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Evidence Library · Later pregnancy risks

What a donor egg pregnancy does to your risk of preeclampsia

Roughly one in nine as a single pregnancy, and more than one in four with twins.

This is the single most important thing that is left out of donor egg conversations. It has good absolute numbers, so there is no excuse for leaving it out.

Pooled across 27 studies covering 7,089 donor egg pregnancies, 1,139,540 naturally conceived pregnancies and 72,742 IVF pregnancies with the woman's own eggs:

PreeclampsiaDonor eggsNatural conceptionIVF with own eggs
Single pregnancies10.7%2.0%4.1%
Multiple pregnancies27.8%7.5%9.7%

The authors summarised it as: Nearly one in six women will suffer PE after OD. That fraction, about 17%, averages single and twin pregnancies together, which is why it sits between the two figures in the table.

The adjusted odds ratio against natural conception was 3.24, and against IVF with your own eggs it was 2.67. Compared with natural conception the increase was larger for severe preeclampsia than for preeclampsia overall. Compared with IVF using your own eggs, the two were the same.

Two other pooled analyses agree on the direction. One found the excess in preterm birth and low birth weight after donor egg conception disappeared after adjusting for preeclampsia, which suggests the placental and blood pressure pathway is doing the work rather than donor conception harming babies directly.

This is why single embryo transfer matters even more hereOne of the pooled analyses ends with an explicit recommendation that single embryo transfer should be the option of choice in oocyte-donation cycles.

Look at the second row of the table. Carrying twins from donor eggs takes the preeclampsia risk to more than one in four.
What a complete donor egg conversation contains"You have roughly a 40% chance per transfer regardless of your age" and "your chance of preeclampsia rises from about 2% with natural conception, or about 4% with IVF using your own eggs, to about 11%, or about 28% if you carry twins" are both true, and they belong in the same conversation.

Note the middle figure. Most women reading this are choosing donor eggs instead of IVF with their own eggs, not instead of conceiving naturally, so 4% is the comparison that actually applies to them. If you have only been told the success rate, ask for the rest.
Where this comes from:
97. Keukens A, van Wely M, van der Meulen C, Mochtar MH. Pre-eclampsia in pregnancies resulting from oocyte donation, natural conception or IVF: a systematic review and meta-analysis. Hum Reprod. 2022;37(3):586-599.
98. Storgaard M, Loft A, Bergh C, Wennerholm UB, Söderström-Anttila V, Romundstad LB, et al. Obstetric and neonatal complications in pregnancies conceived after oocyte donation: a systematic review and meta-analysis. BJOG. 2017;124(4):561-572.
99. Moreno-Sepulveda J, Checa MA. Risk of adverse perinatal outcomes after oocyte donation: a systematic review and meta-analysis. J Assist Reprod Genet. 2019;36(10):2017-2037.

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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.