Impact of indication for oocyte and embryo reception on reproductive and obstetric outcomes.

Objectives This study aims to assess if the indication for oocyte reception (OR) or embryo reception (ER) impacts the reproductive and obstetric outcomes by evaluating our experience at a tertiary fertility centre and by performing a literature review on this subject. Several previous studies have reported that in contrast to other types of fertility treatment, the indication for OR/ER seems to have little impact on the outcomes. However, the compared indication groups vary considerably between these studies, and some data indicates worse outcomes in patients who developed premature ovarian insufficiency (POI) due to Turner syndrome or treatment with chemotherapy/radiotherapy. Design Retrospective analysis of all cases of OR/ER at a tertiary fertility centre from 2001 until 2020. We analysed 584 cycles in 194 individual patients. A literature review on the impact of indication on reproductive or obstetric outcomes of OR/ER was performed using the following databases: PubMed/MEDLINE, EMBASE and the Cochrane Library. A total of 27 studies were included and analysed. Participants, Setting, Methods For the retrospective analysis patients were divided into three major indication groups: failure of autologous assisted reproductive technology, POI and genetic disease carrier. To assess reproductive outcomes we determined pregnancy rate, implantation rate, miscarriage rate and live birth rate. For comparing obstetric outcomes we reviewed the term of birth, mode of delivery and birthweight. Outcomes were compared using a Fisher exact Test, Chi-square test and one-way ANOVA utilizing the GraphPad tool. Results There were no significant differences in reproductive and obstetric outcomes between the three major indication groups in our population, in line with the findings reported by existing literature. Data on impaired reproductive outcomes in patients with POI after chemotherapy/radiotherapy is conflicting. Obstetrically these patients are at higher risk of preterm birth and possibly also low birthweight, especially after abdomino-pelvic or total body irradiation. For patients with POI due to Turner syndrome, most data suggest similar pregnancy rates but a higher rate of pregnancy loss, and obstetrically an increased risk of hypertensive disorders and caesarean section. Limitations The small number of patients in the retrospective analysis resulted in low statistical power when evaluating differences between smaller subgroups. There was some missing data on the occurrence of complications during pregnancy. Our analysis covers a period of twenty years, during which several technological innovations have also been made. Conclusions Our study shows that the important heterogeneity in couples treated with OR/ER does not significantly impact their reproductive or obstetric outcomes, except for POI due to Turner syndrome or treatment with chemotherapy/radiotherapy where there seems to be an important uterine/endometrial component that cannot be entirely overcome by providing a healthy oocyte.