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Total follicle stimulating hormone dose is negatively correlated with live births in a donor/recipient model with fresh transfer: an analysis of 8,627 cycles from the Society for Assisted Reproductive Technology Registry

      Objective

      Oocyte donation has optimized our understanding of ovarian stimulation. Increasing the follicle-stimulating hormone (FSH) dose has been shown to adversely affect live birth rates in autologous cycles. Our objective is to assess whether this relationship holds true within the donor/recipient population.

      Design

      Retrospective cohort study.

      Setting

      Not applicable.

      Patients

      Data from 2014−2016 included 8,627 fresh donor cycles.

      Interventions

      None.

      Main outcome measures

      Live birth, clinical pregnancy, and miscarriage rates.

      Results

      The mean donor age ± standard deviation (SD) was 25.8 ± 2.8 years. Donors underwent a median of 16 days (interquartile range [IQR] 12, 19) of stimulation with a median (IQR) total FSH dose and daily dose of 2,350.0 (1,800.0, 3,025.0) and 153.8 (113.2, 205.0) IU, respectively. The live birth rate was 56.7% per transfer. For every 500-unit increase in FSH dose, there was a 3% reduction in the odds of a live birth (odds ratio [OR] 0.97; 95% confidence interval 0.95, 0.99), and a 3% reduction in the odds of a clinical pregnancy (OR 0.97; 95% confidence interval 0.95, 0.99). Days of stimulation and average daily dose were not significantly associated with live birth or clinical pregnancy. No significant association was found between miscarriage rates and total FSH dose, days of stimulation, or average daily dose.

      Conclusion

      This is a novel report of a negative association of total FSH dosage on fresh IVF live births, performed in the donor population to control for oocyte source and endometrial receptivity.
      La dosis total de hormona foliculoestimulante está negativamente correlacionada con los recién nacidos en un modelo de donante/receptora con transferencia en fresco: un análisis de 8,627 ciclos del Registro de la Sociedad de Tecnología en Reproducción Asistida.

      Objetivo

      La donación de ovocitos ha optimizado nuestra comprensión de la estimulación ovárica. Se ha demostrado que el aumento de la dosis de la hormona foliculoestimulante (FSH) afecta adversamente las tasas de nacido vivo en ciclos autólogos. Nuestro objetivo es evaluar si esta relación se mantiene cierta en la población donante/receptora.

      Diseño

      Estudio de cohorte retrospectivo.

      Escenario

      No aplicable.

      Paciente(s)

      Datos de 2014-2016 que incluyeron 8,627 ciclos de donación en fresco.

      Intervención(es)

      Ninguna.

      Medida de resultado principal(es)

      Tasas de nacido vivo, embarazo clínico y aborto.

      Resultado(s)

      La edad media de las donantes ± la desviación estándar (SD) fue 25.8 ± 2.8 años. Las donantes se sometieron a una media de 16 días (rango intercuartílico [IQR] 12, 19) de estimulación, con una media (IQR) de dosis total de FSH y de dosis diaria de 2,350.0 (1,800.0, 3,025.0) y 153.8 (113.2, 205.0) UI, respectivamente. La tasa de nacido vivo fue de 56.7% por transferencia. Por cada 500 unidades de incremento en la dosis de FSH, hubo un 3% de reducción en la probabilidad de nacido vivo (razón de probabilidad [OR] 0.97; intervalo de confianza del 95% de 0.95, 0.99) y un 3% de reducción en la probabilidad de embarazo clínico (OR 0.97; intervalo de confianza del 95% de 0.95, 0.99). Los días de estimulación y la dosis diaria promedio no estaban significativamente asociados con nacido vivo o embarazo clínico. No se encontró asociación significativa entre tasas de aborto y dosis total de FSH, días de estimulación o dosis diaria promedio.

      Conclusión(es)

      Este es un estudio novedoso sobre la asociación de la dosis total de FSH con nacidos vivos en FIV en fresco, realizado en la población de donantes para controlar la fuente de ovocitos y la receptividad endometrial.

