in their 40s and 50s. By the time of the perimenopause, pregnancy rarely occurs.
Oocyte donation is an integral part of modern assisted reproductive care and has been used as an aid for conception for young women with premature ovarian failure (POF). Currently, it is also being used to overcome the age-related decline in fertility. A number of IVF treatment clinics use oocyte donation which reverses the age-related decline in implantation and birth rates in older women and restores pregnancy potential.
However, one of the principle concerns regarding this process is the incidence of obstetric and neonatal complications in older patients.
A 56-year-old woman a case of primary fertility and menopausal for 15 years and had undergone 7 IVF cycles at various clinics with no success reported to our clinic.
The woman was counseled about the success rate and age-related pregnancy complications during her first visit.
In her second visit with her husband extensive pre-cycle screening was done which included medical screening such as complete blood count, biochemistry, thyroid profile, fasting blood glucose, glucose tolerance test (GTT), urinalysis, chest X-ray, coagulation parameters, PAP smear, and treadmill with echocardiography.
The reproductive screening was done which included transvaginal ultrasound, endometrial biopsy, and mock embryo transfer. The patient was also screened for Human Immunodeficiency Virus (HIV), venereal diseases, Hepatitis B (HBsAg) and Hepatitis C virus (HCV). Preconceptual and psychosocial counseling was also given.
When all the test reports were normal then she was first given practice hormone replacement cycle of estrogen and progesterone. She was regularly monitored for endometrial thickness via transvaginal ultrasounds. An optimum 10.5mm of thickness was achieved on day 14 of the cycle. She was then given 100 IU/ml progesterone.
In the next cycle, she was given hormone replacement therapy with the same dose as in practice cycle. A young donor about 26 years of age was screened for oocyte donation for the patient.
7 viable eggs were retrieved from the donor and the husband’s sperm was injected using Intracytoplasmic Sperm Injection (ICSI). When the 7 eggs fertilized and cleaved, 3 embryos were transferred.
Positive serum and urinary beta human chorionic gonadotrophin (hCG) diagnosed pregnancy after 14 days of embryo transfer. Progesterone pessary was given daily for the first 16 weeks of pregnancy. Also, estradiol valerate was given for endometrial regeneration for up to 16 weeks of pregnancy.
An ultrasound scan confirmed twin pregnancy. She delivered a female baby weighing 2.33 kg and a male baby weighing 2.65 kg through caesarean section at 30 weeks gestation.
Oocyte and embryo donation is an established standard of practice for the treatment of age-related infertility and is associated with high rates of pregnancy success. Prior to oocyte donation, adoption was the only way for couples to attain parenthood. Thanks to the advancement in technology now oocyte donation and low cost of IVF in India is a mode of therapy not only for infertile women but also for the ones who are at high risk for passing on genetic disorders.
However, obstetrical events and outcomes associated with advanced reproductive age can’t be overlooked. Women of advanced reproductive age considering oocyte or embryo donation should undergo complete medical testing.
Though oocyte donation–IVF has given hope and happiness to millions of couples across the globe yet the post conception complications both physical and emotional cannot be ignored at a high maternal age.
In summary, IVF±ICSI using oocyte donation is highly successful. Increased pregnancy rate and a number of stimulated cycles required for pregnancy are important figures which can be used to inform women seeking pregnancy via IVF and oocyte donation. Although it is reassuring to postmenopausal women that their chances of conceiving and having a baby are excellent, it is also important that IVF treatment clinics counsel the patient about the higher rates of minor and major complications involved.