JAMA Paper: Donor egg cycles for IVF have increased, as have good outcomes for donor egg births

Woodruff Health Sciences Center | Oct. 17, 2013

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Janet Christenbury
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Jennifer Kawwass is a third-year reproductive endocrinology and infertility fellow in Emory's Department of Gynecology and Obstetrics.

The number of donor egg in-vitro fertilization (IVF) cycles has increased over a 10-year period of time in the U.S., and outcomes of births from the donor eggs have improved, according to researchers at Emory University. The results, published by the Journal of the American Medical Association (JAMA), were released early online today to coincide with its presentation at the American Society for Reproductive Medicine annual meeting in Boston. 

Between 2000 and 2010, Emory and CDC researchers, led by Jennifer Kawwass, MD, a third-year reproductive endocrinology and infertility fellow in Emory's Department of Gynecology and Obstetrics, looked at trends using donor oocytes (egg cells) in the U.S. and birth outcomes. The researchers used surveillance data from the Centers for Disease Control and Prevention's National Assisted Reproductive Technology (ART) Surveillance System (NASS). Fertility centers are mandated to report their data to the system, which includes information on more than 95 percent of all IVF cycles performed across the nation. 

The researchers examined data at 443 clinics (93 percent of all U.S. fertility centers) and found the number of donor egg cycles performed increased from 10,801 in 2000 to 18,306 in 2010. An increasing trend was also seen in the percentage of cycles that involved frozen embryos (26.7 percent to 40.3 percent) and elective single-embryo transfers (vs. transfers of multiple embryos) (0.8 percent to 14.5 percent). Good perinatal outcomes increased from 18.5 percent to 24.4 percent. (Good perinatal outcome is defined as a single live-born infant delivered at 37 weeks or later weighing 5.5 pounds or more.) 

"We believe the increase in donor egg use and successful birth outcomes from those donor eggs are multi-fold,” says Kawwass. "More women with diminished ovarian reserve are using donor egg for IVF and having successes. And improved technology, along with better access to donor eggs, in part because of egg freezing capabilities, is also increasing numbers. It has also become more socially acceptable to use donor egg when choosing IVF.” 

Kawwass, who is a fellow at the Emory Reproductive Center, observed that the average age remained stable at 28 years for donors and 41 years for recipients. Recipient age was not associated with likelihood of good perinatal outcome. 

"We also found that transferring a single day 5 embryo was associated with an increased likelihood of good perinatal outcome,” says Kawwass. "Negative predictors included  tubal and uterine factor infertility (having damaged or abnormal fallopian tubes and/or uterus). Women with these diagnoses may have less chance of achieving a good perinatal outcome. Non-Hispanic black race was also associated with a lower chance of good perinatal outcomes as compared to non-Hispanic white race,” Kawwass explains. 

Further studies are needed to understand the mechanisms underlying the factors associated with unsuccessful outcomes, according to the Emory researchers. 

Co-authors on the paper include: Donna Session, MD, associate professor in the Department of Gynecology and Obstetrics at Emory and medical director of the Emory Reproductive Center; Denise Jamieson, MD, clinical professor, Department of Gynecology and Obstetrics at Emory and branch chief, Women’s Health & Fertility Branch, Division of Reproductive Health, CDC; and Dmitry Kissin, MD, MPH, adjunct assistant professor, Department of Gynecology and Obstetrics at Emory and team lead, Assisted Reproductive Technology Surveillance and Research, Women’s Health & Fertility Branch, Division of Reproductive Health, CDC.