title: Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA. lubnapal@hotmail.com
authors.forename: Lubna
authors.initials: L
authors.lastname: Pal
authors.forename: Sangita
authors.initials: S
authors.lastname: Jindal
authors.forename: Barry R
authors.initials: BR
authors.lastname: Witt
authors.forename: Nanette
authors.initials: N
authors.lastname: Santoro
mesh_terms: 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
chemical_list: D006062:Gonadotropins; D004958:Estradiol; D005640:Follicle Stimulating Hormone