How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach

Vaughan, Denis A.; Leung, Angela Q.; Resetkova, Nina; Ruthazer, Robin; Penzias, Alan S.; Sakkas, Denny; Alper, Michael M.

doi:10.1016/j.fertnstert.2016.10.037

Cited by 89 publications

(34 citation statements)

References 46 publications

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“…The positive association between oocyte yield and live birth outcome in fresh and frozen IVF cycles has been well established [1,13]. Following analysis of >400, 0000 IVF cycles, Sunkara et al (2011) demonstrated a strong association between the number of oocytes retrieved and live birth rate, where it increased with number of oocytes up to 15, plateaued between 15 and 20 and steadily declined beyond 20 oocytes [1].…”

Section: Discussionmentioning

confidence: 99%

Live birth rate is associated with oocyte yield and number of biopsied and suitable blastocysts to transfer in preimplantation genetic testing (PGT) cycles for monogenic disorders and chromosomal structural rearrangements

Ben-Nagi

Jones

Naja³

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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ObjectivesTo investigate whether live birth (LB) is associated with oocyte yield and number of biopsied and suitable blastocyst to transfer following preimplantation genetic testing (PGT) for monogenic disorders (PGT-M) and chromosomal structural rearrangements (PGT-SR).Study designAll couples underwent controlled ovarian stimulation, blastocyst biopsy, vitrification and transfer of suitable embryo(s) in a frozen embryo transfer (FET) cycle.ResultsOf 175 couples who underwent PGT treatment, 249 oocytes retrievals were carried out and 230 FET were subsequently undertaken. 122/230 (53%, 95% CI 47–59) FET resulted in a LB and 16/230 (7%, 95% CI 4–11) have resulted in ongoing pregnancies. 21/230 (9%, 95% CI 6–14) FET resulted in miscarriage and 69/230 (30%, 95% CI 24–36) concluded with failed implantation. Two (1%, 95% CI 0–3) transfers underwent termination for congenital malformation, with no evidence of misdiagnosis by prenatal testing. The relationship between number of oocytes retrieved and number of blastocysts biopsied and suitable embryos to transfer were significant (p = 0.00; Incidence rate ratio (IRR) 1.05; 95% 1.04–1.06; p = 0.00; IRR 1.04; 95%, 1.03–1.06), respectively. The number of oocytes collected (p = 0.007; OR 1.06; 95% CI 1.01–1.10), the number of blastocysts biopsied (p = 0.001; OR 1.14; 95% 95% CI 1.06–1.23) and the number of suitable embryos to transfer (p = 0.00; OR 1.38; 95% CI 1.17–1.64) were all significantly associated with the odds of achieving a LB. There is a 14% and 38% increased chance of a LB per additional blastocyst biopsied and suitable embryo to transfer, respectively.ConclusionsPGT-M and PGT-SR outcomes are significantly associated with egg yield, number of blastocysts to biopsy and suitable embryos to transfer.

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Section: Discussionmentioning

confidence: 99%

Live birth rate is associated with oocyte yield and number of biopsied and suitable blastocysts to transfer in preimplantation genetic testing (PGT) cycles for monogenic disorders and chromosomal structural rearrangements

Ben-Nagi

Jones

Naja³

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Advocates of mild stimulation suggest that obtaining fewer oocytes could achieve a lower embryo aneuploidy rate and a better implantation rate [10,11]. In contrast, other studies have reported that the numbers of usable blastocysts and euploid embryos increased with the number of oocytes retrieved [12]. These findings may explain the positive association between the number of oocytes retrieved and the CLBR.…”

Section: Discussionmentioning

confidence: 95%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Zhao

Shi

et al. 2020

Reprod Biol Endocrinol

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Background: In recent years, some studies have shown that there is a positive association between the number of oocytes retrieved and the cumulative live birth rate (CLBR) after fresh and frozen cycles of one oocyte retrieval. However, almost no studies have examined the association between the number of oocytes retrieved and the CLBR when using the "freeze-all" strategy. We performed this study to investigate the effects of an extreme oocyte yield during the first "freeze-all" cycle on the cumulative live birth rate among patients younger than 35 years old. Methods: This was a retrospective cohort study performed in a university-affiliated reproductive medicine centre. Data obtained from 3276 women aged younger than 35 years who underwent their first "freeze-all" cycle (IVF/ICSI) were collected between January 2009 and December 2016. In all, 5025 frozen cycles took place during the followup period from January 2009 to December 2018. Patients were divided into five groups according to oocytes retrieved (group 1: 4-10 oocytes; group 2: 11-20 oocytes; group 3: 21-30 oocytes; group 4: 31-40 oocytes; group 5: > 40 oocytes). The primary outcome was the cumulative live birth rate. Results: Unadjusted results showed that the cumulative live birth rate significantly increased as the number of oocytes retrieved increased and reached up to 93.82% in cases with yields of 21-30 oocytes (P < 0.05), after which it did not have a significant increase (P > 0.05). After adjusting for confounders, our results showed that the number of oocytes retrieved is an independent positive predictor of cumulative live birth rate when using a "freeze-all" strategy. (P < 0.001). In addition, the fertilization rate and the gonadotropin dose also influenced the cumulative live birth rate (P<0.05). Conclusions: Among women younger than 35 years old who underwent the "freeze-all" strategy, the number of oocytes retrieved positively correlated with the cumulative live birth rate. Taking both efficacy and safety into account, ovarian stimulation should be rational, and the upper limit of the oocyte yield should be no more than 30.

