Optimum oocyte retrieved and transfer strategy in young women with normal ovarian reserve undergoing a long treatment protocol: a retrospective cohort study

Abstract

For young women with normal ovarian reserve, retrieving 10∼12 oocytes might result in optimized pregnancy outcomes in a fresh cycle with low OHSS risk and would not compromise cumulative outcomes. When ≥16 oocytes were retrieved, a "freeze-all" embryo strategy might be preferable.

PIVET rFSH dosing algorithms for individualized controlled ovarian stimulation enables optimized pregnancy productivity rates and avoidance of ovarian hyperstimulation syndrome

“…The proportion of women with >15 oocytes retrieved per egg collection was 11.6%. This was significantly lower than those receiving conventional rFSH dosages (112.5–300 IU) recently reported 20 (38.2%) ( P <0.0001) and demonstrated our milder stimulation.…”

“…However, their pregnancy rates were actually high, in keeping with our earlier published data that <5 oocytes from younger high-responders generate embryos that have a higher implantation rate than those from higher order oocyte collections. 6 While those <30 years and patients 40–44 years had a mean number of 1.1 and 1.5 embryos transferred, respectively, the overall mean was 1.28±0.45, which was significantly lower ( P <0.001) than that demonstrated in another study (1.94±0.24), which was also described as an “optimum oocyte retrieval and transfer strategy.” 20 Furthermore, we noted a trend toward higher embryo utilization rates over oocyte utilization rates in all cases, but both of these rates were increased in older patients. The higher embryo utilization rate reflects the higher number of usable, mature, and fertilizable M-II eggs and is a useful index signifying the proportion of eggs that are actually mature.…”

Frozen embryo transfer can be performed in the cycle immediately following the freeze-all cycle

“…Therefore, any procedure that has an effect on endometrial development has the potential to impair embryo implantation, placentation, intrauterine fetal growth, and ultimately the chances of LB [12]. The use of high gonadotropin dose COS is acknowledged to be pivotal to the success of IVF, in terms of oocyte numbers [1][2][3]8]. However, the use of high gonadotropin dose COS significantly affects the early luteal phase [10,12,17] of a treatment cycle, with the supraphysiological levels of estrogen and progesterone that often arise affecting the ability of the endometrium to proliferate, differentiate, and mature [6,[29][30][31].…”

“…Live birth (LB) rates in human IVF have been seen to increase with increasing numbers of oocytes retrieved; generally, the relationship between LB rates and oocyte numbers follows a sigmoid-curve with LB rates starting to reach optimal levels when > 6 oocytes are retrieved, with the increase no longer significant when > 15 oocytes are retrieved [1,3]. Likewise, cumulative LB (cLB) rates increase with increasing oocyte numbers; however, cLB rates continue to increase significantly in cycles with > 15 oocytes were retrieved [1].…”

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“…The remaining parts of harvested ovary might be used as a backup for replacing the primary graft if needed. The procedure of re-implanting ovarian tissue might be done into the cortex of intact ovary through Douglas pouch approach under guidance of ultrasonography such as performed for retrieving oocytes used in in-vitro fertilization (IVF) [32].…”