Abstract
Purpose
To assess the relation between number of inseminated oocytes and cumulative live birth rate (CLBR) in order to provide guidance for limiting the number of surplus blastocysts.
Methods
The study was a retrospective, single-center cohort analysis of 1223 ART complete cycles. Cycles were stratified according to female age (≤ 34, 35–38, and 39–42 years) and number of inseminated oocytes (1–5, 6–10, and > 10). Inclusion criteria were indication for IVF/ICSI with own spermatozoa and blastocyst culture up to day 6 of all embryos.
Results
In patients younger than 35 years, insemination of more than ten oocytes produced an increase in overall blastocyst number, CLBR (40.3%, 54.3%, and 75.8%, respectively, for each oocyte group) and surplus embryo rate (12.9%, 27.8%, and 49.7% of cases for each group). Instead, in the middle age group, the use of more than ten oocytes was solely associated with an increase in the rate of surplus embryos (1.25%, 21.33%, and 28.68% of cases after stratification for oocyte number). In older patients, neither CLBR (9.1%, 23.9%, and 24.7%, respectively) nor rate of surplus embryos (2.0%, 7.1%, and 13.4% of cases for each group) were higher in cycles with more than ten inseminated oocytes.
Conclusion
In women up to 38 years, sustainable CLBR are achieved while limiting the number of inseminated oocytes and the resulting blastocysts remaining unused. Based on this notion, novel treatment strategies could pursue high outcome rates, while alleviating the problems derived from surplus stored embryos.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Tiitinen A, Hydén-Granskog C, Gissler M. What is the most relevant standard of success in assisted reproduction? The value of cryopreservation on cumulative pregnancy rates per single oocyte retrieval should not be forgotten. Hum Reprod. 2004;19:2439–41.
Maheshwari A, McLernon D, Bhattacharya S. Cumulative live birth rate: time for a consensus? Hum Reprod. 2015;30(12):2703–7.
Scaravelli G, Levi-Setti PE, Livi C, La Sala G, Ubaldi FM, Greco E, et al. Correc- tion to: contribution of cryopreservation to the cumulative live birth rate: a large multicentric cycle-based data analysis from the Italian National Regis- try. J Assist Reprod Genet. 2019;36:2297.
Zacà C, Bazzocchi A, Pennetta F, Bonu MA, Coticchio G, Borini A. Cumula- tive live birth rate in freeze-all cycles is comparable to that of a conventional embryo transfer policy at the cleavage stage but superior at the blastocyst stage. Fertil Steril. 2018;110:703–9.
Germond M, Urner F, Chanson A, Primi MP, Wirthner D, Senn A. What is the most relevant standard of success in assisted reproduction?: The cumulated singleton/twin delivery rates per oocyte pick-up: the CUSIDERA and CUTWIDERA. Hum Reprod. 2004;11:2442–4.
Zacà C, Coticchio G, Tarozzi N, Nadalini M, Lagalla C, Garolla A, et al. Sperm count affects cumulative birth rate of assisted reproduction cycles in relation to ovarian response. J Assist Reprod Genet. 2020;37:1653–9.
de Mouzon J, Goossens V, Bhattacharya S, Castilla JA, Ferraretti AP, Korsak V, et al. Assisted reproductive technology in Europe, 2006: results generated from European registers by ESHRE. Hum Reprod. 2010;25:1851–62.
Rienzi L, Gracia C, Maggiulli R, LaBarbera AR, Kaser DJ, Ubaldi FM, et al. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance. Hum Reprod Update. 2017;23:139–55.
Law 19 February 2004 No. 40 https://www.gazzettaufficiale.it/eli/id/2004/02/24/004G0062/sg
Borini A, Lagalla C, Bonu MA, Bianchi V, Flamigni C, Coticchio G. Cumulative pregnancy rates resulting from the use of fresh and frozen oocytes: 7 years’ experience. Reprod Biomed Online. 2006;12(4):481–6.
Borini A, Gambardella A, Bonu MA, Dal PL, Sciajno R, Bianchi L, et al. Comparison of IVF and ICSI when only few oocytes are available for insemination. Reprod BioMed Online. 2009;19:270–5.
Dal Prato L, Borini A, Cattoli M, Bonu MA, Sciajno R, Flamigni C. Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist. Fertil Steril. 2002;77(5):956–60.
Scaravelli G, Zacà C, Levi Setti PE, Livi C, Ubaldi FM, Villani MT, Greco E, Coccia ME, Revelli A, Ricci G, Fusi F, Vigiliano V, De Luca R, Bolli S, Borini A. Fertilization rate as a novel indicator for cumulative live birth rate: a multicenter retrospective cohort study of 9,394 complete in vitro fertilization cycles. Fertil Steril. 2021;116(3):766–73.
Bartolacci A, Intra G, Coticchio G, dell'Aquila M, Patria G, Borini A. Does morphological assessment predict oocyte developmental competence? A systematic review and proposed score. J Assist Reprod Genet. 2022;39(1):3–17.
European Court of Human Rights, 27.8.2015, ref., Parrillo v. Italy. Application No. 46470/11. Judgment issued on 27th August 2015, in www.echr.coe.int
European Court of Human Rights. Evans v. the United Kingdom. Application No. 6339/05. Judgment issued on 10th April 2007. Available at: https://hudoc.echr.coe.int/ eng#{“itemid”:[“001-80046”]}
Saket Z, Källén K, Lundin K, Magnusson Å, Bergh C. Cumulative live birth rate after IVF: trend over time and the impact of blastocyst culture and vitrification. Hum Reprod Open. 2021;2021(3):hoab021.
Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011;26(7):1768–74.
Polyzos NP, Drakopoulos P, Parra J, Pellicer A, Santos-Ribeiro S, Tournaye H, Bosch E, Garcia-Velasco J. Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicenter multinational analysis including ∼15,000 women. Fertil Steril. 2018;110(4):661–670.e1.
Datta AK, Campbell S, Felix N, Singh JSH, Nargund G. Oocyte or embryo number needed to optimize live birth and cumulative live birth rates in mild stimulation IVF cycles. Reprod Biomed Online. 2021;43(2):223–32.
Fanton M, Cho JH, Baker VL, Loewke K. A higher number of oocytes retrieved is associated with an increase in fertilized oocytes, blastocysts, and cumulative live birth rates. Fertil Steril. 2023;119(5):762–9. https://doi.org/10.1016/j.fertnstert.2023.01.001.
Hill MJ, Richter KS, Heitmann RJ, Lewis TD, DeCherney AH, Graham JR, Widra E, Levy MJ. Number of supernumerary vitrified blastocysts is positively correlated with implantation and live birth in single-blastocyst embryo transfers. Fertil Steril. 2013;99(6):1631–6.
Funding
The study was self-funded by the authors’ institution.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zacà, C., Coticchio, G., Calesini, C. et al. Towards a more sustainable balance between optimal live birth rate and supernumerary embryos in ART treatments. J Assist Reprod Genet 41, 939–946 (2024). https://doi.org/10.1007/s10815-024-03043-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10815-024-03043-7