The outcome of in-vitro fertilization treatment by egg donation and intracytoplasmatic sperm injection for severe male factor infertility: a preliminary report

Due to a paucity of donated eggs, we have excluded, until recently, couples with severe male factor infertility from our egg donation programme, except for those who accepted insemination with donor spermatozoa. The purpose of this study was to assess the feasibility of a shared in-vitro fertilization (IVF)-embryo transfer treatment whenever the recipients have severe oligoasthenoteratozoospermia (OTA) and need intracytoplasmic sperm injection (ICSI) for egg fertilization. The results from 163 consecutive couples with ovarian failure who underwent 273 cycles of IVF with donated eggs and augmented with ICSI were analysed. The rate of diploid fertilization was 54.7%; in 92.3% of the cycles, at least one embryo was available for transfer. Forty-seven clinical pregnancies were achieved, representing 18.6% conceptions per transfer. The highest pregnancy rate was achieved in menopausal patients aged 40-45 years (26.2% per cycle) and the lowest in patients >45 years old (10.8% per cycle, P = 0.03). Overall, 28.8% of the couples achieved a clinical pregnancy. A total of 196 treatment cycles resulted in 46 clinical pregnancies (23.5%) among the donors. No statistical differences were found in pregnancy rate achieved by the donors when compared with the recipients. We conclude that ICSI with egg donation is a reliable treatment in patients with ovarian failure and severe OTA.     

Success rates with gamete intrafallopian transfer and in vitro fertilization in women of advanced maternal age

OBJECTIVE: To evaluate the effect of maternal age on outcomes for IVF and GIFT in women 40 to 45 years of age. DESIGN: Retrospective. SETTING: Boston IVF, a free-standing university-affiliated IVF and GIFT unit. PATIENTS: A total of 2,931 cycles of IVF and 1,826 cycles of GIFT were analyzed in women undergoing assisted reproductive technologies (IVF or GIFT) using autologous eggs. INTERVENTIONS: Medical records of patient outcomes were reviewed. RESULTS: For patients undergoing IVF, the cancellation rate for initiated cycles showed significant differences in women aged 25 to 39 (38.3%), women aged 40 to 43 (49.5%), and women aged 44 to 45 years (69.5%). A significantly lower delivery rate per stimulation and delivery rate per retrieval was found in women aged 40 to 43 years when compared with women aged 25 to 39 years. No deliveries occurred in 59 cycles in women aged 44 to 45 years, thereby representing a significant difference when compared with both women aged 25 to 39 years and women aged 40 to 43 years. For patients undergoing GIFT, the cancellation rate for initiated cycles was significantly higher in women aged 40 to 43 (25.0%) and 44 to 45 years (31.0%) when compared with women aged 25 to 39 years (15.1%). A significantly lower delivery rate per stimulation and delivery rate per retrieval was found in women aged 40 to 43 and 44 to 45 years when compared with women aged 25 to 39 years. CONCLUSIONS: Success rates for IVF and GIFT decline significantly in women > 40 years old. Women aged > or = 44 years are unlikely to benefit from the use of IVF and GIFT.     

Preimplantation adoption: establishing pregnancy using donated oocytes and spermatozoa

The experience of transferring embryos produced through in-vitro fertilization (IVF) utilizing donated oocytes and spermatozoa is described. Recipients (n = 28; aged 38-59 years) received oral micronized oestradiol and i.m. progesterone and were synchronized to donors undergoing ovarian stimulation. Reasons for selecting therapy included advanced reproductive age (> 42 years; n = 21) or hypergonadotrophic hypogonadism (n = 7), combined with severe male factor infertility in 23 couples. Five women were single and without partners. Oocytes were fertilized by cryopreserved spermatozoa designated for use by the recipient. Up to five embryos were transferred transcervically. Supernumerary embryos were cryopreserved. A total of 36 aspirations produced 15.6 +/- 7.3 oocytes per retrieval. In 10/36 cycles (27.8%), embryos were available for cryopreservation. Using fresh embryos, the overall pregnancy rate was 38.9% (14/36), clinical pregnancy rate 33.3% (12/36), and ongoing/delivered pregnancy rate 30.6% (11/36). Three ongoing pregnancies were later established by transferring cryopreserved embryos. Adjusting for these events, the per aspiration overall pregnancy rate per retrieval was 47.2%, clinical pregnancy rate 41.7%, and ongoing/delivered pregnancy rate 38.9%. Implantation rates per individual embryo transferred were 16.6% following fresh embryo transfer. A viable pregnancy was achieved by 14 of 28 women (50% cumulative pregnancy rate). We conclude that using donor oocytes and donor spermatozoa is efficacious and allows couples of whom both members suffer from severe gamete abnormalities and single functionally agonadal women an effective means of achieving pregnancy.     

