Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization.
OBJECTIVE
To determine if attempts to maximize oocyte yield during ovarian stimulation translates into improved outcome of in vitro fertilization (IVF) cycles.


METHODS
Retrospective study.


METHODS
Academic tertiary care IVF center.


METHODS
806 de-identified nondonor IVF cycles.


METHODS
Evaluation of fresh nondonor IVF cycles (n = 806) for the period January 1, 1999, to December 30, 2001.


METHODS
Cycle cancellation, clinical pregnancy, spontaneous miscarriage, and live birth after IVF.


RESULTS
Advancing age, independent of ovarian reserve status (reflected by early follicular phase FSH and estradiol) augured a worse prognosis for all outcomes. Higher gonadotropin use lowered cycle cancellations but was associated with a statistically significantly reduced likelihood of clinical pregnancy and live birth and a trend toward a higher likelihood for spontaneous miscarriage after IVF.


CONCLUSIONS
Our data add to the accruing literature suggesting adverse influences of excess gonadotropin use on IVF outcomes. Although an aggressive approach to controlled ovarian hyperstimulation results in a statistically significant reduction in cycle cancellations, the excessive use of gonadotropins detrimentally influences live birth after IVF.
Pal
Lubna
L
Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA. lubnapal@hotmail.com
Jindal
Sangita
S
Witt
Barry R
BR
Santoro
Nanette
N
D000328:Adult; D015925:Cryopreservation; D004305:Dose-Response Relationship, Drug; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006062:Gonadotropins / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D054315:Oocyte Retrieval; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome
D006062:Gonadotropins; D004958:Estradiol; D005640:Follicle Stimulating Hormone