Fertilización asistida con óvulos donados: indicaciones y resultados

Las mujeres retrasan cada vez más la maternidad por diferentes motivos, lo que les ocasiona recurrir a tratamientos de fertilización in vitro (FIV) con óvulos propios u óvulos donados para conseguir embarazo. En los tratamientos de FIV con óvulos donados se realiza una selección estricta de las donantes, quienes son sometidas a estimulación ovárica con posterior aspiración de los folículos. La edad recomendada para donar es entre 21 y 34 años. Se recomienda un máximo de 6 donaciones por donante. La receptora es la persona a quien se le realizará la transferencia del embrión y llevará el embarazo. Las tasas de embarazo con esta técnica de reproducción asistida son altas y las indicaciones más frecuentes son edad materna avanzada y falla ovárica precoz.

Women are increasingly delaying childbearing for different reasons, which causes them to resort to in vitro fertilization (IVF) treatments with their own oocytes or donated oocytes to achieve pregnancy. In IVF treatments with donated oocytes, donors are strictly selected and undergo ovarian stimulation with subsequent follicle aspiration. The recommended age to donate is between 21-34 years old. A maximum of 6 donations per donor is recommended. The recipient is the person to whom the embryo transfer will be performed and who will carry the pregnancy. Pregnancy rates with this assisted reproduction technique are high and the most frequent indications are advanced maternal age and early ovarian failure.

Sudden death of an egg donor during oocyte retrieval due to ovarian hyperstimulation syndrome

ABSTRACT Ovarian Hyperstimulation Syndrome (OHSS) is uncommon among oocyte donors during in vitro fertilization (IVF) procedure and is rarely associated with death. We report a case of a 23-year-old oocyte donor who suddenly died on the operation table during oocyte retrieval. She had no risk factors in her menstrual history, laboratory, or clinical parameters. The antagonist cycle, triggered with the GnRH agonist protocol, was carried out. The cause of death at autopsy was attributed to respiratory failure due to acute massive pulmonary edema, which developed due to the complication of OHSS. Only a few autopsy cases associated with OHSS have been published, but, as far as we know, no clinical or autopsy cases of sudden death caused by OHSS have been reported.

Técnicas de substituição de DNA mitocondrial para reduzir a transmissão da Síndrome de Leigh / Mitochondrial DNA replacement techniques to reduce Leigh syndrome transmission

A Síndrome de Leigh (SL) é uma doença neuro-metabólica congênita, que faz parte do grupo das encefalopatias fatais, com progressão e morte dentro de 2 anos, em média. A SL é causada por mutações no DNA que causam alterações na geração de ATP celular pelas mitocôndrias. As mitocôndrias contêm seu próprio DNA (mtDNA) e, ao contrário do DNA nuclear, o mtDNA é herdado somente da mãe. Mulheres portadores de mutações causadoras da SL podem vivenciar experiências muito tristes ao tentarem realizar o sonho da maternidade. As técnicas de substituição de mtDNA mutado com mtDNA saudável de doadora, oferecem a essas mulheres a possibilidade de terem uma criança geneticamente relacionada sem a SL. O desenvolvimento e a aplicação clínica de terapias de substituição de mtDNA já são uma realidade, tendo o primeiro bebê gerado a partir da técnica nascido em 2016. Mas será que essas técnicas são seguras? Neste trabalho, revisamos a SL e algumas técnicas de substituição de mtDNA já aplicadas em humanos, que envolvem a transferência de pronúcleos de zigotos ou de fuso acromático de oócitos. Concluímos que, apesar dos resultados promissores, ainda é cedo para assegurar a aplicabilidade clínica de técnicas de substituição de mtDNA em seres humanos. (AU)

