[Risk of perinatal complication and egg donation: Role of resorting to cross border care?
OBJECTIVES In France, egg donation is covered by Social insurance among women<43 years old. Because of shortage of egg donor, women aged 43 years or more cannot resort to egg donation in French infertility centers, leading them to turn to the foreign centers having practices different and less regulated than in France. We are thus brought to take care of the pregnancy and of the delivery of these women. Our objective was to estimate if the perinatal risks are more important after egg donation abroad than in case of egg donation in a French center. MATERIAL AND METHODS Retrospective study between January, 2010 and April, 2013, comparing women having had an egg donation to Cochin then having delivered in the maternity hospital of their choice (n=88) and the women having had an egg donation abroad then having delivered in the Port Royal maternity (n=121) First, the modalities of egg donation were compared between the Cochin hospital and the foreign centers. Second, the obstetric and perinatal outcomes were compared between both groups, then by stratifying according to the type of pregnancy (singleton or multiple) RESULTS Among women having had an egg donation abroad, the age of the donor was lower (25.7 vs. 31.7, P=0.001) the average number of embryos transferred higher (2.1+ 0.6 vs. 1.7+ 0.5, P=0.001) and the rate of multiple pregnancies higher (47.9% vs. 9.1% P=0.001) than among women having had an egg donation at Cochin. We observed after egg donation abroad compared to egg donation at Cochin, a birth weight significantly lower (2678+ 745g vs. 3045+ 682g, P=0.001) and a prevalence of intrauterine growth retardation higher (11.1% vs. 4.2% P=0.04) Among singletons, abnormal placentation was more frequent in case of egg donation abroad (17.5% vs. 5.1% P=0.02) In case of twin pregnancy, we highlighted very high rates of complications, without significant difference according to the place where egg donation was practiced. CONCLUSION We observed an increased risk of intrauterine growth retardation after egg donation abroad, which could essentially be explained by the association between advanced maternal age and multiple gestation. For other obstetric and perinatal complications, the differences between both groups were less important than expected, but very high in both groups, whether the egg donation was realized in France or abroad. The complications seem mainly due to the multiple gestations, justifying the transfer of a single embryo whenever possible.
Journal de gynecologie, obstetrique et biologie de la reproduction