Oocyte or embryo donation to women of advanced reproductive age: an Ethics Committee opinion
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, …
Ethics Committee of the American Society for Reproductive Medicine (2016). Oocyte or embryo donation to women of advanced reproductive age: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2016.07.002
Ethics Committee of the American Society for Reproductive Medicine. Oocyte or embryo donation to women of advanced reproductive age: an Ethics Committee opinion. Fertility and sterility. 2016. doi:10.1016/j.fertnstert.2016.07.002
Ethics Committee of the American Society for Reproductive Medicine. "Oocyte or embryo donation to women of advanced reproductive age: an Ethics Committee opinion." Fertility and sterility, 2016.
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RRM Academy Synopsis
ASRM calls healthy women 45 to 54 "reasonable" donor egg candidates
A 2016 ASRM ethics opinion calls many healthy women aged 45 to 54 reasonable candidates for donor eggs or embryos. Among women over 55, the Committee advises against treatment. The opinion replaces a 2013 statement.
Key Findings
The Committee believes many women aged 45 to 54 are healthy and well prepared to parent, making them reasonable candidates for donated oocytes and embryos.
The Committee finds that donor-egg pregnancy after natural menopause does not depart significantly enough from accepted fertility treatments to count as ethically inappropriate.
The Committee advises that donation be strongly discouraged when underlying medical problems exist, particularly hypertension or diabetes, and that it be discouraged after age 55 even in women with no such problems.
The Committee holds that programs may ethically decline to treat women of advanced reproductive age, citing concerns for the health and wellbeing of patient and offspring.
One series of 45 live births to healthy women aged 50 to 63 reported pregnancy-induced hypertension in 35%, gestational diabetes in 20% and cesarean delivery in 78%.
Interpretation
The American Society for Reproductive Medicine (ASRM) Ethics Committee wrote an opinion that weighs arguments for and against and states its judgment. The Committee calls the outcome data on pregnancy after natural menopause preliminary and scant, and only case reports describe pregnancies over age 60. The obstetric figures come from earlier studies. The report says it reflects the views of Committee members and does not dictate an exclusive course of treatment. The Committee also wants the partner's age and health, if there is a partner, included in the counseling discussion.
RRM Context
Donor eggs supply the egg from another woman, so the recipient's own ovarian function stays as it was. Restorative reproductive medicine looks for why fertility declined in each partner and treats that cause. The Committee advises a thorough medical evaluation of women over 45, to assess physical fitness for pregnancy, before transfer. Restorative care shares that principle of evaluating first.
Our editorial summary of this paper, not the article's abstract.
Abstract
Advanced reproductive age (ARA) is a risk factor for female infertility, pregnancy loss, fetal anomalies, stillbirth, and obstetric complications. Oocyte donation reverses the age-related decline in implantation and birth rates of women in their 40s and 50s and restores pregnancy potential beyond menopause. However, obstetrical complications in older patients remain high, particularly related to operative delivery and hypertensive and cardiovascular risks. Physicians should perform a thorough medical evaluation designed to assess the physical fitness of a patient for pregnancy before deciding to attempt transfer of embryos to any woman of advanced reproductive age (>45 years). Embryo transfer should be strongly discouraged or denied to women of ARA with underlying conditions that increase or exacerbate obstetrical risks. Because of concerns related to the high-risk nature of pregnancy, as well as longevity, treatment of women over the age of 55 should generally be discouraged. This statement replaces the earlier ASRM Ethics Committee document of the same name, last published in 2013 (Fertil Steril 2013;100:337-40).
Ethics and Policy › Reproductive Ethics › Access to Treatment · Clinical Guidelines and Standards › Guidelines by Clinical Area › Fertility and Infertility Guidelines · Assisted Reproduction › Donor Gametes and Surrogacy › Egg Donation
Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, L Francis, E Gates, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, S Klipstein, Barb Koenig, B Koenig, Andy Barbera, Drew Barbera, A Barbera, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, M Sauer, Becky Sokol, R Sokol, S Tipton, L Westphal
PMID 27450186 27450186 DOI 10.1016/j.fertnstert.2016.07.002 10.1016/j.fertnstert.2016.07.002 Ethics Committee of the American Society for Reproductive Medicine et al. 2016, Ethics Committee of the American Society for Reproductive Medicine 2016