Skip to main content
SpringerLink
Log in

Association between the number of oocytes retrieved and cumulative live birth rate in women aged 35–40 years undergoing long GnRH agonist IVF/ICSI cycles

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To study the association between the numbers of oocytes retrieved and the cumulative live birth rates (LBR) in women aged 35–40 years undergoing long GnRH agonist IVF/ICSI cycles.

Methods

A total of 931 women aged 35–40 years who underwent their first cycle of IVF/ICSI treatment between January 2010 and December 2013 at Nanjing Drum Tower Hospital were identified and reviewed. The main endpoint of this study was the cumulative LBR after one complete oocyte retrieval, which included fresh and all subsequent frozen–thaw embryo transfer cycles. Odds ratios (OR) and 95% confidence interval (CI) for live birth were estimated by multivariate logistic regression analysis. Furthermore, all the women were divided into four groups based on the number of oocytes retrieved: 0–4, 5–9, 10–14 or ≥15 oocytes group. Variables were then compared among groups.

Results

We found that 634 out of the 931 patients (68.1%) achieved at least one live birth. The number of oocytes retrieved was an independent predictive factor for live birth, with OR 1.20 (95% CI 1.15–1.26) when adjusted for age (years), duration of infertility and Gn (gonadotrophin) doses. The cumulative LBR in the four different oocyte groups was 35.6, 68.8, 83.4 and 89.2%, respectively. When the 1–4 oocytes group was issued as a reference, the ORs for cumulative LBR gradually increased to 3.66, 6.74 and 11.77 in other three oocytes groups, respectively. The moderate–severe ovarian hyperstimulation syndrome (OHSS) rate was dramatically increased in the ≥15 oocytes group (6.9%) when compared to that in the 10–14 oocytes group (0.8%), while the cumulative LBR only increased 5.8% (from 83.4 to 89.2%).

Conclusions

The ideal number of oocytes retrieved in women aged 35–40 years is 10–14 oocytes, which achieves a high cumulative LBR while maintaining an acceptable low OHSS rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Germond M, Primi MP, Urner F, Chanson A, Wirthner D, Senn A (2004) Number of transferred embryos: how to reduce multiple pregnancies. Ann N Y Acad Sci 1034:93–100. doi:10.1196/annals.1335.011

    Article  PubMed  Google Scholar 

  2. van der Gaast MH, Eijkemans MJ, van der Net JB, de Boer EJ, Burger CW, van Leeuwen FE (2006) Optimum number of oocytes for a successful first IVF treatment cycle. Reprod Biomed Online 13(4):476–480

    Article  PubMed  Google Scholar 

  3. Chen YH, Xu XH, Wang Q, Zhang SD, Jiang LL, Zhang CL, Ge ZJ (2015) Optimum oocyte retrieved and transfer strategy in young women with normal ovarian reserve undergoing a long treatment protocol: a retrospective cohort study. J Assist Reprod Genet 32(10):1459–1467. doi:10.1007/s10815-015-0571-6

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ji J, Liu Y, Tong XH, Luo L, Ma J, Chen Z (2013) The optimum number of oocytes in IVF treatment: an analysis of 2455 cycles in China. Hum Reprod 28(10):2728–2734. doi:10.1093/humrep/det303

    Article  PubMed  Google Scholar 

  5. Drakopoulos P, Blockeel C, Stoop D, Camus M, de Vos M, Tournaye H (2016) Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos? Hum Reprod 31(2):370–376. doi:10.1093/humrep/dev316

    PubMed  Google Scholar 

  6. Demko ZP, Simon AL, McCoy RC, Petrov DA, Rabinowitz M (2016) Effects of maternal age on euploidy rates in a large cohort of embryos analyzed with 24-chromosome single-nucleotide polymorphism-based preimplantation genetic screening. Fertil Steril 105(5):1307–1313. doi:10.1016/j.fertnstert.2016.01.025

    Article  CAS  PubMed  Google Scholar 

  7. Spandorfer SD, Chung PH, Kligman I, Liu HC, Davis OK, Rosenwaks Z (2000) An analysis of the effect of age on implantation rates. J Assist Reprod Genet 17(6):303–306

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Garrido N, Bellver J, Remohí J, Simón C, Pellicer A (2011) Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success. Fertil Steril 96(1):40–46. doi:10.1016/j.fertnstert.2011.05.008