Improved techniques for first-trimester fetal reduction using simultaneous abdominal and transvaginal ultrasonographic guidance. Preliminary report

Simultaneous transabdominal injection of potassium chloride (KCl) assisted by transvaginal ultrasonographic guidance was evaluated in 5 patients who conceived due to various assisted reproductive techniques and ovarian stimulation. All 5 underwent first-trimester fetal reduction for multiplicity of high-order pregnancies. Four sets of triplets were reduced to twin, and 1 twin pregnancy was reduced to a singleton. Less than 2 ml of 2 mEq/ml KCl per fetus was needed for each case. No fetal or maternal complications nor technical failure attributable to the procedure were recorded. All pregnancies were delivered > or = 35 weeks of gestation. Transabdominal fetal reduction using simultaneous transvaginal ultrasonographic guidance for selective feticide combines the benefits of both the transabdominal and transvaginal approaches, mainly in selected cases in which some experts prefer the abdominal route, but find it technically difficult to practice. Further experience is needed to confirm our encouraging preliminary results before drawing any definitive conclusions.     

Oocyte donation program: initial experiences at Southeastern Fertility Institute

From March 1994 to February 1996, 28 infertile couples participated in the oocyte donation program in 33 treatment cycles at the Southeastern Fertility Institute. Of the 31 cycles with embryo transfer, 15 cycles (48.4 percent) resulted in a clinical pregnancy with fetal heart beat by ultrasound. The spontaneous first trimester abortion rate was 3/15 (20 percent), multiple pregnancy rate 3/15 (20 percent), live birth rate 11/15 (73.3 percent) and delivery rate 12/15 (80 percent). It is recommended that oocyte donation procedure is a highly successful treatment option for women with ovarian failure or repeated unsuccessful trials of assisted reproductive technologies.     

Factors responsible for multiple pregnancies after ovarian stimulation and intrauterine insemination with gonadotropins

PURPOSE: The present study was undertaken in order to analyze possible factors that could be responsible for multiple pregnancies in normoovulatory women undergoing superovulation with gonadotropins and intrauterine artificial insemination. METHODS: We retrospectively analyzed several clinical parameters in patients that achieved gestation with this treatment. Patients were divided into two groups depending on sperm origin (husband and donor sperm). Furthermore, they were subclassified as follows: (a) cycles resulting in single pregnancies (n = 366), (b) cycles ending in multiple pregnancies (n = 126), and (c) a control group composed of unsuccessful cycles (n = 366). RESULTS: In cycles employing husband's sperm, the age, number of cycles necessary to reach pregnancy, serum estradiol (E2) levels, and number of follicles were significantly (P < 0.05) different in multiple pregnancies compared to single or nonpregnant cycles. In donor insemination, women with multiple pregnancies were significantly younger than nonpregnant patients. There was a significant increase in the number of follicles developed (P < 0.00001) and serum E2 levels on the day of hCG (P < 0.05) in multiple compared to single pregnancies and unsuccessful cycles. The number of motile sperm in the insemination specimen was not different among the established groups. When both types of treatments were grouped, pregnant patients were significantly (P < 0.00001) younger than women with failed cycles. In addition, multifetal pregnancies were significantly (P < 0.05) more frequent in women < 30 years old. E2 production was significantly (P < 0.00008) higher in twin and multifetal pregnancies than in single or nonpregnant cycles. Follicular development was also significantly (P < 0.00001) higher in twin and multifetal pregnancies compared to failed cycles. CONCLUSIONS: The results suggest that young women (< 30 years) who develop more than six follicles with E2 > 1000 pg/ml when stimulated with gonadotropins are at higher risk of multiple gestation. These data may be helpful in preventing this undesired complication of assisted reproduction techniques.     