      Key Words

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      References

        • Christianson M.S.
        • Bellver J.
        Innovations in assisted reproductive technologies: impact on contemporary donor egg practice and future advances.
        Fertil Steril. 2018; 110: 994-1002
        • Kawwass J.F.
        • Monsour M.
        • Crawford S.
        • Kissin D.M.
        • Session D.R.
        • Kulkarni A.D.
        • et al.
        Trends and outcomes for donor oocyte cycles in the United States, 2000–2010.
        JAMA. 2013; 310: 2426-2434
        • Hogan R.G.
        • Wang A.Y.
        • Li Z.
        • Hammarberg K.
        • Johnson L.
        • Mol B.W.
        • et al.
        Oocyte donor age has a significant impact on oocyte recipients’ cumulative live-birth rate: a population-based cohort study.
        Fertil Steril. 2019; 112: 724-730
        • Wang Y.A.
        • Farquhar C.
        • Sullivan E.A.
        Donor age is a major determinant of success of oocyte donation/recipient programme.
        Hum Reprod. 2012; 27: 118-125
        • Cohen M.A.
        • Lindheim S.R.
        • Sauer M.V.
        Donor age is paramount to success in oocyte donation.
        Hum Reprod. 1999; 14: 2755-2758
        • Faber B.M.
        • Hamacher P.
        • Muasher S.J.
        • Toner J.P.
        The impact of an egg donor’s age and her prior fertility on recipient pregnancy outcome.
        Fertil Steril. 1997; 68: 370-372
        • Barton S.E.
        • Missmer S.A.
        • Ashby R.K.
        • Ginsburg E.S.
        Multivariate analysis of the association between oocyte donor characteristics, including basal follicle stimulating hormone (FSH) and age, and IVF cycle outcomes.
        Fertil Steril. 2010; 94: 1292-1295
        • Letterie G.
        • Marshall L.
        • Angle M.
        The relationship of clinical response, oocyte number, and success in oocyte donor cycles.
        J Assist Reprod Genet. 2005; 22: 115-117
        • Hariton E.
        • Kim K.
        • Mumford S.L.
        • Palmor M.
        • Bortoletto P.
        • Cardozo E.R.
        • et al.
        Total number of oocytes and zygotes are predictive of live birth pregnancy in fresh donor oocyte in vitro fertilization cycles.
        Fertil Steril. 2017; 108: 262-268
        • Rubio C.
        • Mercader A.
        • Alama P.
        • Lizan C.
        • Rodrigo L.
        • Labarta E.
        • et al.
        Prospective cohort study in high responder oocyte donors using two hormonal stimulation protocols: impact on embryo aneuploidy and development.
        Hum Reprod. 2010; 25: 2290-2297
        • Baker V.L.
        • Brown M.B.
        • Luke B.
        • Smith G.W.
        • Ireland J.J.
        Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles.
        Fertil Steril. 2015; 104: 1145-1152
        • Zegers-Hochschild F.
        • Adamson G.D.
        • Dyer S.
        • Racowsky C.
        • de Mouzon J.
        • Sokol R.
        • et al.
        The international glossary on infertility and fertility care, 2017.
        Hum Reprod. 2017; 32: 1786-1801
        • Pal L.
        • Jindal S.
        • Witt B.R.
        • Santoro N.
        Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization.
        Fertil Steril. 2008; 89: 1694-1701
        • Baart E.B.
        • Martini E.
        • Eijkemans M.J.
        • Van Opstal D.
        • Beckers N.G.
        • Verhoeff A.
        • et al.
        Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial.
        Hum Reprod. 2007; 22: 980-988
        • Ryan A.
        • Wang S.
        • Alvero R.
        • Polotsky A.J.
        Prolonged gonadotropin stimulation for assisted reproductive technology cycles is associated with decreased pregnancy rates for all women except for women with polycystic ovary syndrome.
        J Assist Reprod Genet. 2014; 31: 837-842
        • Lu C.L.
        • Yan Z.Q.
        • Song X.L.
        • Xu Y.Y.
        • Zheng X.Y.
        • Li R.
        • et al.
        Effect of exogenous gonadotropin on the transcriptome of human granulosa cells and follicular fluid hormone profiles.
        Reprod Biol Endocrinol. 2019; 17: 49
        • Borges Jr., E.
        • Zanetti B.F.
        • Setti A.S.
        • Braga D.P.
        • Figueira R.C.S.
        • Iaconelli Jr., A.
        FSH dose to stimulate different patient' ages: when less is more.
        JBRA Assist Reprod. 2017; 21: 336-342
        • Hong K.H.
        • Franasiak J.M.
        • Werner M.M.
        • Patounakis G.
        • Juneau C.R.
        • Forman E.J.
        • et al.
        Embryonic aneuploidy rates are equivalent in natural cycles and gonadotropin-stimulated cycles.
        Fertil Steril. 2019; 112: 670-676
        • Sekhon L.
        • Shaia K.
        • Santistevan A.
        • Cohn K.H.
        • Lee J.A.
        • Beim P.Y.
        • et al.
        The cumulative dose of gonadotropins used for controlled ovarian stimulation does not influence the odds of embryonic aneuploidy in patients with normal ovarian response.
        J Assist Reprod Genet. 2017; 34: 749-758
        • Barash O.O.
        • Hinckley M.D.
        • Rosenbluth E.M.
        • Ivani K.A.
        • Weckstein L.N.
        High gonadotropin dosage does not affect euploidy and pregnancy rates in IVF PGS cycles with single embryo transfer.
        Hum Reprod. 2017; 32: 2209-2217
        • Pereira N.
        • Reichman D.E.
        • Goldschlag D.E.
        • Lekovich J.P.
        • Rosenwaks Z.
        Impact of elevated peak serum estradiol levels during controlled ovarian hyperstimulation on the birth weight of term singletons from fresh IVF-ET cycles.
        J Assist Reprod Genet. 2015; 32: 527-532
        • Zhang W.
        • Tian Y.
        • Xie D.
        • Miao Y.
        • Liu J.
        • Wang X.
        The impact of peak estradiol during controlled ovarian stimulation on the cumulative live birth rate of IVF/ICSI in non-PCOS patients.
        J Assist Reprod Genet. 2019; 36: 2333-2344