A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health

Abstract

The fetus is a semi-allograft for the maternal host in natural pregnancy, but the fetus is a complete allograft after oocyte donation (OD), and there is greater antigenic dissimilarity with the mother. Thus, OD pregnancy is a good model for understanding how the fetus is protected by the maternal immune system. Recent clinical data have revealed a higher risk of miscarriage, gestational hypertension, preterm birth, and low birth weight with OD pregnancy. There is also a higher incidence of chorionic deciduitis, dense fibrinoid deposits in the chorionic basal plate, inflammatory lesions in the chorionic plate, and C4d deposition on syncytiotrophoblasts in OD pregnancy. Impaired accumulation of T cells, regulatory T (Treg) cells, natural killer (NK) cells, and monocytes in the decidua basalis and poor remodeling of spiral arteries are observed in OD pregnancy irrespective of whether preeclampsia occurs. These findings may partly explain why OD pregnancy is associated with a high risk of gestational hypertension and preeclampsia. We need to clarify the immunological and pathological differences between uncomplicated and complicated OD pregnancy. In uncomplicated OD pregnancy, the level of HLA match between mother and baby is significantly higher than would be expected by chance, suggesting that miscarriage may be frequent with marked HLA mismatch. This review discusses the relationship between various aspects of the immune system and complications of OD pregnancy.

Maternal intra‐ and postpartum near‐miss following assisted reproductive technology: a retrospective study

“…Severe maternal morbidity may not only herald maternal mortality but is also associated with significant healthcare cost, long‐lasting rehabilitation programmes, and family burden. Based on recent trends in high‐income countries, the annual rate of women experiencing severe maternal morbidity has been steadily rising . Increases in severe maternal morbidity are believed to result from a combination of factors, including advanced maternal age, prepregnancy obesity, pre‐existing chronic conditions, and caesarean delivery.…”

“…Based on recent trends in high-income countries, the annual rate of women experiencing severe maternal morbidity has been steadily rising. 25,26 Increases in severe maternal morbidity are believed to result from a combination of factors, including advanced maternal age, prepregnancy obesity, pre-existing chronic conditions, and caesarean delivery. The results of this study suggest that the increasing use of ART might be one of the determinants of the observed increase in maternal morbidity.…”

Resultados maternos y perinatales de los embarazos obtenidos por técnicas de reproducción asistida. Revisión de la literatura

“…Una reciente revisión sistemática y metanálisis reportó que los embarazos obtenidos por DO presentan un riesgo mayor de SHE (OR 2.63, IC 95% 2.17-3.18), preeclampsia (OR 2.64, IC 95% 2.29-3.04), preeclampsia severa (OR 3.22, IC 95% 2.30-4.49), PP (OR 1.57, IC 95% 1.33-1.86) y BPN (OR 1.25, IC 95% 1.20-1.30) comparado con los embarazos obtenidos por FIV autóloga 45 . El mayor riesgo de trastornos hipertensivos podría estar asociado a factores como la edad materna avanzada y una mayor prevalencia de patologías médicas, a la vez que a defectos en la placentación inducidos por la preparación endometrial artificial y una eventual incompatibilidad inmunológica a antígenos derivados del feto 46 .…”

Reactive Species Interactome Alterations in Oocyte Donation Pregnancies in the Absence and Presence of Pre-Eclampsia

“…In an oocyte donation pregnancy, the fetus is fully allogeneic towards the mother, since it carries both oocyte donor antigens and paternal antigens; this antigenic dissimilarity in unmatched oocyte donation pregnancies is comparable to the antigenic dissimilarity in unmatched organ transplantation [5]. Due to the enhanced allogeneic nature of oocyte donation, these pregnancies presumably need more or different maternal immune adaptations, compared to naturally conceived pregnancies [5,13,14,15]. The increased adaptive load on the immune system between naturally conceived and oocyte donation pregnancies may explain why the latter are more often accompanied by immune-disturbance related obstetrical complications, such as pregnancy induced hypertension and pre-eclampsia [13,15,16].…”

“…Due to the enhanced allogeneic nature of oocyte donation, these pregnancies presumably need more or different maternal immune adaptations, compared to naturally conceived pregnancies [5,13,14,15]. The increased adaptive load on the immune system between naturally conceived and oocyte donation pregnancies may explain why the latter are more often accompanied by immune-disturbance related obstetrical complications, such as pregnancy induced hypertension and pre-eclampsia [13,15,16]. Oocyte donation pregnancies more often coincide with other risk factors for pregnancy complications, such as the self-evident need for artificial reproductive techniques, advanced maternal age, primiparity, cause of infertility, and multiple gestations [17,18,19,20,21].…”