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Association between oocyte donation and maternal and perinatal outcomes in women aged 43 years or older.

BACKGROUND
Although older maternal age is a risk factor for pregnancy complications, an increasing number of women delay conception until the age of 40, and some must resort to IVF with oocyte donation. Our objective was to study the association between IVF, both with and without oocyte donation, and maternal and perinatal outcomes in a population of older women.


METHODS
This retrospective study covered all women, aged 43 or more, who gave birth between 2008 and 2010. Univariate and multivariate analyses with logistic regression models were used to compare maternal and perinatal outcomes as a function of mode of conception: without IVF, with IVF using own oocytes or with IVF and oocyte donation.


RESULTS
The study included 380 women, including 40 who had IVF without oocyte donation (10.5%) and 104 who had both (27.4%). There were 326 singleton and 54 multiple pregnancies. Overall, the complication rate was high: 8.7% pre-eclampsia, 6.1% gestational diabetes, 20.2% preterm delivery and 8.2% very preterm delivery (before 33 weeks), 44.8% Cesarean sections and 7.4% severe post-partum hemorrhage (PPH). The pre-eclampsia rate differed significantly between the groups (3.8% after no IVF, 10.0% after IVF only and 19.2% after IVF with oocyte donation, P< 0.001). After adjustment, the risk of pre-eclampsia was significantly higher in women with donated oocytes compared with pregnant women without IVF [adjusted OR = 3.3 (1.2-8.9)]. The rate of twin pregnancy was significantly higher in women with IVF and oocyte donation (39.4 versus 15.0% with IVF only and 2.5% without IVF, P< 0.001). Twin pregnancy was significantly associated with the risk of preterm delivery [adjusted OR = 8.9 (4.0-19.9)] and PPH [adjusted OR = 3.5 (1.3-9.5)].


CONCLUSION
In women aged 43 years or older, pregnancies obtained by IVF with oocyte donation are associated with higher rates of pre-eclampsia and twin pregnancies than those obtained without IVF or with IVF using their own oocytes.