Over the last two decades, the predominant indication for oocyte donation has shifted from women with premature ovarian failure to mostly women of advanced reproductive age. Factors responsible for this trend relate to the changing demographic of the population at large. More women are delaying childbearing to pursue education and careers, marriages are occurring later in life, divorce and remarriage are more common, and effective contraception and available abortion services have eliminated many unintended pregnancies. For the older patient, traditional IVF remains
an option, however pregnancy rates decline precipitously after 36 years of age, mostly due to the age associated decline in normal oocytes (Figure 2). In contrast, pregnancy rates in women using donor oocytes are known to be as high as 50% per embryo transfer in recipients across all age groups
(CDC 2005). Indeed, women in their sixties have also given birth with donor oocytes, demonstrating that the postmenopausal uterus maintains the capacity to support pregnancies if provided adequate hormonal support (Antinori et al 1995; Paulson et al 1997). However, oocyte recipients experience increased obstetrical complications such as pregnancy induced hypertension (16%–40%), cesarean section (40%–76%), and gestational diabetes (20%) (Soderstrom Anttila 2001; Sheffer-Mimouni et al
2002; Paulson et al 2002).