Is there an optimal number of oocytes retrieved at which live birth rates or cumulative live birth rates per aspiration are maximized after ART? A systematic review

Law, Yin Jun; Zhang, Ning; Kolibianakis, Efstratios; Costello, Michael; Keller, Elena; Chambers, Georgina M.; Venetis, Christos

doi:10.1016/j.rbmo.2020.10.008

Cited by 28 publications

(13 citation statements)

References 51 publications

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“…It is noteworthy that 12-15 oocytes optimised cumulative LBR, as with conventional IVF (Law, et al, 2021, Magnusson, et al, 2018, the only difference being that there was no incidence of severe OHSS in our study population. In conventional IVF however, high cumulative LBR is accompanied by a rising OHSS rate (Drakopoulos, et al, 2016), even when an agonist trigger is used (Connell, et al, 2019).…”

mentioning

confidence: 74%

Response to: Is mild stimulation the way forward?

Datta¹,

Campbell

Nargund

2022

Reproductive BioMedicine Online

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mentioning

confidence: 74%

Response to: Is mild stimulation the way forward?

Datta¹,

Campbell

Nargund

2022

Reproductive BioMedicine Online

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“…This study did not report a plateau in cumulative live birth rate and a further increase of 5% was detected beyond 27 oocytes. A recent systematic review of 16 studies (comprising five studies evaluating live birth rate from fresh cycles, five studies evaluating cumulative live birth rate from stimulated cycles and six studies evaluating both) suggested that 12–18 oocytes was the optimal number of oocytes associated with maximal fresh live birth rate, whereas cumulative live birth rate continued to increase with the number of oocytes retrieved ( 45 ).…”

Section: Results Of the Consensus And Actionable Recommendations (Including Supportive Evidence)mentioning

confidence: 99%

Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus

et al. 2021

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BackgroundA Delphi consensus was conducted to evaluate global expert opinions on key aspects of assisted reproductive technology (ART) treatment.MethodsTen experts plus the Scientific Coordinator discussed and amended statements plus supporting references proposed by the Scientific Coordinator. The statements were distributed via an online survey to 35 experts, who voted on their level of agreement or disagreement with each statement. Consensus was reached if the proportion of participants agreeing or disagreeing with a statement was >66%.ResultsEighteen statements were developed. All statements reached consensus and the most relevant are summarised here. (1) Follicular development and stimulation with gonadotropins (n = 9 statements): Recombinant human follicle stimulating hormone (r-hFSH) alone is sufficient for follicular development in normogonadotropic patients aged <35 years. Oocyte number and live birth rate are strongly correlated; there is a positive linear correlation with cumulative live birth rate. Different r-hFSH preparations have identical polypeptide chains but different glycosylation patterns, affecting the biospecific activity of r-hFSH. r-hFSH plus recombinant human LH (r-hFSH:r-hLH) demonstrates improved pregnancy rates and cost efficacy versus human menopausal gonadotropin (hMG) in patients with severe FSH and LH deficiency. (2) Pituitary suppression (n = 2 statements): Gonadotropin releasing hormone (GnRH) antagonists are associated with lower rates of any grade ovarian hyperstimulation syndrome (OHSS) and cycle cancellation versus GnRH agonists. (3) Final oocyte maturation triggering (n=4 statements): Human chorionic gonadotropin (hCG) represents the gold standard in fresh cycles. The efficacy of hCG triggering for frozen transfers in modified natural cycles is controversial compared with LH peak monitoring. Current evidence supports significantly higher pregnancy rates with hCG + GnRH agonist versus hCG alone, but further evidence is needed. GnRH agonist trigger, in GnRH antagonist protocol, is recommended for final oocyte maturation in women at risk of OHSS. (4) Luteal-phase support (n = 3 statements): Vaginal progesterone therapy represents the gold standard for luteal-phase support.ConclusionsThis Delphi consensus provides a real-world clinical perspective on the specific approaches during the key steps of ART treatment from a diverse group of international experts. Additional guidance from clinicians on ART strategies could complement guidelines and policies, and may help to further improve treatment outcomes.