Multifetal pregnancy reduction: modification of the technique and analysis of the outcome

OBJECTIVE: To modify the technique of multifetal pregnancy reduction and to study the outcome of reduced twins in comparison with nonreduced twins and high-order multiple gestations. DESIGN: Prospective controlled study. SETTING: The Egyptian IVF-ET Center, Cairo. PATIENT(S): Seventy-five patients with high-order multiple pregnancies resulting from assisted reproduction. Controls were 40 nonreduced twin pregnancies and 22 high-order multiple gestations. INTERVENTION(S): Transvaginal ultrasonically guided multifetal pregnancy reduction was performed. The first 30 cases were done using KCl as a cardiotoxic agent. The modified technique was used for the last 45 cases at an earlier gestational age (approximately 7 weeks) by eliminating the use of KCI and by aspirating the embryonic parts. MAIN OUTCOME MEASURE(S): Miscarriage rate, gestational age at delivery, birth weight, and pregnancy complications. RESULT(S): Using the modified technique, the miscarriage rate was 8.8% and 41 patients delivered between 32 and 39 weeks of gestation (mean+/-SD, 36.9+/-2.45 weeks). The mean (+/-SD) birth weight was 2,450.51+/-235.44 g. The miscarriage rate, fetal wastage rate, mean gestational age, and mean birth weight were similar in reduced and nonreduced twins and were significantly better than in nonreduced triplets and quadruplets. CONCLUSION(S): The modified technique of multifetal pregnancy reduction significantly improved outcomes, which were similar to those of nonreduced twins resulting from assisted reproduction and significantly better than those of nonreduced triplets and quadruplets.     

Successful immunomodulating in AIDS patients with ursodeoxycholic acid--a pilot study

OBJECTIVE: To determine the effect of mechanical assisted hatching on the pregnancy rate (PR). DESIGN: A retrospective comparative analysis of hatched versus nonhatched consecutive assisted reproductive technology (ART) cycles. SETTING: A hospital-based ART program. PATIENT(S): Patients undergoing ART treatment with assisted hatching (1994-1996) were compared with patients who did not have assisted hatching (1990-1993). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy rate, multiple PR, and rate of monozygotic twinning. RESULT(S): With hatching, the clinical PR per ET increased from 25.2% to 37.1% and the multiple PR per ET increased from 6.8% to 13.1%. In the nonhatched series, there were no monozygotic twins compared with eight cases in the hatched series (1.2% per ET). CONCLUSION(S): Mechanical assisted hatching increases the PR but concomitantly elevates the rate of multiple gestation and multiple gestation of high order. There is a particularly high risk of monozygotic twinning with mechanical hatching.     

Semen quality: is there a paternal effect on pregnancy outcome in in-vitro fertilization/intracytoplasmic sperm injection?

The objective of this study was to investigate the role of the spermatozoon (paternal effects) on implantation and pregnancy outcome in in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Male individuals of three types were analysed: infertile men with oligoasthenoteratozoospermia (OAT), infertile men with normozoospermia and fertile men (donors). Female counterparts were judged to have comparable egg quality within two groups studied, i.e. infertile women with pure mechanical (tubal) infertility and recipients of donor eggs. There were significantly higher differences in implantation and pregnancy rates in groups using donor spermatozoa and donor egg recipients. Analyses of key set groups revealed a trend toward a poorer implantation and pregnancy outcome when comparing OAT versus normozoospermic patients within IVF, but not within ICSI treatments, in couples with tubal infertility. In couples who were recipients of donor eggs, no differences were observed between OAT patients treated by ICSI and normozoospermic patients treated with IVF. No significant differences were observed in miscarriage rates within any groups studied. In conclusion, the poorer results observed in OAT patients undergoing IVF may be secondary to spermatozoal effects due to a high insemination concentration. Overall, there does not seem to be a significant effect of severe male infertility (OAT) on implantation and pregnancy outcome. However, this does not preclude that specific sperm aberrations may exert a negative effect on embryogenesis and therefore on implantation potential following assisted or in-vivo reproduction.     

Enhancement of outcome from intracytoplasmic sperm injection: does co-culture or assisted hatching improve implantation rates?

