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Why is use of donor eggs not viewed as treatment failure? A call for improvements in treatments with autologous oocytes

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Based on national registry reports, after age 42, the number of IVF cycles utilizing autologous oocytes is very small; after age 43, autologous oocyte use in US IVF cycles is almost non-existent. We here argue that the in vitro fertilization (IVF) field has created a self-fulfilling prophecy by basically abandoning the utilization of autologous oocytes after ages 42–43 years. This not only resulted in almost no IVF cycles with autologous oocytes being performed but also in abandonment of research that could lead to improvements in IVF outcomes in older women when using autologous oocytes. As a consequence, IVF has largely stagnated in this area. We further argue that third-party oocyte donation in clinical IVF should be considered a treatment failure, as it requires patients to choose a second rather than a first-choice treatment. Such a redesignation of third-party egg donation would not only be appropriate but could lead to necessary changes in physician attitudes, considering that women almost exclusively prefer to conceive with their autologous oocytes.

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We acknowledge the constant input of interesting new ideas from large numbers of patients.


The idea for this manuscript arose from the very low utilization of autologous eggs in IVF cycles in the USA above age 42–43. All 3 authors contributed equally to the final manuscript.

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Correspondence to Norbert Gleicher.

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N.G. is the owner of a for-profit fertility centre, the CHR in New York, NY. He and D.H.B. are co-inventors on several pending and already awarded US patents claiming therapeutic benefits from androgen supplementation in women with low functional ovarian reserve. Both are also co-inventors on patents relating to the FMR1 gene in diagnostic functions in female fertility and to AMH as a potentially therapeutic agent in female infertility. N.G. and D.H.B. receive royalties from Fertility Nutraceuticals, LLC, in which N.G. also holds shares. Both in the past received research grants, travel funds and/or speaker honoraria from pharma and/or medical device companies, though none in any way related to hear presented materials. E.Y.A. has no conflicts to declare.

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Gleicher, N., Barad, D.H. & Adashi, E.Y. Why is use of donor eggs not viewed as treatment failure? A call for improvements in treatments with autologous oocytes. J Assist Reprod Genet 37, 1583–1588 (2020).

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