Leigh syndrome (SL) is a congenital neurometabolic disease included in the group of fatal encephalopathies, with progression and death within 2 years on average. SL is caused by mutations in the DNA that cause changes in the generation of cellular ATP by mitochondria. Mitochondria contain their own DNA (mtDNA) and, unlike nuclear DNA, mtDNA is inherited only from the mother. Women with SL mutations may experience mournful situations when attempting to fulfill the dream of motherhood. Techniques for replacing mutant mtDNA with healthy donor mtDNA provide these women with the possibility of having a genetically related child without SL. The development and clinical application of mtDNA replacement therapies is a reality, and the first baby generated using the technique was born in 2016. However, are these techniques safe? In this article, we review SL and some mtDNA replacement techniques that have been used in humans, which involve zygote pronuclear transfer or oocyte spindle transfer. We conclude that, despite the promising results, it is too early to ensure that mtDNA replacement techniques are clinically applicable to humans. (AU)

Shared oocyte donation: ideas and expectations in a bioethical context based on a qualitative survey of brazilian women / Doação compartilhada de oócitos: ideias e expectativas em um contexto bioético com base em um levantamento qualitativo de mulheres brasileiras

Abstract Objective Assisted reproduction combines innovative technologies and new forms of procreation through gamete donation; however, it also leads to moral and ethical issues and to the wide application of referential bioethics. The objective of the present study was to understand the bioethical context of shared oocyte donation. Methods The present qualitative study used the Collective Subject Discourse methodology to interview donors and recipients in Brazil. Results Donors suffer from infertility, and in vitro fertilization opens the possibility of having a child; however, the cost is high, and helping the recipient is more important than the financial cost. The recipients regret delaying motherhood; adopting a child is their last option, and they desire to feel the physical stages of pregnancy. The recipients find the rules unfair regarding the lack of an oocyte bank and the fact that the treatment must be performed in shared cycles; however, oocyte donation makes it possible to realize the common dream of motherhood. Conclusion The obtained data showed that the patients are suffering and frustrated due to infertility, and they realize that in vitro fertilization may be the treatment they need. These women believe that children are essential in the constitution of the family, and scientific advances bring about innovative technologies and new forms of family constitution, with repercussions in the social, economic, political, and family contexts that lead to bioethical questions in Postmodernity.

Resumo Objetivo A reprodução assistida agrega tecnologias inovadoras e novas formas de procriação pormeio da doação de gametas; no entanto, também leva a questões éticas e morais e à ampla aplicação da bioética referencial. O objetivo deste estudo foi compreender o contexto bioético da doação compartilhada de oócitos. Métodos Este estudo qualitativo utilizou a metodologia do Discurso do Sujeito Coletivo para entrevistar doadoras e receptoras no Brasil. Resultados As doadoras sofrem de infertilidade, e a fertilização in vitro abre a possibilidade de ter um filho; no entanto, o custo é alto, e ajudar a receptora é mais importante do que o custo financeiro. As receptoras se arrependem de retardar a maternidade; adotar uma criança é sua última opção, e elas desejam sentir os estágios físicos da gravidez. As receptoras consideramas regras injustas emrelação à falta de um banco de oócitos e ao fato de que o tratamento deve ocorrer emciclos compartilhados; no entanto, a doação de oócitos possibilita a realização do sonho comum da maternidade. Conclusão Os dados obtidosmostraram que as pacientes estão sofrendo e frustradas devido à infertilidade, e percebem que a fertilização in vitro pode ser o tratamento de que necessitam. Essas mulheres acreditam que as crianças são essenciais na constituição da família, e os avanços científicos agregam tecnologias inovadoras e novas formas de constituição familiar com repercussões nos contextos sociais, econômicos, políticos e familiares que levam a questões bioéticas na Pós-modernidade.

