Live birth after oocyte donation in women with Turner syndrome compared with other causes of premature ovarian insufficiency: a retrospective cohort study

PURPOSE: To compare live birth rates after in vitro fertilization (IVF) with oocyte donation between women with Turner syndrome and women with premature ovarian insufficiency (POI) of other etiologies and to evaluate the relationships between uterine volume, duration of hormone replacement therapy (HRT), and obstetric outcomes. METHODS: This retrospective cohort study included 97 women with POI undergoing IVF with oocyte donation at a university-affiliated tertiary care center between 2007 and 2023, including 30 women with Turner syndrome and 67 with POI of other etiologies. Artificial endometrial preparation cycles were used for all recipients. Uterine volume was measured by transvaginal ultrasound prior to the first embryo transfer. Primary outcome was live birth per embryo transfer. Secondary outcomes included live birth according to embryo transfer rank, associations between uterine volume and obstetric or neonatal outcomes, and the relationship between uterine volume and duration of prior HRT. RESULTS: A total of 245 embryo transfers were performed. Live birth rates per embryo transfer were comparable between women with Turner syndrome and those with other POI etiologies (29% vs. 27%). However, women with Turner syndrome had a significantly lower probability of achieving live birth at the first embryo transfer (adjusted odds ratio [OR] 0.09; 95% confidence interval [CI] 0.01-0.64), whereas no significant difference was observed after three or more transfers. Median uterine volume prior to IVF did not differ significantly between groups, despite a substantially longer duration of prior HRT in women with Turner syndrome (15.5 vs. 3.0 years). No significant association was observed between uterine volume and duration of HRT in either group. Among singleton pregnancies, decreasing uterine volume was associated with increased risks of preeclampsia, intrauterine growth restriction, non-cephalic presentation, and adverse neonatal outcomes. CONCLUSIONS: Women with Turner syndrome achieve live birth rates after IVF with oocyte donation comparable to those of women with other POI etiologies, although more embryo transfer attempts may be required. No clear association between uterine volume and duration of HRT was observed. However, decreasing uterine volume was associated with adverse obstetric outcomes, highlighting the importance of early hormonal management and careful obstetric surveillance in this population.