Skip to main content
Top
Published in: Reproductive Biology and Endocrinology 1/2020

01-12-2020 | ICSI | Research

Cumulative live birth rates according to the number of oocytes retrieved following the “freeze-all” strategy

Authors: Zhonghua Zhao, Hao Shi, Jing Li, Yile Zhang, Caihong Chen, Yihong Guo

Published in: Reproductive Biology and Endocrinology | Issue 1/2020

Login to get access

Abstract

Background

In recent years, some studies have shown that there is a positive association between the number of oocytes retrieved and the cumulative live birth rate (CLBR) after fresh and frozen cycles of one oocyte retrieval. However, almost no studies have examined the association between the number of oocytes retrieved and the CLBR when using the “freeze-all” strategy. We performed this study to investigate the effects of an extreme oocyte yield during the first “freeze-all” cycle on the cumulative live birth rate among patients younger than 35 years old.

Methods

This was a retrospective cohort study performed in a university-affiliated reproductive medicine centre. Data obtained from 3276 women aged younger than 35 years who underwent their first “freeze-all” cycle (IVF/ICSI) were collected between January 2009 and December 2016. In all, 5025 frozen cycles took place during the follow-up period from January 2009 to December 2018. Patients were divided into five groups according to oocytes retrieved (group 1: 4–10 oocytes; group 2: 11–20 oocytes; group 3: 21–30 oocytes; group 4: 31–40 oocytes; group 5: > 40 oocytes). The primary outcome was the cumulative live birth rate.

Results

Unadjusted results showed that the cumulative live birth rate significantly increased as the number of oocytes retrieved increased and reached up to 93.82% in cases with yields of 21–30 oocytes (P < 0.05), after which it did not have a significant increase (P > 0.05). After adjusting for confounders, our results showed that the number of oocytes retrieved is an independent positive predictor of cumulative live birth rate when using a “freeze-all” strategy. (P < 0.001). In addition, the fertilization rate and the gonadotropin dose also influenced the cumulative live birth rate (P<0.05).