Fatores que envolvem o alcance da maternidade por meio de material genético de terceiros / Factors involving maternity through third-party genetic material

Objetivo: Identificar alguns dos obstáculos enfrentados por mulheres que buscam a maternidade utilizando material genético de terceiros. Método: estudo exploratório descritivo com abordagem qualitativa tendo como foco depoimentos disponíveis em dois espaços virtuais voltados para mulheres envolvidas na Reprodução Humana Assistida (RHA) heteróloga. Resultados: A análise dos relatos possibilitou identificar alguns obstáculos enfrentados por mulheres que buscavam a RHA heteróloga. Pode-se destacar o incentivo ao processo de tomada de decisão quanto à RHA heteróloga; solidariedade diante das vivências relatadas; socialização de experiências e compartilhamento do conhecimento construído; apoio a outras mulheres; doação compartilhada de oócitos e embriões; enfrentamento do preconceito quanto à utilização de gametas doados. Conclusão: Os blogs constituem importante fórum de discussões com compartilhamento de dúvidas, conhecimentos e explicitação das ambiguidades quanto ao tema. O anonimato parece favorecer essas trocas (AU).

OBJECTIVE: To identify some obstacles faced by women who search for motherhood by using third-party genetic material. METHOD: This is an exploratory descriptive study with qualitative approach focusing on available testimonies from two selected virtual spaces for women involved with heterologous Assisted Human Reproduction (AHR). RESULTS: The reports analysis allowed the identification of a series of problems faced by women who searched for AHR. They highlight the motivation to the process of decision making on heterologous AHR; sympathy about the related experiences; sharing of experiences and developed knowledge; support to other women; shared oocytes and embryos donation; coping with prejudice regarding the use of donated gametes. CONCLUSION: Blogs are an important discussion forum with doubts sharing, knowledge and explanation of the ambiguity of this theme. The anonymity seems to help these information exchanges (AU).

What do Infertile Women Think about Oocyte Reception, Oocyte Donation, and Child Adoption? / O que as mulheres inférteis pensam em relação a ovo recepção, doação de oócitos e adoção de crianças?

Abstract Purpose The views of infertile couples regarding oocyte donation by third parties and adoption are unknown, as these may be interpreted as a final closure of the available options for conception. This study aimed to determine the acceptance of oocyte donation, oocyte reception, and child adoption of infertile women who submitted to assisted reproductive technology (ART) treatment Methods Sixty-nine women who were under treatment for infertility and submitted to ART procedures were included in this cross-sectional study. They were evaluated using semi-structured questionnaires administered during ovulation induction in a treatment cycle. Marital status, religion, years of schooling, occupation, type of infertility, age, duration of infertility, number of previous ART cycles, mean oocyte number per cycle, and mean number of embryos per cycle had no influence on a woman's acceptance of oocyte donation or oocyte reception. Results More than 90% of the patients thought that the subject of "adoption" should be brought up during their ART treatments, although they preferred to discuss this topic with psychologists, not doctors. Women with occupations were more willing to consider adoption. Conclusion The opinions of these patients on these issues seem to be based on personal concepts and ethical, religious, and moral values. Women preferred to discuss adoption with psychologists rather than doctors.

Resumo Objetivo Não se sabe ao certo o que os casais inférteis acham sobre doação de óvulos por terceiros e adoção, condições estas que podem ser interpretadas como um encerramento definitivo das opções disponíveis para concepção. Este estudo teve como objetivo determinar a aceitação da doação de oócitos, ovo recepção e adoção de crianças por mulheres inférteis submetidas a tratamento de reprodução assistida (RA). Métodos Sessenta e nove mulheres em tratamento para infertilidade e submetidas a procedimentos de RA foram incluídas neste estudo transversal. Elas foram avaliadas por meio de questionários semiestruturados administrados durante a indução da ovulação em um ciclo de tratamento. Resultados O estado civil, religião, escolaridade, ocupação, tipo de infertilidade, idade, duração da infertilidade, número de ciclos de RA anteriores, o número médio de oócitos por ciclo e de embriões por ciclo médio não tiveram influência sobre a aceitação da doação ou da recepção de oócitos. Mais de 90% das mulheres acha que o tema "adoção" deve ser discutido durante o tratamento de RA, porém preferem discutir este tema com psicólogos, e não com médicos. As mulheres com ocupações foram mais predispostas a considerar a adoção. Conclusão As opiniões destas pacientes sobre estas questões parecem ser baseadas em conceitos pessoais e valores éticos, religiosos e morais. As mulheres preferiam discutir a adopção com psicólogos, em vez de médicos.