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“…Fertility drugs like gonadotrophins (FSH, LH and HCG) ( Ludwig et al , 2002 ; Lunenfeld, 2002 ; Lehert et al , 2014 ; Peeraer et al , 2015 ; Ata and Seli, 2015 ; Humaidan et al , 2017 ) and GnRH agonists/antagonists ( Al-Inany et al , 2016 ) are important for effective ovarian stimulation and ovulation triggering in order to obtain multiple mature and high quality oocytes in one cycle and to reduce time to live birth in patients. Indeed, there is clear evidence that the cumulative live birth rate per patient is correlated with the number of oocytes recovered after one ovarian stimulation cycle ( Sunkara et al , 2011 ; Drakopoulos et al , 2016 ; Vaughan et al , 2017 ). The choices for physicians to balance the importance of the number of oocytes versus the risk of ovarian hyperstimulation syndrome (OHSS) have been greatly expanded with flexible ways to determine not only the FSH starting dose, using a variety of blood or ultrasound biomarkers such as AMH, FSH and AFC and clinical markers such as female age, BMI and previously recovered number of oocytes, but also to adapt the gonadotrophin dose as needed with small dose changes of 12.5 IU, at any time during ovarian stimulation, to decrease the risks of either OHSS and poor ovarian response ( La Marca and Sunkara, 2014 ; van Tilborg et al , 2016 ; Allegra et al , 2017 ).…”

Section: The Essential Role Of Industry In Reproductive Medicine Todamentioning

confidence: 99%

Transparent collaboration between industry and academia can serve unmet patient need and contribute to reproductive public health

D’Hooghe

2017

Human Reproduction

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The pharmaceutical and device industry has greatly contributed to diagnostic and therapeutic approaches in reproductive medicine in a very highly regulated environment, ensuring that development and manufacturing follow the highest standards. In spite of these achievements, collaboration between industry and physicians/academia is often presented in a negative context. However, today more than ever, partnership between industry and academia is needed to shorten the timeline between innovation and application, and to achieve faster access to better diagnostics, drugs and devices for the benefit of patients and society, based on complementary knowledge, skills and expertise. Such partnerships can include joined preclinical/clinical and post-marketing research and development, joint intellectual property, and joint revenue. In Europe, the transparency of this collaboration between pharmaceutical industry and medical doctors has been made possible by the Compliance and Disclosure Policy published by the European Federation of Pharmaceutical Industries and Associations (EFPIA), which represents the major pharmaceutical companies operating in Europe, and includes as members some but not all companies active in infertility and women's health. Under the EFPIA Disclosure Code of conduct, companies need to disclose transfers of value including amounts, activity type and the names of the recipient Health Care Professionals and Organizations. EFPIA member companies have also implemented very strict internal quality control processes and procedures in the design, statistical analysis, reporting, publication and communication of clinical research, according to Good Clinical Practice and other regulations, and are regularly inspected by competent authorities such as the US Food and Drug Administration (FDA) or European Medicines Agency (EMA) for all trials used in marketing authorization applications. The risk of scientific bias exists not only in the pharmaceutical industry but also in the academic world. When academics believe in a hypothesis, they may build their case by emphasizing the arguments supporting their case, and either refute, refuse, oppose or ignore arguments that challenge their assumptions. A possible solution to reduce this bias is international consensus on study design, data collection, statistical analysis and reporting of outcomes, especially in the area of personalized reproductive medicine, e.g. to demonstrate superiority or non-inferiority of personalized ovarian stimulation using biomarkers. Equally important is that declarations of interest are reported transparently and completely in scientific abstracts and publications, and that ghost authorship is replaced by proactive and clear co-authorship for experts from industry where such co-authorship is required based on the prevailing ICMJE criteria. In that context, however, reviewers should stop believing that publications by industry authors only, or by mixed groups of co-authors from industry and academia, are more prone to bias than papers ...

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How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach

Abstract: We demonstrate that one fresh cycle with high oocyte yield is an optimal way to plan IVF treatment. With modern cryopreservation methods, the concept of "one-and-done" could safely achieve ≥2 live births with just one stimulation cycle in almost a quarter of our patients.

Cited by 89 publications

References 46 publications

Live birth rate is associated with oocyte yield and number of biopsied and suitable blastocysts to transfer in preimplantation genetic testing (PGT) cycles for monogenic disorders and chromosomal structural rearrangements

Live birth rate is associated with oocyte yield and number of biopsied and suitable blastocysts to transfer in preimplantation genetic testing (PGT) cycles for monogenic disorders and chromosomal structural rearrangements

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

Transparent collaboration between industry and academia can serve unmet patient need and contribute to reproductive public health

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