title: Gonadotropin stimulation demonstrates a ceiling effect on in vitro fertilization outcomes.
abstract: OBJECTIVE
  To determine the effect of number of oocytes retrieved and number of 2PN embryos developed on in vitro fertilization (IVF) outcomes.
  
  
  METHODS
  Retrospective data analysis.
  
  
  METHODS
  University practice.
  
  
  METHODS
  Reproductive-aged women (n = 467).
  
  
  METHODS
  First fresh nondonor cycle of IVF.
  
  
  METHODS
  Clinical pregnancy rate
  
  
  RESULTS
  Clinical pregnancy rates increase until age 30 (odds ratio (OR) 1.72 per year (95% confidence interval 1.19-2.49)) before demonstrating a linear decline. In subjects < 37 years old, maximal clinical pregnancy rates are seen when 20 oocytes were retrieved (OR 1.03 (0.96-1.11)), five 2-pronuclei (2PN) embryos developed (OR 1.91 (1.29-2.87)), and no more than two embryos transferred (OR 0.72 (0.56-0.92) for each additional embryo transferred > 2). In subjects > or = 37 years old, maximum clinical pregnancy rates were achieved in subjects who had ten oocytes retrieved (OR 1.09 (1.01-1.18)), 20 2PN embryos developed (OR 1.29 (1.03-1.62)), and no more than two embryos transferred (OR 0.72 (0.56-0.92) for each additional embryo transferred > 2).
  
  
  CONCLUSIONS
  The odds of achieving a successful clinical pregnancy with IVF are greatest with retrieval of approximately 20 oocytes, transfer of no more than 2 embryos, and the development of about five 2PN embryos in women < 37 years old and ten 2PN embryos in women > or = 37 years old.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA. danielle.lane@kp.org
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Lane
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Mary S
authors.initials: MS
authors.lastname: Croughan
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000706:statistics & numerical data*; D006062:Gonadotropins / Q000008:administration & dosage*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010053:Ovary / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006062:Gonadotropins