Abstract
Purpose
To evaluate live birth rates (LBRs) for in vitro fertilization (IVF) cycles with ≤5 follicles at trigger, with the goal of helping patients with low follicle counts decide whether to proceed to retrieval.
Methods
This is a retrospective cohort study from an urban, university-affiliated fertility center. All IVF cycles that yielded <10 oocytes between 2016 and 2020 were reviewed. Cycles were included if <5 follicles measuring >14 mm were verified on trigger day. The primary outcome was LBR per retrieval after fresh or frozen transfer. Secondary outcomes were number of oocytes, mature oocytes, 2-pronuclear zygotes (2-PNs), blastocysts for transfer/biopsy, and euploid blastocysts (if preimplantation genetic testing for aneuploidy (PGT-A) was used).
Results
1502 cycles (900 with PGT-A) from 972 patients were included. Mean number of oocytes, mature oocytes, 2-PNs, blastocysts for transfer/biopsy, and euploid blastocysts differed by follicle number (p < 0.001). Across all age groups, there were differences in LBR associated with follicle number (p < 0.001). However, within age groups, not all results were significant. For example, for patients <35 years, LBR did not differ by follicle number and among patients 35–37 years; LBR with two or three follicles was lower than with five (p < 0.02). LBR for patients 35–40 years was <20% with 1–3 follicles and 25–40% with 4–5 follicles. LBR for patients >41 years was <5% with 1–3 follicles and <15% with 4–5 follicles.
Conclusion
As expected, LBR is higher with more follicles. Providing patients with <5 follicles with specific data can help them weigh the emotional, physical, and financial costs of retrieval.
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Data availability
Data for this study can be made available upon request.
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Dr. McCulloh has the following conflicts of interest: Director at Biogenetics Laboratory in Mountainside, NJ; Director at the Sperm and Embryo Bank of New York in New York, NY; Director at Biogenetics Laboratory in Brooklyn, NY; Director of Clinical Science at ReproART: the Georgian-American Center for Reproductive Medicine in Tblilis, Georgia; consulting services through McCulloh Associates in Port Washington, NY; recent Scientific Advisory Board member of GranataBio in Duxbury, MA. The other authors of this study have no conflicts of interest to report.
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Bayefsky, M.J., Cascante, S.D., McCulloh, D.H. et al. Live birth rates in in vitro fertilization cycles with five or fewer follicles. J Assist Reprod Genet 41, 223–229 (2024). https://doi.org/10.1007/s10815-023-02985-8
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DOI: https://doi.org/10.1007/s10815-023-02985-8