Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth: an analysis of 256,381 in vitro fertilization cycles

卵巢过度刺激综合征 卵母细胞 体外受精 活产 控制性卵巢过度刺激 妇科 医学 人类受精 产科 男科 生物 怀孕 胚胎 解剖 遗传学 细胞生物学
作者
R.G. Steward,Lan Lan,Anish Shah,Jason S. Yeh,Thomas M Price,J. Goldfarb,Suheil J. Muasher
出处
期刊:Fertility and Sterility [Elsevier]
卷期号:101 (4): 967-973 被引量:302
标识
DOI:10.1016/j.fertnstert.2013.12.026
摘要

ObjectiveTo investigate the association between oocyte number and the rates of ovarian hyperstimulation syndrome (OHSS) and live birth (LB) in fresh autologous in vitro fertilization (IVF) cycles.DesignRetrospective cohort study.SettingAn academic reproductive medicine practice.Patient(s)We analyzed data from 256,381 IVF cycles using the 2008–2010 Society for Assisted Reproductive Technology national registry. Patients were divided into five groups based on retrieved oocyte number.Main Outcome Measure(s)Rates of OHSS and LB were calculated for each group. A generalized estimating equation (GEE) was used to assess differences in OHSS and LB between groups. Receiver operating characteristic (ROC) curves were used to evaluate oocyte number as a predictor of OHSS and LB.Intervention(s)None.Result(s)The LB rate increased up to 15 oocytes, then plateaued (0–5: 17%, 6–10: 31.7%; 11–15: 39.3%; 16–20: 42.7%; 21–25: 43.8%; and >25 oocytes: 41.8%). However, the rate of OHSS became much more clinically significant after 15 oocytes (0–5: 0.09%; 6–10: 0.37%; 11–15: 0.93%; 16–20: 1.67%; 21–25: 3.03%; and >25 oocytes: 6.34%). These trends remained after adjustment with the use of GEE. ROC curves revealed that although oocyte number is not useful in the prediction of LB, 15 retrieved oocytes is the number that best predicts OHSS risk.Conclusion(s)Retrieval of >15 oocytes significantly increases OHSS risk without improving LB rate in fresh autologous IVF cycles. In general, less aggressive stimulation protocols should be considered, especially in high-responders, to optimize outcomes. To investigate the association between oocyte number and the rates of ovarian hyperstimulation syndrome (OHSS) and live birth (LB) in fresh autologous in vitro fertilization (IVF) cycles. Retrospective cohort study. An academic reproductive medicine practice. We analyzed data from 256,381 IVF cycles using the 2008–2010 Society for Assisted Reproductive Technology national registry. Patients were divided into five groups based on retrieved oocyte number. Rates of OHSS and LB were calculated for each group. A generalized estimating equation (GEE) was used to assess differences in OHSS and LB between groups. Receiver operating characteristic (ROC) curves were used to evaluate oocyte number as a predictor of OHSS and LB. None. The LB rate increased up to 15 oocytes, then plateaued (0–5: 17%, 6–10: 31.7%; 11–15: 39.3%; 16–20: 42.7%; 21–25: 43.8%; and >25 oocytes: 41.8%). However, the rate of OHSS became much more clinically significant after 15 oocytes (0–5: 0.09%; 6–10: 0.37%; 11–15: 0.93%; 16–20: 1.67%; 21–25: 3.03%; and >25 oocytes: 6.34%). These trends remained after adjustment with the use of GEE. ROC curves revealed that although oocyte number is not useful in the prediction of LB, 15 retrieved oocytes is the number that best predicts OHSS risk. Retrieval of >15 oocytes significantly increases OHSS risk without improving LB rate in fresh autologous IVF cycles. In general, less aggressive stimulation protocols should be considered, especially in high-responders, to optimize outcomes.
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