Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicenter multinational analysis including ∼15,000 women

Abstract

This is the largest multicenter study evaluating for the first time the impact of ovarian response on cumulative live birth rate. The significant progressive increase of cumulative live birth rate with the number of oocytes in our study suggests that ovarian stimulation may not have a detrimental effect on oocyte/embryo quality in good-prognosis women less than 40 year old. Nevertheless, although very high ovarian response may further increase cumulative live birth rates, ovarian stimulation should be rational and avoid extreme response in terms of oocytes retrieved to preserve patients' convenience and safety and avoid ovarian hyperstimulation syndrome or other iatrogenic complications.

Management Strategies for POSEIDON Group 2

“…Older female age, longer duration of infertility, higher basal FSH levels were negative predictors whereas higher number of oocytes and good embryo quality were positive predictors. There has been consistent evidence of a strong association between number of oocytes retrieved and live birth reinforcing that the number of oocytes is an important prognostic variable for IVF success (21)(22)(23)(24). It is therefore paramount that the OS regimens optimize number of oocytes retrieved to maximize success.…”

The cumulative live birth rate after a freeze-only strategy versus a conventional fresh embryo transfer strategy: a call for more level 1 evidence

“…Elective freezing of all embryos and the performance of a frozen embryo transfer, also known as a freeze-only strategy, has been demonstrated by randomized trials to result in a higher rate of live births in women with polycystic ovary syndrome [4] and in ovulatory women who undergo single blastocyst transfer [5] compared with a fresh embryo transfer. Nevertheless, most of the available evidence regarding the cumulative live birth rate after a freeze-only strategy compared with a fresh embryo transfer strategy is from observational studies [6,7], including the current study by Smith et al [2].…”

Cumulative live birth rates according to the number of oocytes retrieved following the “freeze-all” strategy

“…To date, studies investigating the association between the number of oocytes retrieved and the CLBR for the "freezeall" strategy were scarce. However, we found ten studies to date that evaluated the association between the number of oocytes retrieved and CLBR following a conventional in vitro fertilization strategy, which consists of a single fresh and all frozen-thawed embryo transfers after one aspiration, and all found a positive correlation between the number of oocytes retrieved and the CLBR [8,9,[12][13][14][15]. Apart from showing a positive correlation, some of these ten studies determined what oocyte number was ideal for the optimal CLBR.…”

“…However, we do not recommend that an extreme oocyte yield should be a goal given the risks of ovarian torsion, venous thromboembolism and arterial thrombosis, particularly because achieving an oocyte retrieval number higher than 30 is pointless when using the "freeze-all" strategy. This may be because younger women should have a sufficient number of euploid embryos to provide multiple possibilities for achieving a live birth, and the surplus embryos would therefore be wasted in these individuals [15].…”