title: Can you ever collect too many oocytes?
abstract: OBJECTIVE
  Does the chance of pregnancy keep improving with increasing number of oocytes, or can you collect too many?
  
  
  CONCLUSIONS
  Clinical pregnancy (CP) and live birth (LB) rates per embryo transfer varied from 10.2 and 9.2% following one oocyte collected to 37.7 and 31.3% when >16 oocytes were collected. Regression modelling indicated success rates increased or at least stayed the same with number of oocytes collected.
  
  
  BACKGROUND
  It has been suggested that if >15 oocytes are collected, the success rate for fresh embryo transfers decreases. As this is counterintuitive, as more oocytes should result in more embryos, with a better choice of quality embryos, we decided to analyse the recent experience in a busy IVF unit.
  
  
  METHODS
  A retrospective analysis of clinical pregnancy and live birth outcome, with respect to number of oocytes collected at Monash IVF for the 2-year period between August 2010 and July 2012, where patients under the age of 45 years underwent a fresh embryo transfer. This included 7697 stimulated cycles for IVF and ICSI.
  
  
  METHODS
  Statistical analysis involved data tables and graphs comparing oocyte number with outcome. Results of women who had their first oocyte collection with an embryo transfer within the reference period were analysed by logistic regression analysis including other covariates that might influence pregnancy outcome. Analysis was also carried out of all the 7679 oocyte collections undertaken, resulting in fresh embryo transfers by generalized estimating equations to allow for the within subject correlation in outcomes for repeated treatments.
  
  
  RESULTS
  The number of oocytes collected varied from 1 to 48. Clinical pregnancy and live birth rates per embryo transfer varied from 10.2 and 9.2% when only one oocyte was collected to 37.7 and 31.3% when >16 oocytes were collected. Regression modelling indicated success rates increased or at least stayed the same or with the number of oocytes collected. The percentage of women with embryos cryopreserved increased from under 20% with <4 oocytes collected to over 70% with >16 oocytes collected. There was a slight increase (from 18 to 22%) in oocyte immaturity and a more marked increase (from 0 to 3%) in cancelling fresh transfers to prevent Ovarian Hyperstimulation Syndrome (OHSS) with increase in number of oocytes collected above 16. The results of this study suggest that you cannot collect too many oocytes as both clinical pregnancy and live birth rates do not decrease with high numbers of oocytes collected. However, once >15 oocytes are collected, everything gets quite uncertain.
  
  
  CONCLUSIONS
  As the data become sparse above 15 oocytes, we could not demonstrate a significant increase in pregnancy rates above this number. Larger studies would be required to answer the question whether there is a plateau, or rates continue to increase. The negative of aggressive stimulation to produce many oocytes is that the risk of OHSS increases, and this is the most serious complication of ovarian stimulation.
  
  
  BACKGROUND
  No funding was required. There is no conflict of interest, except that G.K., V.M. and C.M. are shareholders in Monash IVF Pty Ltd.
authors.affiliation: Medical School, University of Edinburgh, Edinburgh, UK.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Briggs
authors.affiliation: Monash IVF, Richmond, VIC 3121, Australia gkovacs@monashivf.com.
authors.forename: Gabor
authors.initials: G
authors.lastname: Kovacs
authors.affiliation: Monash IVF, Richmond, VIC 3121, Australia.
authors.forename: Vivien
authors.initials: V
authors.lastname: MacLachlan
authors.affiliation: Monash IVF, Richmond, VIC 3121, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Motteram
authors.affiliation: University of Melbourne, Carlton, VIC, Australia.
authors.forename: H W Gordon
authors.initials: HW
authors.lastname: Baker
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D054315:Oocyte Retrieval; D011247:Pregnancy; D011256:Pregnancy Outcome; D012044:Regression Analysis; D012189:Retrospective Studies
keywords: oocyte numbers; ovarian stimulation; pregnancy rate