INDICATIONS FOR OOCYTE DONATION
From beginning the most oocyte donation programs was carried out for women with premature ovarian failure. However, the high pregnancy rate achieved with oocyte donation led to its more widespread.
Today egg donation use in other groups of patients, primarily in older patients and those with genetic diseases.
Free encyclopedia Wikipedia show us practically unlimited age for getting pregnancy after egg donation. It is absolutely clear that oocyte donation is the most successful technique for achieving pregnancies in perimenopausal women. But acceptance of oocyte donation over the age of 45 – 50 years is becoming controversial.
We have not tenets about age limitation for egg donation in Ukraine but we need understanding the reasonable age in all cases.
Specking shortly about indications for egg donation we could speak about two groups of indications:
Premature ovarian failure and Resistant ovary syndrome.. Almost 50% of oocyte recipients suffer from premature ovarian failure due to different reasons and the most of them younger of 40 years. It is estimated that at least 1–3% of women experience premature menopause due to premature ovarian failure. This condition can present in 10–20% of women as primary amenorrhea and in up to 18% as secondary one. The diagnosis of ovarian failure is based on the finding of raised follicle stimulating hormone (FSH) levels over the realistic level and decreasing anti mullerian hormone level bellow the reasonable level. Actually premature (preterm) ovarian failure could be resulted after suffering of such conditions like autoimmune disorders, hypothyroidism, diabetes and other less commonly associated conditions such as autoimmune thyroiditis and inflammatory bowel, autoimmune polyglandular syndrome, fragile-X syndrome or its family risk that could be checked in 13% with premature ovarian failure; and of couse rare inherited syndromes such as blepherophimosis and ptosis or Perrault's syndrome (deafness and short stature); a history of Addison's disease and others.
Resistant ovary syndrome is the type or early phase of premature ovarian failure. This syndrome has been reasoned that a lack of sensitivity of the gonadotropin receptors, or a defect in the adenylate cyclase pathway, and is characterized by amenorrhea, normal secondary sexual characteristics and raised levels of FSH and lutenizing hormone (LH).
Genetically transmissible diseases and syndroms. Couples with risk of genetically transmissible diseases having children with fatal or severely disabling diseases may request oocyte donation. Even if prenatal diagnosis is available for a most number of these conditions, for some couples termination of pregnancy is unacceptable. Recent advances in preimplantation genetic diagnosis (PGD) have enabled couples to undergo IVF and transfer of normal embryos selected by embryo biopsy but the high cost and complexity of the procedure puts it beyond the means of many. X-linked diseases which includes hemophilia A and B, and some varieties of primary musclewasting diseases such as Becker's muscular dystrophy (X-linked recessive) and Duchenne's muscular dystrophy (X-linked recessive), should be offered genetic counseling. Galactosemia is transferase deficiency is usually fatal by 4 weeks of life and strictly needs lactose-free diet. Patients with galactosemia could have mild learning difficulties and could suffering of infertility. Thus patients with galactosemia seeking fertility treatment may opt for donated oocytes to avoid transmission galactosemia to the offspring. Turner's syndrome is characterized by an XO chromosome pattern or mosaics (XO/XX) and the rest have deletions, rings or isochromosomes. Patients typically present with short stature, cubitus valgus, low intelligence quotient (IQ) and amenorrhea due to streak gonads. Congenital cardiac defects in the form of coarctation of the aorta, bicuspid aortic valve, ventricular septal defect and aortic root abnormalities are common. A small proportion of patients, particularly the mosaics and the variants, can be fertile, but premature ovarian failure is more common in this group.
Oocyte donation may be an option for all such patients.
Second group of indications for egg donation is including repeated IVF failures such as: repeated poor response to superovulation gonadotropin stimulation; repeated failure of oocyte recovery; repeated failure of fertilization due to poor oocyte quality; repeated poor-quality embryos; repeated implantation failure of apparently normal embryos.