    Article  PubMed  Google Scholar 

  9. Templeton A, Morris JK, Parslow W (1996) Factors that affect outcome of in vitro fertilisation treatment. Lancet 348(9039):1402–1406. doi:10.1016/S0140-6736(96)05291-9

    Article  CAS  PubMed  Google Scholar 

  10. Committee on Gynecologic Practice (2015) Committee opinion no. 618: ovarian reserve testing. Obstet Gynecol 125(1):268–273. doi:10.1097/01.AOG.0000459864.68372.ec

    Article  Google Scholar 

  11. Vuong TN, Phung HT, Ho MT (2015) Recombinant follicle-stimulating hormone and recombinant luteinizing hormone versus recombinant follicle-stimulating hormone alone during GnRH antagonist ovarian stimulation in patients aged ≥35 years: a randomized controlled trial. Hum Reprod 30(5):1188–1195. doi:10.1093/humrep/dev038

    Article  CAS  PubMed  Google Scholar 

  12. Ashrafi M, Bahmanabadi A, Akhond MR, Arabipoor A (2015) Predictive factors of early moderate/severe ovarian hyperstimulation syndrome in non-polycystic ovarian syndrome patients: a statistical model. Arch Gynecol Obs 292(5):1145–1152. doi:10.1007/s00404-015-3723-0

    Article  CAS  Google Scholar 

  13. Maheshwari A, McLernon D, Bhattacharya S (2015) Cumulative live birth rate: time for a consensus? Hum Reprod 30(12):2703–2707. doi:10.1093/humrep/dev263

    PubMed  Google Scholar 

  14. Golan A, Ron-el R, Herman A, Soffer Y, Weinraub Z, Caspi E (1989) Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv 44(6):430–440

    Article  CAS  PubMed  Google Scholar 

  15. Zhou J, Wang S, Wang B, Wang J, Chen H, Zhang N, Hu Y, Sun H (2015) The value of HCG serum concentrations after trigger in predicting pregnancy and live birth rates in IVF–ICSI. Reprod Biomed Online 30(6):667–673. doi:10.1016/j.rbmo.2015.02.013

    Article  CAS  PubMed  Google Scholar 

  16. Ding LJ, Wang B, Shen XY, Yan GJ, Zhang NY, Hu YL, Sun H (2013) Withdrawal of GnRH agonist decreases oestradiol and VEGF concentrations in high responders. Reprod Biomed Online 27(2):131–139. doi:10.1016/j.rbmo.2013.04.014

    Article  CAS  PubMed  Google Scholar 

  17. Van Landuyt L, Verpoest W, Verheyen G, De Vos A, Van de Velde H, Liebaers I (2011) Closed blastocyst vitrification of biopsied embryos: evaluation of 100 consecutive warming cycles. Hum Reprod 26(2):316–322. doi:10.1093/humrep/deq338

    Article  PubMed  Google Scholar 

  18. Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology (2011) The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod 26(6):1270–1283. doi:10.1093/humrep/der037

    Article  Google Scholar 

  19. Abuzeid MI, Bolonduro O, La Chance J, Abozaid T, Urich M, Ullah K, Ali T, Ashraf M, Khan I (2014) Cumulative live birth rate and assisted reproduction: impact of female age and transfer day. Facts Views Vis Obgyn. 6(3):145–149

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Wu CH, Lee TH, Chen HH, Chen CI, Huang CC, Lee MS (2015) The influence of female age on the cumulative live-birth rate of fresh cycles and subsequent frozen cycles using vitrified blastocysts in hyper-responders. Taiwan J Obstet Gynecol 54(5):567–571. doi:10.1016/j.tjog.2015.08.009

    Article  PubMed  Google Scholar 

  21. Toftager M, Bogstad J, Løssl K, Prætorius L, Zedeler A, Bryndorf T, Nilas L, Pinborg A (2017) Cumulative live birth rates after one ART cycle including all subsequent frozen–thaw cycles in 1050 women: secondary outcome of an RCT comparing GnRH-antagonist and GnRH-agonist protocols. Hum Reprod 32(3):556–567. doi:10.1093/humrep/dew358

    CAS  PubMed  Google Scholar 

  22. De Vos A, Van Landuyt L, Santos-Ribeiro S, Camus M, Van de Velde H, Tournaye H, Verheyen G (2016) Cumulative live birth rates after fresh and vitrified cleavage-stage versus blastocyst-stage embryo transfer in the first treatment cycle. Hum Reprod 31(11):2442–2449. doi:10.1093/humrep/dew219