Cuerpos abstractos, riesgos concretos: dispositivos clínicos y la salud de las donantes de óvulos en la medicina reproductiva argentina / Abstract bodies, concrete risks: clinical devices and the health of ova donors in Argentine reproductive medicine

RESUMEN Desde una perspectiva metodológica inspirada por los estudios en ciencia y tecnología, este trabajo analiza dos dispositivos clínicos (estándares bioestadísticos y registros de donación) que se utilizan en la medicina reproductiva argentina con el objetivo de controlar el denominado "riesgo genético" que se originan en el uso de óvulos donados, así como los riesgos para la salud de las mujeres donantes. Al examinar cómo la implementación de criterios de control desatiende la especificidad de la donación de óvulos, el artículo propone que no es la ausencia de criterios y controles clínicos en fertilidad lo que produce el inadecuado control de esos riesgos, sino que es la forma concreta en la cual se implementan tales controles lo que resulta en un potencial perjuicio para la salud de las mujeres donantes.

ABSTRACT Using a methodological perspective grounded in science and technology studies, this article analyzes two sociotechnical devices used in Argentine reproductive medicine (biostatistical measures and donation registries) with the aim of controlling both the so-called "genetic risk" arising from the use of donated ova as well as the health risks to female donors. By examining how the deployment of monitoring criteria disregards the specificity of ova donation, the article suggests that it is not the absence of control measures and clinical criteria that produces an inadequate monitoring of such risks, but rather the concrete ways in which such measures are implemented that results in potential harms to the health of female donors.

Donación de ovocitos vitrificados en paciente con síndrome de Turner

El síndrome del Turner es una aberración cromosómica con pérdida total o parcial de uno de los dos cromosomas sexuales. La característica clásica es la baja estatura y la insuficiencia ovárica debido a la disgenesia ovárica. La donación de ovocitos ha hecho posible que pacientes con ST puedan gestar, pero con alta mortalidad materna por rotura de la arteria aorta o por desórdenes hipertensivos. Se da a conocer el embarazo múltiple de un paciente con ST en un programa de donación de ovocitos vitrificados.

Turner syndrome is a chromosome aberration with complete or partial loss of one of the sexual chromosomes. Classical characteristics are short stature and ovarian failure due to dysgenesia. Oocyte donation has made possible gestation in Turner's patients but resulting in high maternal mortality due to rupture of the aorta or hypertensive disorders. The case of a Turner syndrome patient resulting in multiple pregnancy in a vitrified oocyte donor program is presented.

O que influencia doação de óvulos quando não há compensação financeira? / What influences oocyte donation when there is no financial compensation?

Aim: To evaluate the influence of factors such as age, education level and previous treatment for infertility in the decision to donate or receive eggs. Methods: Patients visting our service for the first time answered the question: “Would you donate or receive eggs?”. We assessed whether the inclination to donate or receive was related to age, level of education and the previous unsuccessful treatment for infertility.Results: 313 patients were included and most (56.9%) said they would donate eggs while only 34.5% would receive a donation. When giving and receiving were evaluated jointly we observed a positive correlation between them (Pearson correlation: r = 0.537, p < 0.01). Patients that underwent previous treatments for infertility were significantly more prone to egg donation (63.4% yes vs. 36.6% no, p < 0.05 vs no previous treatment group), but not toreceive (41.8% yes vs. 58, 2% no). In high and low levels of education most patients were in favor of donation (55.4% and 61.3%, respectively), but against the idea of receiving (33.9%and 37.5%, respectively). There was no significant differences between groups. The age of the patients (< 35 years old or > 35 years old) did not influence the will do donate (58.2% and56.4% respectively) or receive eggs (36.9% and 33.0%, respectively).Conclusions: Our results help understand the factors that may influence the decision to participate in an egg-sharing scheme. We could speculate that patients who have previously undergone unsuccessful treatments are more open to egg-sharing, despite their age or educational background. It would also be relevant to investigate the psychosocial reasons that make couples more willing to donate eggs than receiving.

