Hum. Reprod. Advance Access published online on July 5, 2009
Human Reproduction, doi:10.1093/humrep/dep238
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The aged uterus: multifetal pregnancy outcome after ovum donation in older women
1 Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Kfar Saba, Israel 2 Ramat Gan, and Meir Medical Center, Kfar Saba, Israel
3 Correspondence address. Tel: +972-3-5302169; Fax: +972-3-5302922; E-mail: michal.simchen{at}sheba.health.gov.il
BACKGROUND: We aimed to investigate whether multifetal pregnancies are at risk of more pregnancy complications in women of advanced age after ovum donation.
METHODS: Pregnancy outcome in women after ovum donation aged 40 and above was extracted. Labor and delivery data as well as antenatal records of women carrying twins were compared with those of singletons, as well as to a control group of all twin pregnancies delivered at Sheba Medical Center during 2007.
RESULTS: One hundred and twenty-five women after ovum donation aged 
40 were studied. Of those, 42 women carried twin pregnancies and 83 carried singletons. The 42 women carrying twins comprised the study group and were compared with 417 control women with twins. Mean maternal age was 49.2 ± 4.3 years. Hypertensive complications (50%), diabetes in pregnancy (31%) and hospitalization in pregnancy (69%) were all extremely high in the study group. Mean gestational age at delivery was lower for the study group compared with controls (35.2 ± 2.3 versus 35.7 ± 2.6 weeks), with 35.7% of infants in the study group born 
34 weeks gestation compared with 21.8% of controls, (OR: 1.99, 95% CI: 1.02–3.89). Mean birthweight was also significantly lower for study group infants compared with controls, with 77% of study infants born <2500 g compared with only 60% of controls (OR: 2.22, 95% CI: 1.3–3.77).
CONCLUSIONS: Pregnancy in advanced maternal age women after ovum donation carrying twins is associated with significant maternal and fetal complications, with increased risks of prematurity and lower birthweight. Possibly, the aged uterus is less suitable for carrying a multifetal pregnancy than a younger uterus. Therefore, the alternative of transferring a single, good-quality embryo should be the preferred option.
Key words: multifetal pregnancy/ovum donation/advanced maternal age/ED/egg donation
Submitted on January 22, 2009; resubmitted on June 8, 2009; accepted on June 9, 2009.