    Article  PubMed  Google Scholar 

  23. Hornstein MD (2016) State of the ART: assisted reproductive technologies in the US. Reprod Sci 23(12):1630–1633. doi:10.1177/1933719116667227

    Article  PubMed  Google Scholar 

  24. Sunkara SK, Khalaf Y, Maheshwari A, Seed P, Coomarasamy A (2014) Association between response to ovarian stimulation and miscarriage following IVF: an analysis of 124 351 IVF pregnancies. Hum Reprod 29(6):1218–1224. doi:10.1093/humrep/deu053

    Article  PubMed  Google Scholar 

  25. Tigges J, Godehardt E, Soepenberg T, Maxrath B, Friol K, Gnoth C (2016) Determinants of cumulative ART live-birth rates in a single-center study: age, fertilization modality, and first-cycle outcome. Arch Gynecol Obstet 294(5):1081–1089. doi:10.1007/s00404-016-4162-2

    Article  PubMed  Google Scholar 

  26. Du XF, Yang XH, Li J, Hao M, Guo YH (2016) Growth hormone co-treatment within a GnRH agonist long protocol improves implantation and pregnancy rates in patients undergoing IVF-ET. Arch Gynecol Obstet 294(4):877–883. doi:10.1007/s00404-016-4163-1

    Article  CAS  PubMed  Google Scholar 

  27. Tannus S, Turki R, Cohen Y, Son WY, Shavit T, Dahan MH (2017) Reproductive outcomes after a single dose of gonadotropin-releasing hormone agonist compared with human chorionic gonadotropin for the induction of final oocyte maturation in hyper-responder women aged 35–40 years. Fertil Steril 107(6):1323–1328.e2. doi:10.1016/j.fertnstert.2017.04.014

  28. Vlaisavljević V, Kovačič B, Knez J (2017) Cumulative live birth rate after GnRH agonist trigger and elective cryopreservation of all embryos in high responders. Reprod Biomed Online S1472–6483(17):30151–30157. doi:10.1016/j.rbmo.2017.03.017

    Google Scholar 

  29. Verwoerd GR, Mathews T, Brinsden PR (2008) Optimal follicle and oocyte numbers for cryopreservation of all embryos in IVF cycles at risk of OHSS. Reprod Biomed Online 17(3):312–317

    Article  PubMed  Google Scholar 

  30. Reljic M, Vlaisavljević V, Gavrić V, Kovacic B (1999) Number of oocytes retrieved and resulting pregnancy. Risk factors for ovarian hyperstimulation syndrome. J Reprod Med 44(8):713–718

    CAS  PubMed  Google Scholar 

  31. Steward RG, Lan L, Shah AA, Yeh JS, Price TM, Goldfarb JM, Muasher SJ (2014) Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth: an analysis of 256,381 in vitro fertilization cycles. Fertil Steril 101(4):967–973. doi:10.1016/j.fertnstert.2013.12.026

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Centre for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan North Road 53, Nanjing, 210008, China

      Jianjun Zhou, Bin Wang, Yali Hu & Haixiang Sun

    Authors
    1. Jianjun Zhou
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Bin Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Yali Hu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Haixiang Sun
      View author publications

      You can also search for this author in PubMed Google Scholar

    Contributions

    ZJJ: data management/analysis, manuscript writing/editing, WB: manuscript writing/editing, HYL: study design, data collection, manuscript editing, SHX: study design, data management/analysis, manuscript writing/editing.

    Corresponding author

    Correspondence to Haixiang Sun.

    Ethics declarations

    Funding

    This study was supported by Chinese National Natural Science Foundation (81571504, 81200450), Nanjing Medical Science and technique Development Foundation (QRX11166), Maternal and fetus medicine Key Lab of Jiangsu Province (XK 201102,BL2014003).

    Conflict of interest

    Authors declare no conflict of interest with respect to the authorship and/or publication of this article.

    Ethical approval

    All procedures performed in this study involving human participants were in accordance with the ethical standards of the Nanjing Drum Tower Hospital Research Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Jianjun Zhou and Bin Wang contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhou, J., Wang, B., Hu, Y. et al. Association between the number of oocytes retrieved and cumulative live birth rate in women aged 35–40 years undergoing long GnRH agonist IVF/ICSI cycles. Arch Gynecol Obstet 296, 1005–1012 (2017). https://doi.org/10.1007/s00404-017-4503-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00404-017-4503-9

    Keywords

    Search

    Navigation