Objetivo: Avaliar a influência da idade, grau de escolaridade e tratamento anterior na decisão de doar ou receber óvulos. Pacientes e métodos: Mulheres atendidas em nosso serviço responderam à pergunta: “Vocêdoaria ou receberia óvulos?”. Avaliou-se a concordância de aceitação de ovodoação ou ovorecepção com a idade, o grau de escolaridade e tratamento anterior para infertilidade. Resultados: Foram incluídas 313 pacientes e a maioria (56,9%) respondeu que doaria óvulos enquanto apenas 34,5% receberiam. Houve correlação positiva entre doação e recepção (r = 0,537, p < 0,01). Pacientes submetidas a tratamento anterior de infertilidade se mostraram significativamente mais propensas à doação (63,4% sim vs 36,6% não, p < 0.05 vs sem tratamento anterior), mas não a receber (41,8% sim vs 58,2% não). Em níveis altos e baixos de escolaridade a maioria dos pacientes se mostrou a favor da doação (55,4% e 61,3%, respectivamente), mas contra a ideia de receber (37,5% e 33,9%, respectivamente), não houvediferenças significativas entre os grupos. A maioria das pacientes com menos ou mais de 35 anos de idade doaria (58,2% e 56,4%, respectivamente), mas não receberia (36,9% e 33,0%, respectivamente).Conclusões: Nossos resultados são relevantes para entender os fatores que podem influenciar na decisão de participar em um esquema de partilha de óvulos. Poderíamos especular que pacientes previamente submetidas a tratamentos mal sucedidos são mais aberta à ovodoação, apesar de sua idade ou formação educacional.

Motivaciones y actitudes hacia la donación voluntaria de ovocitos: experiencia de la Unidad de Medicina Reproductiva de la Clínica Monteblanco / Motivations and attitudes toward voluntary donation of oocytes

Objetivos: Determinar las motivaciones de mujeres para donar óvulos, y las significaciones que le otorgan a la misma. Método: Entrevista semiestructurada, cualitativa, a 18 mujeres candidatas a donantes de óvulos. Los tópicos analizados incluyeron: experiencias pasadas, fantasías y expectativas en relación a la ovodonación. Resultados: Las edades de las entrevistadas fluctuaron entre 19 y 29 años; 13 eran solteras y 6 tenían al menos un hijo. Más de la mitad estaban estudiando y trabajando al momento de la entrevista. Ninguna tenía antecedente de patología psiquiátrica personal ni familiar. La compensación económica fue la principal motivación para donar, aunque la empatía con las parejas infértiles fue otro importante motivador. Las potenciales donantes refirieron que el anonimato como protector para la donante y la pareja receptora. Las donantes percibieron la maternidad más relacionada con la crianza que con el vínculo genético. Conclusiones: Encontramos que las candidatas para ovodonar perciben la maternidad en función de la crianza y no del vínculo genético. Por lo tanto, asimilaron la donación de ovocitos con la donación de cualquier órgano. Sin embargo, manifiestan su rechazo a tener contacto con la familia receptora. Como era de esperar, la motivación económica fue la principal razón para donar, sin embargo, sentían fuerte empatía con las parejas infértiles.

Aims: To identify the motivating factors of candidates to donate oocytes, and the significance they assign to oocyte donation. Methods: We evaluated 18 volunteers trough a semi-structured interview. Topics discussed included: past experiences, fantasies and expectations towards the process of oocyte donation. Results: The ages fluctuated between 19 and 29 years; 13 were single and 6 had one or more children. More than a half were studying and working at the moment of the interview. None had familiar or personal psychiatric disorders. The economical compensation was the most important reason for the intention to donate, though the empathy with infertile couples was a significant motivator too. Potential donors perceived anonymity as protective for both donor and receptor. They perceived motherhood as rising the child rather than having a genetic link. Conclusions: We found that potential donors perceive motherhood as linked to rising a child, rather than having a genetic link. Therefore, they assimilate oocyte donation to the donation of any other organ. However, they prefer to have no contact with the oocyte receptor. As expected, the main motivator is the economical compensation, however they have strong feelings of empathy towards infertile couples.

