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Live birth rates in in vitro fertilization cycles with five or fewer follicles

  • Assisted Reproduction Technologies
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Abstract

Purpose

To evaluate live birth rates (LBRs) for in vitro fertilization (IVF) cycles with ≤5 follicles at trigger, with the goal of helping patients with low follicle counts decide whether to proceed to retrieval.

Methods

This is a retrospective cohort study from an urban, university-affiliated fertility center. All IVF cycles that yielded <10 oocytes between 2016 and 2020 were reviewed. Cycles were included if <5 follicles measuring >14 mm were verified on trigger day. The primary outcome was LBR per retrieval after fresh or frozen transfer. Secondary outcomes were number of oocytes, mature oocytes, 2-pronuclear zygotes (2-PNs), blastocysts for transfer/biopsy, and euploid blastocysts (if preimplantation genetic testing for aneuploidy (PGT-A) was used).

Results

1502 cycles (900 with PGT-A) from 972 patients were included. Mean number of oocytes, mature oocytes, 2-PNs, blastocysts for transfer/biopsy, and euploid blastocysts differed by follicle number (p < 0.001). Across all age groups, there were differences in LBR associated with follicle number (p < 0.001). However, within age groups, not all results were significant. For example, for patients <35 years, LBR did not differ by follicle number and among patients 35–37 years; LBR with two or three follicles was lower than with five (p < 0.02). LBR for patients 35–40 years was <20% with 1–3 follicles and 25–40% with 4–5 follicles. LBR for patients >41 years was <5% with 1–3 follicles and <15% with 4–5 follicles.

Conclusion

As expected, LBR is higher with more follicles. Providing patients with <5 follicles with specific data can help them weigh the emotional, physical, and financial costs of retrieval.

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Data availability

Data for this study can be made available upon request.

References

  1. Peipert BJ, Montoya MN, Bedrick BS, Seifer DB, Jain T. Impact of in vitro fertilization state mandates for third party insurance coverage in the United States: a review and critical assessment. Reprod Biol Endocrinol. 2022;20:111.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Klinkert ER, Broekmans FJ, Looman CW, Te Velde ER. A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles. Fertil Steril. 2004;81:1247–53.

    Article  PubMed  Google Scholar 

  3. Biljan MM, Buckett WM, Dean N, Phillips SJ, Tan SL. The outcome of IVF-embryo transfer treatment in patients who develop three follicles or less. Hum Reprod. 2000;15:2140–4.

    Article  PubMed  CAS  Google Scholar 

  4. Shrem G, Salmon-Divon M, Mahfoudh AM, Balayla J, Volodarsky-Perel A, Henderson S, et al. Influence of maternal age and ovarian reserve on the decision to continue or to cancel IVF cycles in patients with one or two large follicles: a dual effect. Reprod Sci. 2022;29:291–300.

    Article  PubMed  Google Scholar 

  5. Reichman DE, Gunnala V, Meyer L, Spandorfer S, Schattman G, Davis OK, et al. In vitro fertilization versus conversion to intrauterine insemination in the setting of three or fewer follicles: how should patients proceed when follicular response falls short of expectation? Fertil Steril. 2013;100:94–9.

    Article  PubMed  Google Scholar 

  6. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26:1616–24.

    Article  PubMed  CAS  Google Scholar 

  7. Cohen Y, Tannus S, Alzawawi N, Son WY, Dahan M, Buckett W. Poor ovarian response as a predictor for live birth in older women undergoing IVF. Reprod Biomed Online. 2018;36:435–41.

    Article  PubMed  Google Scholar 

  8. Poseidon Group (Patient-Oriented Strategies Encompassing Individualized Oocyte Number), Alviggi C, Andersen CY, Buehler K, Conforti A, De Placido G, et al. A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Fertil Steril. 2016;105:1452–3.

