Assisted reproductive technologies (ARTs)—notably in vitro fertilization—are becoming commonplace, yet one often hears the complaint that outcomes data about them are lacking. Today, JAMA (the Journal of the American Medical Association) published some data online. The article and an accompanying editorial are available for free online. I will touch on only some of the interesting findings of this report here.
But I note that medicine and bioethics seemingly remain uninterested in the risks to egg donors, about which more at the end of this.
The authors report that fertility clinics (of which there are 443 in the U.S.) are required to provide data to the National ART Surveillance System (NASS) of the Centers for Disease Control and Prevention (CDC). A 1992 law requires fertility clinics to report all ART cycles to the CDC. For this report, the authors reviewed summary data between 2000 and 2010. They used information from all or most of that time to analyze trends in donor oocyte cycles—where one woman donates eggs to be used for ART for a different woman seeking infertility treatment. They also used the most recent data, from 2010, to make some assessments of factors that predict certain outcomes.
Again, just some of the findings that struck me:
- The number of annual donor oocyte cycles increased from 10,801 in 2000 to 18,306 in 2010. (There were 82,563 “autologous” cycles—women having induced ovulation in an attempt to conceive with IVF using their own eggs—in 2010.)
- The percentage of ART cycles using frozen (as opposed to fresh) embryos increased from 26.7% to 40.3%.
- The mean (average) age of donors was the same throughout (28); ditto for recipients (41).
- In 2010, almost all donors were younger than 35.
- In 2010, about 25% of recipients were OVER 45 years old.
- Also in 2010, in the “autologous” (own egg) situation, the woman was over 40 only about 13% of the time.
- “Good perinatal outcomes”—defined as a singleton birth at 37 weeks or later, with the baby weighing at least 2500 grams (about 5 pounds, 8 ounces)—increased from 18.5% to 24.4%. Still a lot of small babies and preemies.
- The rate of elective transfer of just one embryo increased from almost none (0.8%) to 14.5%). Still, in 2010, 74% of the time, 2 embryos were transferred to the recipient. Three or more embryos were transferred less than 10% of the time. Compare that (again in 2010) with the “autologous” (own egg) situation: a single embryo was transferred in about 15% of the cases, two in about 50%, three in about 20%, and four or more in about 10%.
- Five in eight (62.5%) of pregnancies were single pregnancies in 2010, and 44% of these ended in a good perinatal outcome, compared with 36.7% being twin pregnancies with good outcome in 25% of those, and 0.8% of pregnancies being triplet or more, with only one birth (also 0.8% of the total) 37 weeks or later and weighing over 2500 grams.
- Interestingly, neither donor nor recipient age was related to pregnancy outcome.
No other information about infant health was included, nor were there any statements about whether “reductive” abortions were used.
The authors commented that it appears that the American Society of Reproductive Medicine’s recommendation that donor ART be done with single embryo transfer from a donor younger than 35 years was not being followed.
Also, and critically, the authors pointed out that they had no data on health outcomes for the donors. At the end of their paper, they write, “given the increasing trend of oocyte donations, the inclusion of more detailed information about donor risks, such as ovarian hyperstimulation syndrome, in the NASS will be useful for monitoring the safety of donor cycles.”
The writer of the editorial pressed this last point further: “[T]he current NASS data regarding outcomes of donor oocyte cycles have an important limitation—no data on health outcomes in donors. Donors are at risk for all of the complications associated with ovulation induction, including the potentially life-threatening ovarian hyperstimulation syndrome. In addition, there is uncertainty about longer-term issues such as effects on the donor’s own fertility or the need to inform recipients about the discovery of health issues not known at the time of donation…More complete data…are needed so donors can make truly informed choices and, once those data are available, mechanisms can be put in place to ensure that the donor recruitment and consent process at clinics is conducted according to the highest ethical standards.”
The editorialist’s comments are simply mainstream medical and bioethics. It is scandalous that this does not get more attention in the bioethics community. For example, I searched for “oocyte” or “egg” on the website of PRIM&R (Public Responsibility in Medicine and Research) and I got bupkus. Amazing. They should be all over this. Anyone who would like to point me to something I’m missing from the bioethics community, please feel free to comment.