Live birth outcomes after euploid transfer: autologous vs. donor oocyte embryos in patients aged > 35 years

Peter Lindner; Kerry Flannagan; Howard J Li; Jerry Wang; Luis R Hoyos; Meike L Uhler; Michael Homer; Kate Devine; Micah Hill; Phillip Romanski

doi:10.1016/j.xfre.2025.08.006

Live birth outcomes after euploid transfer: autologous vs. donor oocyte embryos in patients aged > 35 years

F S Rep. 2025 Aug 18;6(4):462-469. doi: 10.1016/j.xfre.2025.08.006. eCollection 2025 Dec.

Authors

Peter Lindner^{1

2

3}, Kerry Flannagan¹, Howard J Li^{1

2

3}, Jerry Wang¹, Luis R Hoyos⁴, Meike L Uhler⁵, Michael Homer⁶, Kate Devine^{1

2}, Micah Hill^{1

2

3}, Phillip Romanski^{2

7}

Affiliations

¹ Shady Grove Infertility Rockville, US Fertility, Rockville, Maryland.
² National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
³ Division of Gynecologic Surgery & Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland.
⁴ IVF Florida Reproductive Associates, US Fertility, Margate, Florida.
⁵ Fertility Centers of Illinois, US Fertility, Chicago, Illinois.
⁶ Reproductive Science Center - Bay Area, San Francisco, California.
⁷ Reproductive Medicine Associates of New York, New York, New York.

Abstract

Objective: To compare live birth outcomes between euploid donor oocyte and euploid autologous oocyte-derived embryos among patients with advanced maternal age.

Design: Retrospective cohort study (2010-2023) comparing outcomes of donor and autologous euploid frozen embryo transfers in patients aged ≥35 years.

Subjects: Multicenter fertility practice within the United States including patients aged 35-50 years undergoing their first single euploid frozen embryo transfer. Preimplantation genetic testing was performed for all cases, and only frozen embryo transfers were considered. The exclusion criteria included autologous transfers conducted more than 24 months after oocyte retrieval.

Exposure: Oocyte source (autologous vs. donor).

Main outcome measures: The primary outcome was live birth, defined as delivery after 22 completed gestational weeks. The secondary outcomes included positive human chorionic gonadotropin, biochemical loss, spontaneous abortion, and clinical pregnancy.

Results: A total of 15,013 single euploid frozen embryo transfer cycles were analyzed, including 13,883 autologous and 1,130 donor cycles. The mean age for autologous oocyte retrieval was 37.9 years, compared with 26.9 years for donor-derived oocytes. Live birth occurred in 55.8% of all autologous oocyte-derived euploid frozen embryo transfers in patients aged 35-37 years, the referent age group. There was a linear decrease in live birth rate as the age group increased. Live birth occurred in 49.4% of donor oocyte-derived euploid frozen embryo transfers in the 38-40-year group, the referent group. There was no statistically significant decrease in live birth rate as age increased in the donor oocyte-derived euploid embryo transfers.

Conclusion: Increasing maternal age decreases the likelihood of live birth for autologous euploid embryo transfers; however, the likelihood of live birth did not change with increasing maternal age among patients using donor oocyte-derived euploid embryos. This suggests that oocyte quality depends not only on ploidy status but also on age-related ooplasmic factors.

Keywords: Increasing maternal age; advanced maternal age; autologous euploid embryo transfers; donor-oocyte-derived euploid transfers; live birth rate.