Aspectos bioéticos da reprodução assistida no tratamento da infertilidade conjugal / Bioethical issues of assisted reproduction in infertility treatment

A aspiração à reprodução é tida como um objetivo essencial de vida, legítimo e incontestável. A infertilidade acarreta para muitas pessoas uma crise vital prolongada e o estresse resultante frequentemente leva à morbidade emocional e a problemas interpessoais. Um entre cada seis casais apresenta infertilidade e, para 20% deles, o único caminho para obter gestação e, consequentemente, filhos é a reprodução assistida. Este texto discute os aspectos bioéticos da fertilização in vitro no tratamento da infertilidade, com o objetivo de contribuir para a reflexão e o debate desta temática pela comunidade científica. Abordamos as questões relacionadas ao casal, ao embrião e ao nascituro, considerando também o uso de gametas doados e de cessão temporária do útero

The aspiration for reproduction is considered as a crucial, legitimate and unquestionable goal in life. For many people, infertility leads to a prolonged life crisis, and the resulting stress often leads to emotional morbidity and interpersonal problems. One in six couples suffers from infertility, and for 20% of them, the only way to achieve pregnancy and have children is Assisted Reproduction. This paper discusses the bioethical aspects of IVF treatment for infertility, so as to contribute to the reflection and discussion of this topic by the scientific community. We address issues concerning the couple, the embryo and the unborn child, also addressing the use of donated gametes and surrogate uterus

¿Cincuenta años, el límite para donación de ovocitos en la posmenopausia? / Is reaching fifty the limit for oocyte donation in postmenopausal women?

Introducción: el número de mujeres que actualmente postergan su embarazo se encuentra en aumento, de igual forma el número de parejas que recurren a los programas de medicina reproductiva es cada día mayor. La donación de ovocitos ha permitido la consecución de embarazos en mujeres posmenopáusicas; sin embargo, no existe consenso sobre cuál es la edad máxima de la receptora. Objetivo: proponer un límite máximo para ofrecer donación de ovocitos de acuerdo al tiempo de crianza. Conclusión: debido a un mayor tiempo de crianza, se propone la donación de ovocitos hasta los 50 años.

Introduction: the number of females who now postpone their decision to become pregnant is increasing and the number of couples who use reproductive medicine programmes becomes greater every day. Oocyte donation has enabled postmenopausal women to become pregnant, even though no consensus has been reached concerning the maximum age for receiving such treatment. Objective: it is proposed that a maximum age limit be imposed for receiving a donation, due to increased upbringing time. Conclusion: patients should only be offered the chance to receive ovodonation up to age 50 due to the pertinent upbringing time occurring later in life.

Outcome of pregnancy in women with polycystic ovary syndrome treated by in vitro maturation of immature oocytes / 中华妇产科杂志

n occurring after the treatment of IVM in women with PCOS are not mounting. However, the relative high rates of multiple pregnancies, low birth weight and preterm labor were increased.