In two separate prospectively randomized trials, intracytoplasmic sperm injection (ICSI) cycles were studied in a controlled manner to monitor the effects of either bovine oviductal epithelial cell co-culture (n = 119) or assisted hatching by zona drilling (n = 100). In the first study, immediately following ICSI, all eggs were placed directly either onto partial monolayers of bovine oviductal cells or into regular culture medium. Although the embryo developmental rate was apparently compromised in part by the presence of the co-culture cells, ultimately there were no significant differences in either the viable pregnancy rate (31.6% co-culture versus 29.0% control) or the embryonic implantation rate (11.4% co-culture versus 13.6% control). Assisted hatching also had no significant impact on ICSI cycle outcome in terms of either the viable pregnancy rate (30.0% assisted hatching versus 32.0% control) or the embryonic implantation rate (8.5% assisted hatching versus 13.5% control). However, in female patients aged > or = 35 years, assisted hatching appeared to convey a marginally significant benefit in terms of both the viable pregnancy rate (35.5% assisted hatching versus 11.1% control) and the embryonic implantation rate (10.3% assisted hatching versus 3.1% control). It seems that the overall improvement of ICSI cycle outcome cannot be achieved by the general application of either co-culture or assisted hatching. Nevertheless, it is possible that there remain specific patient groups that might benefit from selected use of either of these modalities.     

The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection

Factors other than spermatozoa could be the major determinant of the success of assisted reproduction treatment in cases of male infertility. Our aim was to evaluate the effect of the wife's age and ovarian reserve on assisted reproduction success rates in the most severe type of male infertility, i.e. azoospermia. A total of 249 consecutive couples suffering from male infertility caused by azoospermia underwent microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI). Of these men, 186 had irreparable obstructive azoospermia, and 63 had non-obstructive azoospermia due to testicular failure. Neither the pathology, the source, the quantity, nor the quality of spermatozoa had any effect on fertilization or pregnancy rates. Maternal age and ovarian reserve (number of eggs) had no effect on fertilization or embryo cleavage, but did dramatically affect the embryo implantation, pregnancy and delivery rates. Wives of azoospermic men who were in their 20s had a 46% live delivery rate per cycle, wives aged 30-36 years had a 34% live delivery rate per cycle, wives aged 37-39 years had a 13% live delivery rate per cycle, and wives > or = 40 years had only a 4% live delivery rate per cycle. The number of eggs retrieved also affected pregnancy and delivery rate, but to a lesser extent than age. In virtually all cases of obstructive azoospermia, and in 62% of cases with non-obstructive azoospermia caused by germinal failure, sufficient spermatozoa could be retrieved to perform ICSI, with normal fertilization and embryo cleavage. However, the pregnancy rate and the live delivery rate were dependent strictly on the age of the wife, and on her ovarian reserve. Unfortunately, exaggerated claims of high pregnancy rates can thus easily be made by manipulating, in a very simple way, selection for female factors.     

Effects of fetal number and multifetal reduction on length of in vitro fertilization pregnancies

OBJECTIVE: To determine the effects of multifetal reduction and other variables on the duration of gestation of in vitro fertilization (IVF) pregnancies. METHODS: All 274 IVF pregnancies from the inception of the Women and Infants' Hospital IVF Program on May 26, 1988, until December 31, 1993, were evaluated. RESULTS: Spontaneous reduction occurred in ten pregnancies, and multifetal reduction was elected in 28 multiple gestations. Among 260 pregnancies that remained viable beyond 20 weeks, 162 singletons (37.9 +/- 0.29 weeks; mean +/- standard error) had a longer mean gestation than did 64 twins (34.6 +/- 0.61 weeks), 25 pregnancies reduced to twins (33.4 +/- 1.0 weeks), or nine triplets (29.7 +/- 1.9 weeks). Triplets delivered 4.9 weeks earlier than nonreduced twins (P < .05) and 3.7 weeks before twins resulting from multifetal pregnancy reduction (P < .05). Regression analysis showed that at the 8-week ultrasound, each viable fetus could be expected to reduce the duration of the gestation by about 3.6 weeks, and each fetus reduced medically or as a result of natural causes could be expected to prolong the gestation by approximately 3.0 weeks. Only 14% of triplet pregnancies underwent spontaneous multifetal reduction. CONCLUSION: Multifetal reduction of pregnancies with three or more fetuses was beneficial and increased the duration of gestation.     

