Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth: an analysis of 256,381 in vitro fertilization cycles.
OBJECTIVE
To investigate the association between oocyte number and the rates of ovarian hyperstimulation syndrome (OHSS) and live birth (LB) in fresh autologous in vitro fertilization (IVF) cycles.


METHODS
Retrospective cohort study.


METHODS
An academic reproductive medicine practice.


METHODS
We analyzed data from 256,381 IVF cycles using the 2008-2010 Society for Assisted Reproductive Technology national registry. Patients were divided into five groups based on retrieved oocyte number.


METHODS
Rates of OHSS and LB were calculated for each group. A generalized estimating equation (GEE) was used to assess differences in OHSS and LB between groups. Receiver operating characteristic (ROC) curves were used to evaluate oocyte number as a predictor of OHSS and LB.


METHODS
None.


RESULTS
The LB rate increased up to 15 oocytes, then plateaued (0-5: 17%, 6-10: 31.7%; 11-15: 39.3%; 16-20: 42.7%; 21-25: 43.8%; and >25 oocytes: 41.8%). However, the rate of OHSS became much more clinically significant after 15 oocytes (0-5: 0.09%; 6-10: 0.37%; 11-15: 0.93%; 16-20: 1.67%; 21-25: 3.03%; and >25 oocytes: 6.34%). These trends remained after adjustment with the use of GEE. ROC curves revealed that although oocyte number is not useful in the prediction of LB, 15 retrieved oocytes is the number that best predicts OHSS risk.


CONCLUSIONS
Retrieval of >15 oocytes significantly increases OHSS risk without improving LB rate in fresh autologous IVF cycles. In general, less aggressive stimulation protocols should be considered, especially in high-responders, to optimize outcomes.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
Ryan G
RG
Steward
Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
Lan
L
Lan
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
Anish A
AA
Shah
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
Jason S
JS
Yeh
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
Thomas M
TM
Price
University Hospitals Fertility Center, Beachwood, Ohio.
James M
JM
Goldfarb
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina. Electronic address: muashersj@gmail.com.
Suheil J
SJ
Muasher
D000328:Adult; D002452:Cell Count / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D050498:Live Birth / Q000453:epidemiology*; D008875:Middle Aged; D054315:Oocyte Retrieval / Q000706:statistics & numerical data*; D009865:Oocytes / Q000473:pathology* / Q000637:transplantation; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology* / Q000473:pathology*; D011247:Pregnancy; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
Oocyte number; live birth; ovarian hyperstimulation syndrome; pregnancy