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
Background IVF results improved significantly since its early days 32.2% live birth rate for women < 35 years in the UK in 2010 (http://www.hfea.gov.uk/ivf-success-rate.html) Introduction of controlled ovarian stimulation (COS) regimens vital role in IVF Majority of IVF worldwide involves COS
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
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
0 mean of fertil_rate.2.4.6.8 Oocytes retrieved and fertilisation rate Fertilisation rate by egg number in IVF: HFEA data (2000-2008) 1 2 3 4 5 6 7 8 910111213141516171819202122232425262728293031323334353637383940 Sunkara et al., unpublished
0 mean of fertil_rate.2.4.6.8 Oocytes retrieved and fertilisation rate Fertilisation rate by egg number in ICSI: HFEA data (2000-2008) 1 2 3 4 5 6 7 8 910111213141516171819202122232425262728293031323334353637383940 Sunkara et al., unpublished
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
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 ± 8.5 12.9 ± 6.4 <0.001 63.9% 85.7% <0.001 Fertilisation rate 41.6% 58.1% <0.001 Cryopreserved embryos (2PN) 234 522 Aboulghar et al., Fertil Steril. 1997
Egg number and embryo quality Proportion of good quality embryos positively related to ovarian response (OR 1.21, 95% CI 1.07-1.37) 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
Egg number and embryo implantation
Egg number and embryo implantation Simon et al., Hum Reprod. 1995
Egg number and miscarriage Sunkara et al., Hum Reprod. 2014
Egg number and miscarriage Sunkara et al., Hum Reprod. 2014
Egg number and live birth rate 40 30 Live birth rate (%) 20 10 0 1 5 10 15 20 25 30 35 40 Egg number Sunkara et al., Hum Reprod. 2011
Egg number and live birth rate Sunkara et al., Hum Reprod. 2011
Egg number and live birth rate Sunkara et al., Hum Reprod. 2011
Egg number and OHSS Steward et al., Fertil Steril. 2013
Egg number and embryo cryopreservation Retrospective study (2004-2009), 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
Egg number and embryo cryopreservation Vlaisavljevic et al., Advances in Embryo Transfer, In Tech. 2012
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
Egg number and obstetric outcomes
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% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Predicted Risk (Pre-term Birth) Egg Number Predicted Risk (Low birthweight) Sunkara et al., ESHRE 2014
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
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
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
Thank you