Clinical factors affecting the outcomes of oocyte donation cycles / 대한산부인과학회지

OBJECTIVE: Oocyte donation cycle has been a useful model for the assessment of potential factors affecting human pregnancy, such as uterine receptivity or oocyte quality. The purpose of this study was to investigate variable clinical factors affecting the outcomes of oocyte donation cycles. METHODS: This study reviewed 109 cycles of 85 women who underwent oocyte donation in SNUH infertility clinic from March 1992 to February 2004. Variable clinical characteristics were compared between pregnant and non-pregnant group. Data was evaluated by student's t-test, oneway ANOVA, and Chi-square test. RESULTS: Clinical pregnancy rate was 38.5% per cycle and 48.2% per recipient. When pregnant and non-pregnant groups were compared, there was a significant difference in donor age between both groups. (30.2+/-3.6 vs. 32.1+/-4.3, P=0.017). On the other hand, there were no significant differences in mean age, BMI, gravidity of recipient, and peak estradiol level of donor. The number of oocytes retrieved, embryos transferred, fertilization rate, and cumulative embryo score were not different between pregnant and non-pregnant group. Among the various donor age groups, clinical pregnancy rate was significantly higher in or =35 years (50.0% vs 18.2%, P=0.015). There were no significant differences for both endometrial thickness and pattern in the pregnancy rate during the IVF-ET cycles by ovum donation. CONCLUSION: The most reliable predictive factor for pregnancy in oocyte donation cycles is the age of oocyte donor. The mid-cycle endometrial thickness and trilaminar patterns are insignificant predictors. The age of recipient and cumulative embryo score are also insignificant factors.

Turner syndrome: counseling prior to oocyte donation

Ovarian failure is a typical feature of Turner syndrome (TS). Patients are followed clinically with hormone replacement therapy (HRT) and inclusion in the oocyte donation program, if necessary. For patients with spontaneous puberty, genetic counseling regarding preimplantation genetic diagnosis and prenatal diagnosis is indicated. Patients with dysgenetic gonads and a Y chromosome are at increased risk of developing gonadoblastoma. Even though this is not an invasive tumor, its frequent association with other malignant forms justifies prophylactic gonadectomy. It is important to perform gonadectomy before HRT and pregnancy with oocyte donation. Among patients with TS stigmata and female genitalia, many have the Y chromosome in one of the cell lines. For this reason, all patients should undergo cytogenetic analysis. Nevertheless, in cases of structural chromosomal alterations or hidden mosaicism, the conventional cytogenetic techniques may be ineffective and molecular investigation is indicated. The author proposes a practical approach for investigating women with TS stigmata in whom identification of the X or Y chromosome is important for clinical management and follow-up.

A falência ovariana é um achado típico da síndrome de Turner (ST). As pacientes podem ser submetidas à terapia de reposição hormonal (TRH) e incluídas em programas de doação de oócito, quando necessário. Para as pacientes com puberdade espontânea, está indicado o aconselhamento genético para a futura descendência abordando os diagnósticos genéticos pré-natal e pré-implantação. Pacientes com gônadas disgenéticas e cromossomo Y apresentam risco aumentado para desenvolvimento de gonadoblastoma. Embora esse tumor não seja invasivo, sua associação freqüente com tumores malignos justificaria a gonadectomia profilática. Entre as pacientes com estigmas da ST e genitália feminina, muitas apresentam cromossomo Y em pelo menos uma linhagem celular. Por essa razão, todas as pacientes devem ser submetidas à análise citogenética, para a realização de cirurgia antes do início da TRH e da gravidez com doação de oócito. No entanto, em casos de alteração cromossômica estrutural ou mosaicismo críptico, as técnicas citogenéticas convencionais podem não ser efetivas, estando indicada a investigação molecular. Uma abordagem prática para o médico investigar as pacientes com ST é proposta neste artigo, devido à importância da identificação do cromossomo Y ou de um segundo cromossomo X para o manejo clínico e o acompanhamento das pacientes.

Oocyte Donation in Infertility Treatment / 대한산부인과학회지

Recent advances in assisted reproductive technology have been able to overcome the nearly all problems associated with traditional infertility factor. IVF and ET using donated oocyte has brought new hope to many couples who otherwise would remain childless, so oocyte donation can be the alternative treatment modality for specific fatal infertility patients. The high success rate of this procedure has led to its wide application in women with ovarian failure or dysfunction, at various ages and for various etiologies. Oocyte donation is also offered to patients who repeatedly fail to conceive with standard IVF. But there are many conflicting issues in this procedure such as moral, ethical, medical, legal problems. We review the technical aspects related with oocyte donation in infertility treatment and ethico-legal issue.

