Determining the effect of controlled ovarian hyperstimulation with excess gonadotrophin use in IVF on cycle cancellations and pregnancy outcomes.

Despite reducing IVF cycle cancellations, increased gonadotrophin use during controlled ovarian hyperstimulation (COH) may also reduce live births, conclude US researchers.

Lubna Pal, from Albert Einstein College of Medicine in Bronx, New York, and colleagues investigated whether attempts to maximize oocyte yield improve the outcome of IVF cycles.

They studied 806 fresh non-donor cycles, examining rates of cycle cancellation, clinical pregnancy, and spontaneous miscarriage after IVF.

The average age of the women was 36.21 years, and the average dose of gonadotrophin was 3584.33 IU. Clinical pregnancy and live birth rates were 28 percent and 24 percent, respectively, per cycle started, 35 percent and 30 percent, respectively, per egg retrieval, and 37 percent and 32 percent, respectively, per embryo transfer.

For all outcomes, increasing age, regardless of ovarian reserve status, was associated with a worse prognosis.

Higher gonadotrophin use was linked to reduced cycle cancellations, at an adjusted odds ratio of 0.98 per 100 unit increase, but was also associated with a significantly reduced likelihood of clinical pregnancy and live birth, at odds ratios of 0.98 for both, and a trend towards spontaneous miscarriage.

“These associations suggest detrimental influences of excessive gonadotrophins that merit further evaluation; in the interim, based on these data, we advise moderation and caution regarding aggressive attempts at COH,” the team says.

ORGYN.com