Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization
Received 2 February 2007; received in revised form 29 May 2007; accepted 29 May 2007. published online 28 April 2008.
Objective
To determine if attempts to maximize oocyte yield during ovarian stimulation translates into improved outcome of in vitro fertilization (IVF) cycles.
Design
Retrospective study.
Setting
Academic tertiary care IVF center.
Patient(s)
806 de-identified nondonor IVF cycles.
Intervention(s)
Evaluation of fresh nondonor IVF cycles (n = 806) for the period January 1, 1999, to December 30, 2001.
Main Outcome Measure(s)
Cycle cancellation, clinical pregnancy, spontaneous miscarriage, and live birth after IVF.
Result(s)
Advancing age, independent of ovarian reserve status (reflected by early follicular phase FSH and estradiol) augured a worse prognosis for all outcomes. Higher gonadotropin use lowered cycle cancellations but was associated with a statistically significantly reduced likelihood of clinical pregnancy and live birth and a trend toward a higher likelihood for spontaneous miscarriage after IVF.
Conclusion(s)
Our data add to the accruing literature suggesting adverse influences of excess gonadotropin use on IVF outcomes. Although an aggressive approach to controlled ovarian hyperstimulation results in a statistically significant reduction in cycle cancellations, the excessive use of gonadotropins detrimentally influences live birth after IVF.
aDepartment of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
bDepartment of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
Reprint requests: Lubna Pal, M.B.B.S., M.R.C.O.G., M.S., Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 300 George Street, New Haven, Connecticut 06520. (FAX: 203-785-7134).
Supported in part by National Institutes of Health K12 (to L.P.).
The current address for Lubna Pal, M.B.B.S., M.R.C.O.G., M.S., is Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
ABSTRACT