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“…Patients' characteristics are summarized in Table 1. The age, basal follicleforming hormone (bFSH), dose of Gn, duration of Gn, and the proportion of patients with type B PCOS were significantly higher in the low-oocyte group (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) than in the middleoocyte group (12)(13)(14)(15)(16)(17) and high-oocyte group (18-62) (p < 0.05). The body mass index (BMI), and total testosterone were significantly higher in the low-oocyte group than in the highoocyte group (p < 0.05).…”

Section: Patients' Characteristicsmentioning

confidence: 99%

“…In the implementation of IVF, the increased number of oocytes retrieved improved pregnancy rates in women by increasing the number of available embryos for transfer (1). The number of oocytes retrieved is an important factor affecting the cumulative live birth rate, and the cumulative live birth rate (CLBR) increases with the increase in the number of oocytes retrieved (2)(3)(4). However, increasing the number of oocytes retrieved not only increases the incidence of ovarian hyperstimulation syndrome (OHSS) and other complications but also increases the possibility of whole embryo freezing, which prolongs the treatment cycle of patients.…”

Section: Introductionmentioning

confidence: 99%

The Optimal Number of Oocytes Retrieved From PCOS Patients Receiving IVF to Obtain Associated With Maximum Cumulative Live Birth Rate and Live Birth After Fresh Embryo Transfer

et al. 2022

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AimsThis study aims to determine the optimal number of oocytes retrieved so that patients with polycystic ovary syndrome (PCOS) receiving in vitro fertilization (IVF) can obtain the best cumulative live birth rate (CLBR) and live birth after fresh embryo transfer.MethodsThis is a retrospective study of 1,419 patients with PCOS who underwent their first IVF cycle at the Second Hospital of Hebei Medical University from January 2014 to December 2021. Multivariable regression analysis was performed to adjust for factors known to independently affect cumulative live birth aspiration. The number of oocytes retrieved to obtain the best cumulative live birth rate was explored through curve fitting and threshold effect analysis. The decision tree method was used to explore the best number of oocytes retrieved to achieve live birth in the shortest time.Results(1) The number of oocytes retrieved was found to be an independent protective factor for the cumulative live birth rate (OR = 1.09 (95% CI: 1.06, 1.12)). When the number of oocytes retrieved was less than 15, CLBR increased by 16% with each increase in the number of oocytes retrieved (OR = 1.16 (95% CI: 1.11, 1.22)); and when more than 15, CLBR tended to be stable. (2) Live birth after the first fresh embryo transfer was analyzed through a classification decision tree. For patients younger than 35 years old, those with less than 6 oocytes and those with 7–16 oocytes had a similar proportion of live births with fresh embryo transfer but higher than 16 oocytes (53.7% vs. 53.8% vs. 18.4%). Patients older than 35 years old had a similar proportion of live births with fresh embryo transfer (35.7% vs. 39.0%) to those younger than 35 years old, but the proportion of no live births after using up all embryos was higher than those younger than 35 years old (39.3% vs. 19.2%).ConclusionsIn PCOS patients, high CLBR can be obtained when the number of oocytes retrieved was 15 or more. The number of oocytes retrieved from 7 to 16 could achieve more chance of live birth after fresh embryo transfer.

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Is there an optimal number of oocytes retrieved at which live birth rates or cumulative live birth rates per aspiration are maximized after ART? A systematic review

Abstract: Is there an optimal number of oocytes retrieved where live birth rates or cumulative live birth rates per aspiration are maximised after ART? A systematic review,

Cited by 28 publications

References 51 publications

Response to: Is mild stimulation the way forward?

Response to: Is mild stimulation the way forward?

Optimising Follicular Development, Pituitary Suppression, Triggering and Luteal Phase Support During Assisted Reproductive Technology: A Delphi Consensus

The Optimal Number of Oocytes Retrieved From PCOS Patients Receiving IVF to Obtain Associated With Maximum Cumulative Live Birth Rate and Live Birth After Fresh Embryo Transfer

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