Conclusions

Among women younger than 35 years old who underwent the “freeze-all” strategy, the number of oocytes retrieved positively correlated with the cumulative live birth rate. Taking both efficacy and safety into account, ovarian stimulation should be rational, and the upper limit of the oocyte yield should be no more than 30.
Literature
1.
go back to reference Zacà C, Bazzocchi A, Pennetta F, Bonu MA, Coticchio G, Borini A. Cumulative live birth rate in freeze-all cycles is comparable to that of a conventional embryo transfer policy at the cleavage stage but superior at the blastocyst stage. Fertil Steril. 2018;110:703–9.CrossRef Zacà C, Bazzocchi A, Pennetta F, Bonu MA, Coticchio G, Borini A. Cumulative live birth rate in freeze-all cycles is comparable to that of a conventional embryo transfer policy at the cleavage stage but superior at the blastocyst stage. Fertil Steril. 2018;110:703–9.CrossRef
2.
go back to reference Maheshwari A, Pandey S, Shetty A, Hamilton M, Bhattacharya S. Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis. Fertil Steril. 2012;98:368–377.e1–9.CrossRef Maheshwari A, Pandey S, Shetty A, Hamilton M, Bhattacharya S. Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis. Fertil Steril. 2012;98:368–377.e1–9.CrossRef
3.
go back to reference Blockeel C, Drakopoulos P, Santos-Ribeiro S, Polyzos NP, Tournaye H. A fresh look at the freeze-all protocol: a SWOT analysis. Hum Reprod. 2016;31:491–7.CrossRef Blockeel C, Drakopoulos P, Santos-Ribeiro S, Polyzos NP, Tournaye H. A fresh look at the freeze-all protocol: a SWOT analysis. Hum Reprod. 2016;31:491–7.CrossRef
4.
go back to reference Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S. Embryo cryopreservation rescues cycles with premature luteinization. Fertil Steril. 2010;93:636–41.CrossRef Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S. Embryo cryopreservation rescues cycles with premature luteinization. Fertil Steril. 2010;93:636–41.CrossRef
5.
go back to reference Chen ZJ, Shi Y, Sun Y, Zhang B, Liang X, Cao Y, Yang J, Liu J, Wei D, Weng N, Tian L, Hao C, Yang D, Zhou F, Shi J, Xu Y, Li J, Yan J, Qin Y, Zhao H, Zhang H, Legro RS. Fresh versus frozen embryos for infertility in the polycystic ovary syndrome. N Engl J Med. 2016;375:523–33.CrossRef Chen ZJ, Shi Y, Sun Y, Zhang B, Liang X, Cao Y, Yang J, Liu J, Wei D, Weng N, Tian L, Hao C, Yang D, Zhou F, Shi J, Xu Y, Li J, Yan J, Qin Y, Zhao H, Zhang H, Legro RS. Fresh versus frozen embryos for infertility in the polycystic ovary syndrome. N Engl J Med. 2016;375:523–33.CrossRef
6.
go back to reference Wei D, Liu JY, Sun Y, Shi Y, Zhang B, Liu JQ, Tan J, Liang X, Cao Y, Wang Z, Qin Y, Zhao H, Zhou Y, Ren H, Hao G, Ling X, Zhao J, Zhang Y, Qi X, Zhang L, Deng X, Chen X, Zhu Y, Wang X, Tian LF, Lv Q, Ma X, Zhang H, Legro RS, Chen ZJ. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial. Lancet. 2019;393:1310–8.CrossRef Wei D, Liu JY, Sun Y, Shi Y, Zhang B, Liu JQ, Tan J, Liang X, Cao Y, Wang Z, Qin Y, Zhao H, Zhou Y, Ren H, Hao G, Ling X, Zhao J, Zhang Y, Qi X, Zhang L, Deng X, Chen X, Zhu Y, Wang X, Tian LF, Lv Q, Ma X, Zhang H, Legro RS, Chen ZJ. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial. Lancet. 2019;393:1310–8.CrossRef
7.
go back to reference Roque M. Freeze-all policy: is it time for that. J Assist Reprod Genet. 2015;32:171–6.CrossRef Roque M. Freeze-all policy: is it time for that. J Assist Reprod Genet. 2015;32:171–6.CrossRef
8.
go back to reference Drakopoulos P, Blockeel C, Stoop D, Camus M, de Vos M, Tournaye H, Polyzos NP. Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos. Hum Reprod. 2016;31:370–6.PubMed Drakopoulos P, Blockeel C, Stoop D, Camus M, de Vos M, Tournaye H, Polyzos NP. Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos. Hum Reprod. 2016;31:370–6.PubMed
9.
go back to reference Fatemi HM, Doody K, Griesinger G, Witjes H, Mannaerts B. High ovarian response does not jeopardize ongoing pregnancy rates and increases cumulative pregnancy rates in a GnRH-antagonist protocol. Hum Reprod. 2013;28:442–52.CrossRef Fatemi HM, Doody K, Griesinger G, Witjes H, Mannaerts B. High ovarian response does not jeopardize ongoing pregnancy rates and increases cumulative pregnancy rates in a GnRH-antagonist protocol. Hum Reprod. 2013;28:442–52.CrossRef
10.
go back to reference Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, Fauser BC, Broekmans FJ. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update. 2009;15:5–12.CrossRef Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, Fauser BC, Broekmans FJ. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update. 2009;15:5–12.CrossRef
11.
go back to reference Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, Macklon NS, Fauser BC. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod. 2007;22:980–8.CrossRef Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, Macklon NS, Fauser BC. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod. 2007;22:980–8.CrossRef
12.
go back to reference Vaughan DA, Leung A, Resetkova N, Ruthazer R, Penzias AS, Sakkas D, Alper MM. How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach. Fertil Steril. 2017;107:397–404.e3.CrossRef Vaughan DA, Leung A, Resetkova N, Ruthazer R, Penzias AS, Sakkas D, Alper MM. How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach. Fertil Steril. 2017;107:397–404.e3.CrossRef
