Infertility constitutes a major public health issue, and requests for oocyte donation, initially indicated in cases of premature ovarian insufficiency or to avoid the transmission of a maternally inherited genetic disease, are currently increasing due to the rise in requests following IVF failure or in cases of age-related infertility. Pregnancies resulting from oocyte donation are associated with increased obstetric morbidity compared with spontaneous pregnancies or those resulting from IVF with autologous oocytes. However, the influence of the initial indication for oocyte donation on obstetric outcomes is still debated.

To evaluate clinical pregnancy rates and obstetric outcomes of singleton pregnancies after oocyte donation according to the maternal indication.

A retrospective single-center study including infertile women aged 18 to 43 years, managed with oocyte donation between 2012 and 2024 in our Assisted Reproductive Technology center. Clinico-biological data and the outcomes of oocyte donation cycles were analyzed. The obstetric outcomes of singleton ongoing pregnancies were studied according to the etiology of oocyte donation: group 1 (intra-couple IVF failure), group 2 (genetic cause), group 3 (idiopathic POI), group 4 (iatrogenic POI).

A total of 276 women underwent 586 oocyte donation cycles, with embryo transfer performed in 88% of cases under hormone replacement therapy. The clinical pregnancy rate per cycle was 30%, significantly higher in the group 3 idiopathic POI (44.2%,). The live birth rate per cycle was 21% in the overall population and 31% in the group 3 ( p = 0.014). Among the 107 singleton pregnancies resulting in live birth, the most frequent complications were gestational diabetes (23 %) and hypertensive disorders (23%), with no significant difference between the 4 groups. The overall caesarean section rate was 44%.

Patients with idiopathic POI achieve better pregnancy and live birth rates after oocyte donation, without a specific increase in obstetric complications compared with other indications. The increased obstetric morbidity observed after oocyte donation underlines the need for personalized pregnancy follow-up.