    Article  Google Scholar 

  9. Barnhart KT. Live birth is the correct outcome for clinical trials evaluating therapy for the infertile couple. Fertil Steril. 2014;101:1205–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. NYU Langone Fertility Center preliminary clinic summary report. Society for Assisted Reproductive Technology. 2021. https://sartcorsonline.com/Csr/PublicSnapshotReport?ClinicPKID=1895&reportingYear=2021&fromDisclaimer=true. Accessed 1 Sept 2023.

  11. Roberts SA, Wilkinson J, Vail A, Brison DR. Does PGT-A improve assisted reproduction treatment success rates: what can the UK Register data tell us? J Assist Reprod Genet. 2022;39:2547–54.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kucherov A, Fazzari M, Lieman H, Ball GD, Doody K, Jindal S. PGT-A is associated with reduced cumulative live birth rate in first reported IVF stimulation cycles age ≤ 40: an analysis of 133,494 autologous cycles reported to SART CORS. J Assist Reprod Genet. 2023;40:137–49.

    Article  PubMed  Google Scholar 

  13. Munné S, Kaplan B, Frattarelli JL, Child T, Nakhuda G, Shamma FN, Silverberg K, Kalista T, Handyside AH, Katz-Jaffe M, Wells D, Gordon T, Stock-Myer S, Willman S, STAR Study Group. Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good-prognosis patients: a multicenter randomized clinical trial. Fertil Steril. 2019;112:1071-1079.e7.

    Article  PubMed  Google Scholar 

  14. Fujii DT, Quesnell JL, Heitmann RJ. Conversion to IUI versus continuance with IVF in low responder patients: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2018;227:35–40.

    Article  PubMed  Google Scholar 

  15. Shahine LK, Lathi RB, Baker VL. Oocyte retrieval versus conversion to intrauterine insemination in patients with poor response to gonadotropin therapy. Fertil Steril. 2009;92:1315–7.

    Article  PubMed  CAS  Google Scholar 

  16. Delbos L, Parot-Schinkel E, El Hachem H, Legendre G, Descamps P, Boucret L, et al. ConFIRM trial – conversion of in vitro fertilization cycles to intrauterine inseminations in patients with a poor ovarian response to stimulation: a protocol for a multicentric, prospective randomized trial. Trials. 2018;19:565.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. New York University Langone Health, Grossman School of Medicine, 462 First Avenue, Ninth Floor, New York, NY, 10016, USA

    Michelle J. Bayefsky

  2. New York University Langone Prelude Fertility Center, 159 East 53rd Street, 3rd Floor, New York, NY, 10022, USA

    Sarah D. Cascante, David H. McCulloh & Jennifer K. Blakemore

  3. Gameto, Inc., 286 Madison Ave, New York, NY, 10017, USA

    David H. McCulloh

Authors
  1. Michelle J. Bayefsky
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  2. Sarah D. Cascante
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  3. David H. McCulloh
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  4. Jennifer K. Blakemore
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Corresponding author

Correspondence to Michelle J. Bayefsky.

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Conflict of interest

Dr. McCulloh has the following conflicts of interest: Director at Biogenetics Laboratory in Mountainside, NJ; Director at the Sperm and Embryo Bank of New York in New York, NY; Director at Biogenetics Laboratory in Brooklyn, NY; Director of Clinical Science at ReproART: the Georgian-American Center for Reproductive Medicine in Tblilis, Georgia; consulting services through McCulloh Associates in Port Washington, NY; recent Scientific Advisory Board member of GranataBio in Duxbury, MA. The other authors of this study have no conflicts of interest to report.

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Bayefsky, M.J., Cascante, S.D., McCulloh, D.H. et al. Live birth rates in in vitro fertilization cycles with five or fewer follicles. J Assist Reprod Genet 41, 223–229 (2024). https://doi.org/10.1007/s10815-023-02985-8

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  • DOI: https://doi.org/10.1007/s10815-023-02985-8

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