Publication:

Bridging the donor gap: a prospective comparative study of obstetric and perinatal outcomes based on gamete sources in IVF at a tertiary care centre of South India

Background The assisted reproductive technology (regulation) act of 2021 has standardized third-party gamete donation in India. However, the introduction of non-maternal genetic material creates an allogenic state that potentially compromises placentation and increases obstetric risks. This study evaluated maternal and perinatal outcomes across different gamete configurations in a South Indian tertiary care facility.

Methods This prospective comparative observational study consecutively enrolled 125 IVF-conceived pregnancies over an 18-month period. The cohort was stratified into: autologous (n=98), donor sperm (n=11), donor egg (n=8), and dual donor (n=8). Relative risks (RR) and 95% confidence intervals (CI) were calculated. Multivariable logistic regression adjusted for maternal age and pre-existing comorbidities to identify independent predictors of adverse outcomes.

Results In crude analysis, the dual donor cohort carried the highest risk for hypertensive disorders of pregnancy (HDP) (100% incidence; RR: 1.707) and severe pre-eclampsia (75% incidence; RR: 4.641). On multivariable regression, dual donor status emerged as the only significant independent predictor for HDP, showing a 12-fold increase in disease odds (OR: 12.06, 95% CI: 0.68–214.80, p=0.040). Isolated donor sperm or oocyte configurations did not show independent risk predictions for HDP or preterm delivery (p>0.05). Caesarean section rates were exceptionally high across all donor arms (81.8% to 100%). Perinatal outcomes, including neonatal intensive care admissions and congenital anomalies, were reassuringly similar across cohorts, although extremely low birth weight was selectively elevated across all donor categories.

Conclusions Dual donor gamete use is an independent predictor of hypertensive disorders of pregnancy. The elevated clinical risks warrant early high-risk triaging, timely tertiary referral, and proactive first-trimester prophylactic strategies.