Number of oocytes and live births in IVF

Transcription

1 Number of oocytes and live births in IVF Dr Sesh K Sunkara MD, MRCOG Royal Marsden Hospital, London Kings Healthcare Partners (Guy s & St Thomas NHS Foundation Trust), London, UK

2 Background IVF results improved significantly since its early days 32.2% live birth rate for women < 35 years in the UK in 2010 ( Introduction of controlled ovarian stimulation (COS) regimens vital role in IVF Majority of IVF worldwide involves COS

3 Oocytes retrieved and IVF outcomes Association between number of oocytes retrieved and IVF outcomes? Fertilisation rate Oocyte quality Miscarriage rate Live birth rate Obstetric outcomes: preterm birth, low birth weight Ideal number of oocytes to Maximize success Minimize adverse outcomes

4 Egg number and fertilisation rate Retrospective study, 1,894 women Yellow: Green: Orange: Red: Low response (<4 oocytes) Optimal response (4-10 oocytes) Mild hyper response (11-20 oocytes) Severe hyper response (>20 oocytes) Kok et al., Fertil Steril. 2006

5 0 mean of fertil_rate Oocytes retrieved and fertilisation rate Fertilisation rate by egg number in IVF: HFEA data ( ) Sunkara et al., unpublished

6 0 mean of fertil_rate Oocytes retrieved and fertilisation rate Fertilisation rate by egg number in ICSI: HFEA data ( ) Sunkara et al., unpublished

7 Oocyte quantity vs quality Yellow low response (<4 oocytes) Green optimal response (4-10 oocytes) Orange mild hyper response (11-20 oocytes) Red severe hyper response (>20 oocytes) Kok et al., Fertil Steril. 2006

8 Oocyte quantity vs quality Retrospective study comparing women who developed OHSS with normal responders OHSS (n=42) Control (n=183) p value Mean number of oocytes High quality oocytes 25 ± ± 6.4 < % 85.7% <0.001 Fertilisation rate 41.6% 58.1% <0.001 Cryopreserved embryos (2PN) Aboulghar et al., Fertil Steril. 1997

9 Egg number and embryo quality Proportion of good quality embryos positively related to ovarian response (OR 1.21, 95% CI ) Yellow low response (<4 oocytes) Green optimal response (4-10 oocytes) Orange mild hyper response (11-20 oocytes) Red severe hyper response (>20 oocytes) Kok et al., Fertil Steril. 2006

10 Egg number and embryo implantation

11 Egg number and embryo implantation Simon et al., Hum Reprod. 1995

12 Egg number and miscarriage Sunkara et al., Hum Reprod. 2014

13 Egg number and miscarriage Sunkara et al., Hum Reprod. 2014

14 Egg number and live birth rate Live birth rate (%) Egg number Sunkara et al., Hum Reprod. 2011

15 Egg number and live birth rate Sunkara et al., Hum Reprod. 2011

16 Egg number and live birth rate Sunkara et al., Hum Reprod. 2011

17 Egg number and OHSS Steward et al., Fertil Steril. 2013

18 Egg number and embryo cryopreservation Retrospective study ( ), mean age of women 36 ± 4.5 years Proportion blastocyst transfers increased with egg number up to 15 eggs; no significant increase > 15 eggs Proportion of women having surplus blastocysts for freezing increased with egg number up to 18; no significant increase > 18 eggs

19 Egg number and embryo cryopreservation Vlaisavljevic et al., Advances in Embryo Transfer, In Tech. 2012

20 Egg number and obstetric outcomes Pregnancies following ART associated with higher risk low birth weight (LBW) and preterm birth (PTB) (Schieve et al., Matern Child Health J 2007; McDonald et al., Eur J Obstet Gynecol Reprod Biol 2009) Is there an association between response to ovarian stimulation and adverse obstetric outcomes

21 Egg number and obstetric outcomes

22 Predicted Risk Egg number and obstetric outcomes Response to ovarian stimulation and obstetric outcomes following IVF: analysis of 89,202 IVF birth outcomes 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Predicted Risk (Pre-term Birth) Egg Number Predicted Risk (Low birthweight) Sunkara et al., ESHRE 2014

23 Egg number and obstetric outcomes No significant increase in adverse obstetric outcomes among poor responders ( 3 oocytes) Significantly increased risk among hyper responders (> 15 oocytes) compared to normal responders PTB: OR 1.10 (CI: 1.01 to 1.20, p = 0.003) Early PTB: OR 1.32 (CI: 1.11 to 1.58, p < 0.001) LBW: OR 1.09 (CI: 1.00 to 1.20, p = 0.004) Very LBW: OR 1.16 (CI: 0.97 to 1.40, p = 0.02) Sunkara et al., ESHRE 2014

24 Conclusion Number of oocytes retrieved is an important prognostic variable in IVF Robust surrogate outcome for clinical success Non-linear association between oocyte number and live birth following IVF Useful information in planning COS regimens

25 Conclusion Increase, decrease the number of oocytes? COS regimens should aim to optimise number of oocytes Maximise oocytes retrieved in poor responders Regulate oocytes retrieved in hyper responders Ideal number: 15 oocytes Maximize live birth Minimize OHSS, adverse obstetric outcomes

26 Thank you