Abortion surveillance--United States, 1995

CONDITION: Since 1990 (i.e., the year in which the number of abortions was highest), the annual number of abortions in the United States has decreased by 15%. REPORTING PERIOD COVERED: This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States during 1995. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data received from 52 reporting areas: 50 states, the District of Columbia, and New York City. RESULTS: In 1995, a total of 1,210,883 legal abortions were reported to CDC, representing a 4.5% decrease from the number reported for 1994. The abortion ratio was 311 legal induced abortions per 1,000 live births, and the abortion rate was 20 per 1,000 women aged 15-44 years, the lowest ratio and rate recorded since 1975. Women who were undergoing an abortion were more likely to be young, white, and unmarried; most were obtaining an abortion for the first time. Approximately half of all abortions (54%) were performed at < or =8 weeks of gestation, and approximately 88% were performed before 13 weeks. Approximately 16% of abortions were performed at the earliest weeks of gestation (< or =6 weeks), approximately 17% at 7 weeks of gestation, and approximately 21% at 8 weeks of gestation. Few abortions were provided after 15 weeks of gestation -- approximately 4% of abortions were obtained at 16-20 weeks, and 1.4% were obtained at > or =21 weeks. Younger women (i.e., women aged < or =24 years) were more likely to obtain abortions later in pregnancy than were older women. INTERPRETATION: Since 1990, the number of abortions has declined each year. Since 1987, the abortion-to-live-birth ratio has declined; in 1995, it was the lowest recorded since 1975. This decrease in the abortion ratio reflects a trend that a lower proportion of pregnant women obtain induced abortion. ACTIONS TAKEN: The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed, efforts to prevent unintended pregnancy can be evaluated, and the preventable causes of morbidity and mortality associated with abortions can be identified and reduced.     

Oocyte donation: comparison between recipients from different age groups

Oocyte donation was carried out in 87 patients in 141 replacement cycles. These patients received oocytes from 108 women undergoing assisted reproductive technology procedures at our centre. Standardized hormonal replacement therapy and in-vitro fertilization procedures were performed. We divided recipients into four groups according to their age (group A, 21-35 years; B, 36-40 years; C, 41-49 years; and D, 50-61 years). Oocytes donors were 21-35 years old, and equally spread across these different age groups. There were significant differences in the pregnancy and implantation rates according to the age of the recipients; which were 45% and 23% respectively in women 21-35 years old (group A) versus 23% and 10% in women 41-49 years old (group C). A comparison of data between oocyte donors and young recipients, with similar results in donors and young recipients, with pregnancy rates of 45% and 42% and implantation rates of 23% and 19.5% respectively. Statistically significant differences were found between donors and the older recipients, pregnancy rates being 43% versus 23%, and implantation rates 18% versus 10%. These data seem to demonstrate a lesser likelihood of pregnancy and implantation in older recipients because of increasing uterine age.     

"Appearing twin": undercounting of multiple gestations on early first trimester sonograms

An important role of first trimester sonography is to determine whether a pregnancy is a singleton, twin, or higher order multiple gestation. We assessed how frequently sonography at 5.0-5.9 weeks undercounts multiple gestations. We identified all pregnancies at our institution since 1988 in which (1) an initial sonogram obtained at 5.0-5.9 weeks demonstrated at least a singleton intrauterine pregnancy and (2) a subsequent sonogram at 6.0 weeks or beyond demonstrated a living multiple gestation. Twenty-four (11%) of 213 dichorionic twin gestations were initially undercounted as singletons, as were six (86%) of seven monochorionic twin gestations. Among 105 higher order multiples, 17 (16%) were undercounted initially. All but one of the undercounted cases were scanned transvaginally. Undercounting occurred in both natural and assisted conceptions, and it occurred more frequently on sonograms obtained at 5.0-5.4 weeks than at 5.5-5.9 weeks (P = 0.02, Fisher's exact test). Prognosis for undercounted multiple gestations was similar to that of correctly counted ones with respect to several measures of pregnancy outcome, including the likelihood that all fetuses would be delivered liveborn, gestational age at birth, and birth weight (P > 0.20, all comparisons). In conclusion, transvaginal sonography at 5.0-5.9 weeks frequently undercounts multiple gestations. Initially undercounted multiple gestations and those correctly counted have similar pregnancy outcomes.     

Transvaginal multifetal pregnancy reduction: Which? When? How many?

This report contains the experience of our centre, using the transvaginally guided puncture procedure, to reduce the number of fetuses in a multifetal pregnancy to a lower number. The aim of the procedure was to improve perinatal outcome and/or to meet the personal desires of patients and their families. We surveyed 148 multifetal pregnancy reductions. The fetus or fetuses overlying the internal os was most commonly reduced. The total uncorrected loss of the entire pregnancy was 13.4%. The corrected pregnancy loss was 11%. Of the 63 twins left after the reduction, 33 delivered preterm. Of the 36 singletons, two delivered preterm. Our conclusion was that multifetal pregnancy reduction is a safe procedure for the mother and has an acceptable loss rate of the entire pregnancy. The reduction of a fetus overlying the internal os by the transvaginal puncture procedure seems to yield results at least as good as the transabdominally performed puncture procedures for multifetal pregnancy reduction.     

