Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles

Abstract

Objective To evaluate the correlation between total gonadotropin dose and live birth rate Design Retrospective analysis Setting Clinic-based data Patients 658,519 fresh autologous cycles of in vitro fertilization (IVF) reported to the Society for Assisted Reproductive Technology from 2004 to 2012 Interventions None Main outcome measures Logistic regression models were fitted to live birth rates using categorized values for total follicle stimulating hormone (FSH) dose and number of oocytes retrieved as the primary predictor variables. To reduce the effect of the most significant confounders which may lead physicians to prescribe higher doses of FSH, additional analyses were performed limited to good prognosis patients (<35 years of age, BMI<30, no diagnosis of diminished ovarian reserve, endometriosis, or ovulatory disorder) and including duration of gonadotropin treatment. Results Live birth rate significantly decreased with increasing FSH dose, regardless of the number of oocytes retrieved.. The statistically significant decrease in live birth rate with increasing FSH dose remained in patients with good prognosis, and regardless of female age, except for women aged ≥35 with 1–5 oocytes retrieved. Conclusion This analysis suggests that physicians may wish to avoid prescribing a high dose of FSH.. However, the results of this study do not justify the use of minimal stimulation or natural cycle IVF. Capsule Live birth rate decreased with increasing FSH dose, regardless of number of oocytes retrieved.

Euploidy Rates in Donor Egg Cycles Significantly Differ Between Fertility Centers

“…Corroborating evidence is also provided by the study of Baker et al (2015), showing that live birth rates diminish with increasing dosage of gonadotrophins, nearly independently of maternal age (Baker et al, 2015). Taken together, it may be speculated that differences in donor ovarian stimulation regimens used by different treating centers in this study may be a contributing factor to the observed differences in euploidy rates.…”

“…Physicians may have individual preferences for FSH dosage for donors and the number of eggs they aim to collect. Higher FSH dosages in the presence of normal ovarian response may be associated with poorer outcomes (Baker et al, 2015), which may be oocyte quality related. Physicians may also follow different routines during follicle aspiration, for example which follicles they choose to aspirate and at what negative pressure, whether they tend to flush follicles or not, and differences in time between hCG administration and egg retrieval.…”

Pregnancy, birth, and infant outcomes by maternal fertility status: the Massachusetts Outcomes Study of Assisted Reproductive Technology

“…Other factors affecting the endometrium and uterine environment may also be associated with adverse outcomes. Both gonadotropin dose and number of oocytes retrieved are associated with reduced live birth rates and decrements in birthweight (62, 63). …”

Optimal embryo transfer strategy in poor response may include freeze-all

“…From a registry-based retrospective analysis of 658,519 SART reported (2004-2012) fresh autologous IVF cycles, the analysis showed that poor responders (i.e., 1-5 oocytes), whether from low (<1000 IU FSH) or high (>5000 IU FSH) total FSH dose cycles, had reduced pregnancy compared normal responders (i.e., 11-15 oocytes) with similar ovarian stimulation, 21.7 versus 46.5 % and 12.5 versus 26.2 %, respectively [32]. The results of this study, however, exposes the notion held by many that pregnancy outcomes in poor ovarian responders are necessarily always severely reduced, with pregnancy rates of >50 % achieved in cycles with successful blastocyst culture and transfer, especially if transferred in FET.…”