13.
go back to reference Ji J, Liu Y, Tong XH, Luo L, Ma J, Chen Z. The optimum number of oocytes in IVF treatment: an analysis of 2455 cycles in China. Hum Reprod. 2013;28:2728–34.CrossRef Ji J, Liu Y, Tong XH, Luo L, Ma J, Chen Z. The optimum number of oocytes in IVF treatment: an analysis of 2455 cycles in China. Hum Reprod. 2013;28:2728–34.CrossRef
14.
go back to reference Devesa M, Tur R, Rodríguez I, Coroleu B, Martínez F, Polyzos NP. Cumulative live birth rates and number of oocytes retrieved in women of advanced age. A single Centre analysis including 4500 women ≥38 years old. Hum Reprod. 2018;33:2010–7.PubMed Devesa M, Tur R, Rodríguez I, Coroleu B, Martínez F, Polyzos NP. Cumulative live birth rates and number of oocytes retrieved in women of advanced age. A single Centre analysis including 4500 women ≥38 years old. Hum Reprod. 2018;33:2010–7.PubMed
15.
go back to reference Polyzos NP, Drakopoulos P, Parra J, Pellicer A, Santos-Ribeiro S, Tournaye H, Bosch E, Garcia-Velasco J. Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicenter multinational analysis including ∼15,000 women. Fertil Steril. 2018;110:661–670.e1.CrossRef Polyzos NP, Drakopoulos P, Parra J, Pellicer A, Santos-Ribeiro S, Tournaye H, Bosch E, Garcia-Velasco J. Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicenter multinational analysis including ∼15,000 women. Fertil Steril. 2018;110:661–670.e1.CrossRef
16.
go back to reference Magnusson Å, Källen K, Thurin-Kjellberg A, Bergh C. The number of oocytes retrieved during IVF: a balance between efficacy and safety. Hum Reprod. 2018;33:58–64.CrossRef Magnusson Å, Källen K, Thurin-Kjellberg A, Bergh C. The number of oocytes retrieved during IVF: a balance between efficacy and safety. Hum Reprod. 2018;33:58–64.CrossRef
17.
go back to reference Chen YH, Wang Q, Zhang YN, Han X, Li DH, Zhang CL. Cumulative live birth and surplus embryo incidence after frozen-thaw cycles in PCOS: how many oocytes do we need. J Assist Reprod Genet. 2017;34:1153–9.CrossRef Chen YH, Wang Q, Zhang YN, Han X, Li DH, Zhang CL. Cumulative live birth and surplus embryo incidence after frozen-thaw cycles in PCOS: how many oocytes do we need. J Assist Reprod Genet. 2017;34:1153–9.CrossRef
18.
go back to reference Law YJ, Zhang N, Venetis CA, Chambers GM, Harris K. The number of oocytes associated with maximum cumulative live birth rates per aspiration depends on female age: a population study of 221 221 treatment cycles. Hum Reprod. 2019;34:1778–87.CrossRef Law YJ, Zhang N, Venetis CA, Chambers GM, Harris K. The number of oocytes associated with maximum cumulative live birth rates per aspiration depends on female age: a population study of 221 221 treatment cycles. Hum Reprod. 2019;34:1778–87.CrossRef
19.
go back to reference Papanikolaou E, Chartomatsidou T, Timotheou E, Tatsi P, Katsoula E, Vlachou C, Asouchidou I, Zafeiratis O, Najdecki R. In freeze-all strategy, cumulative live birth rate (CLBR) is increasing according to the number of blastocysts formed in women <40 undergoing Intracytoplasmic sperm injection (ICSI). Front Endocrinol (Lausanne). 2019;10:427.CrossRef Papanikolaou E, Chartomatsidou T, Timotheou E, Tatsi P, Katsoula E, Vlachou C, Asouchidou I, Zafeiratis O, Najdecki R. In freeze-all strategy, cumulative live birth rate (CLBR) is increasing according to the number of blastocysts formed in women <40 undergoing Intracytoplasmic sperm injection (ICSI). Front Endocrinol (Lausanne). 2019;10:427.CrossRef
20.
go back to reference Zhu Q, Chen Q, Wang L, Lu X, Lyu Q, Wang Y, Kuang Y. Live birth rates in the first complete IVF cycle among 20 687 women using a freeze-all strategy. Hum Reprod. 2018;33:924–9.CrossRef Zhu Q, Chen Q, Wang L, Lu X, Lyu Q, Wang Y, Kuang Y. Live birth rates in the first complete IVF cycle among 20 687 women using a freeze-all strategy. Hum Reprod. 2018;33:924–9.CrossRef
21.
go back to reference Malizia BA, Hacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. N Engl J Med. 2009;360:236–43.CrossRef Malizia BA, Hacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. N Engl J Med. 2009;360:236–43.CrossRef
22.
go back to reference Sharma V, Allgar V, Rajkhowa M. Factors influencing the cumulative conception rate and discontinuation of in vitro fertilization treatment for infertility. Fertil Steril. 2002;78:40–6.CrossRef Sharma V, Allgar V, Rajkhowa M. Factors influencing the cumulative conception rate and discontinuation of in vitro fertilization treatment for infertility. Fertil Steril. 2002;78:40–6.CrossRef
Metadata
Title
Cumulative live birth rates according to the number of oocytes retrieved following the “freeze-all” strategy
Authors
Zhonghua Zhao
Hao Shi
Jing Li
Yile Zhang
Caihong Chen
Yihong Guo
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Reproductive Biology and Endocrinology / Issue 1/2020
Electronic ISSN: 1477-7827
DOI
https://doi.org/10.1186/s12958-020-00574-3

Other articles of this Issue 1/2020

Reproductive Biology and Endocrinology 1/2020 Go to the issue