Obstetrical outcome after oocyte donation in patients with premature ovarian failure / 대한산부인과학회지

OBJECTIVE: The purposes of this study are to evaluate the obstetric outcome in pregnancies resulting from oocyte donation and to assess the factors related to the obstetric complications. METHODS: The obstetric outcome in pregnancies from the oocyte donation (n=37) was compared with that in pregnancies from conventional IVF program (n=137) in our IVF center between January 1995 and December 2000. Control group was selected by age, parity, and order of gestation matched to the study group. Pregnancy induced hypertension (PIH) was defined as blood pressure >140/90 mmHg on two or more occasions at least 6 hours apart with or without proteinuria after 20 weeks of gestation and not associated with chronic hypertension. Small for gestational age (SGA) was defined as birth weight below tenth percentile for gestational weeks. The data was analyzed using the Statistical Package for Social Sciences (SPSS). RESULTS: Early pregnancy loss rates were 37.8% (14/37) and 23.4% (32/137) in study and control group, respectively (P>0.05). PIH related factors such as mean age, parity and order of gestation were not significantly different among the two groups. However, the incidence of PIH in oocyte donation group (30.0%, 6/20) was significantly higher than control group (8.8%,9/102). There was no significant difference in the incidence of SGA between the two groups. When oocyte donation group was stratified by relationship of oocyte donor to infertile patient (sibling versus non-sibling), the incidence of early pregnancy loss and PIH was significantly higher (chi square test, P<0.05) in non-sibling group (42.3%, 11/26; 38.5%, 5/13) than in control group (23.4%, 32/137; 8.8%, 9/102). CONCLUSION: The incidence of PIH was significantly higher in pregnancies after oocyte donation. Notably, the pregnancies from non-sibling oocyte donors had much higher incidence of early pregnancy loss and PIH than pregnancies from sibling oocyte donors or control group. Therefore, the occurrence of early pregnancy loss and PIH may be related to other factors than age, parity or multiple pregnancy.

The Comparison of Clinical Outcomes between GnRH Agonist Long Protocol and GnRH Antagonist Short Protocol in Oocyte Donation Cycles / 대한불임학회지

OBJECTIVES: To assess and compare the clinical outcomes between GnRH agonist long protocol and GnRH antagonist short protocol in oocyte donation program. MATERIALS AND METHODS: Of total 18 oocyte donation cycles, controlled ovarian hyperstimulation (COH) were performed with GnRH agonist long protocol and GnRH antagonist short protocol in initial 9 cycles and later 9 cycles, respectively. Oral estradiol valerate and progesterone in oil were administrated to all recipients for endometrial preparation. Oral estradiol administration was started from donor cycle day 1 after full shut down of gonadal axis with GnRH agonist in patients with ovarian function. Progesterone was injected from oocyte retrieval day of donor initially, then continuously till pregnancy 12 weeks if pregnancy was ongoing. We compared the parameters of clinical outcomes, such as number of the retrieved oocytes, fertilization rate, high grade embryo production rate, clinical pregnancy rate, implantation rate, ongoing pregnancy rate, COH duration, total gonadotropin dose for COH between GnRH agonist long protocol group and GnRH antagonist group. Statistical analysis was performed using Mann-Whitney test, p0.05). Duration and total gonadotropin dose for COH were 10.94+/-1.70 days and 43.78+/-6.8 vials in 18 cycles, 12.00+/-1.73 days and 48.00+/-6.93 vials in agonist group, 9.88+/-0.78 days and 39.55+/-3.13 vials in antagonist group, respectively. in GnRH agonist long protocol group, significantly longer duration and higher gonadotropin dose for COH were needed (p= 0.012). CONCLUSION: in oocyte donation program, clinical outcomes from controlled ovarian hyperstimulation with GnRH antagonist were comparable to those from GnRH agonist long protocol group, so controlled ovarian hyperstimulation with GnRH antagonist may be effective as GnRH agonist long protocol. At least there may not be harmful effects of GnRH antagonist on oocyte development and quality.