Should we apply assisted reproduction technology to women without limitations of age?

The decline of female fertility with increasing age is due to a physiological diminution of the ovarian reserve of follicles. Hence, a reliable evaluation of the ovarian reserve before performing assisted reproductive technology in aged women provides them and the physician with information about the actual probabilities of pregnancy. Patients aged over 38 years should be accepted in assisted reproduction programs only after confirmation of a healthy ovarian reserve. Patients aged more than 42 years, even in case of a normal ovarian reserve assessment, should be only accepted in selected cases. After 42 years until 46 of age, techniques of in vitro fertilization with oocyte donation may represent an alternative chance of pregnancy to aged women.     

FIVNAT. Influence of attempt rank in in vitro fertilization

The French national register on in vitro fertilization (IVF) FIVNAT, which has collected most of the oocyte pick-ups realised in France since 1986 has allowed us to build a cohort of 35,714 couples, of which the first recovery took place between 1990 and 1994 and followed up to a pregnancy or to the 31st of december, 1996. The per recovery clinical pregnancy rate decreased from 20.2% on the first attempt to 17.4% on the second, and to less than 13% after the sixth. This evolution existed whatever the women's age class or the infertility diagnosis. The women's age remained the most important factor, since the cumulative pregnancy rate decreased from 60% for women aged less than 35 years to 17% for those aged more than 41 years. Among the indications, male infertility using spouse's semen had the poorest prognosis, especially for women aged more than 41 years (9.6%) whereas male infertility using donor's semen among women aged less than 35 years was associated to the best results (68%). It must be noticed than a high percentage of unpregnant women did not come again for a further recovery (40% to 50%). Then, the crude cumulative birth rate (24.4%) was far below the theoretical cumulative one(54.2%).     

Oocyte donation to women of advanced reproductive age: pregnancy results and obstetrical outcomes in patients 45 years and older

We analysed the results of oocyte donation to women of advanced reproductive age (> or = 45 years old) and followed their pregnancies through to delivery in order to assess obstetrical outcomes. Patients (n = 162) aged 45-59 years (mean +/- SD; 47.3 +/- 3.4 years) underwent 218 consecutive attempts to achieve pregnancy. Oocytes (16.2 +/- 7.2 per retrieval) were provided by donors < or = 35 years old. Cleaving embryos (8.2 +/- 4.8 zygotes/couple) were transferred transcervically (4.5 +/- 1.1 per embryo transfer) to recipients prescribed oral micronized oestradiol and intramuscular progesterone. Following oocyte aspiration there were six instances of non-fertilization (2.8%) and 212 embryo transfers. A total of 103 pregnancies was established for an overall pregnancy rate (PR) of 48.6%, which included 17 preclinical pregnancies, 12 spontaneous abortions, and 74 delivered pregnancies (clinical PR 40.6%; delivered PR 34.9%). Multiple gestations were frequent (n = 29; 39.2% of pregnancies) and included 20 twins, seven triplets, and two quadruplets. Two of the triplet and both of the quadruplet pregnancies underwent selective reduction to twins. Antenatal complications occurred in 28 women (37.8% of deliveries) and included preterm labour (n = 9), gestational hypertension (n = 8), gestational diabetes (n = 6), carpel tunnel syndrome (n = 2), pre-eclampsia (n = 2), HELLP syndrome (n = 2), and fetal growth retardation (n = 2). 48 (64.8%) deliveries were by Caesarean section. The gestational age at delivery for singletons was 38.3 +/- 1.3 weeks (range 35-41 weeks), with birth weight 3218 +/- 513 g (range 1870-4775 g); twins 35.9 +/- 2.0 weeks (range 32-39 weeks), birth weight 2558 +/- 497 g (range 1700-3450 g); and triplets 33.5 +/- 0.7 weeks (range 32-34 weeks), birth weight 1775 +/- 190 g (range 1550-2100 g). Neonatal complications (4.6% of babies born) included growth retardation (n = 2), trisomy 21 (n = 1), ventricular septal defect (n = 1), and small bowel obstruction (n = 1). There were no maternal or neonatal deaths. We conclude that oocyte donation to women of advanced reproductive age is highly successful in establishing pregnancy. However, despite careful antenatal screening, obstetrical complications are common, often secondary to multiple gestation.