The probability of a pregnancy resulting in a healthy live birth decreases as women age, particularly after age 35 years. The likelihood of a spontaneous conception decreases,1 whereas the risks of miscarriage2 and a range of late obstetric and perinatal complications3 increase. Assisted reproductive technology (ART) has allowed many couples who would otherwise be unable to have children to have successful pregnancies, but the age-related biological barriers to establishing an ongoing pregnancy that result from increasing maternal age have been difficult to overcome, even with transfer of multiple embryos.4 However, although multiple-embryo transfer increases the chances of pregnancy, it also increases the likelihood of adverse pregnancy outcomes, particularly those related to preterm delivery. In addition, ART is associated with an increased risk of adverse obstetric and perinatal outcomes compared with spontaneous conception, even with singleton pregnancies,5 although the relative contribution of ART vs the underlying cause of infertility to these outcomes is unclear.6 For couples unable to achieve a successful pregnancy through ART with autologous oocytes, presumably because of idiopathic or age-related declines in ovarian reserve, the use of donor oocytes provides an alternative to replacement of multiple embryos derived from autologous oocytes (or an additional option after unsuccessful cycles with multiple embryos). Although the use of donor oocytes increases the probability of conception and live birth in older women,7 studies of donor oocytes and the risk of adverse perinatal outcomes have provided inconsistent results.
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