Research question

What is the optimal number of oocytes retrieved at which maximum live birth rate is observed after fresh autologous assisted reproductive technology (ART) cycles for women of different ages?

Design

Retrospective cohort study of all fresh autologous ART aspiration cycles (n = 256,643) undertaken in Australia and New Zealand between 2009 and 2015. Primary outcome measure was live birth rate (LBR) (delivery of at least one liveborn baby at 20 weeks’ gestation or over per fresh aspiration cycle). Cycles were grouped according to female age (<30, 30–34, 35–49, 40–44 and ≥45 years) and ovarian response (one to three, four to nine, 10–14, 15–19, 20–25 and ≥25 oocytes). Secondary outcome was incidence of ovarian hyperstimulation syndrome (OHSS) requiring hospitalization.

Results

At different oocyte yields, LBR per fresh aspiration cycle peaked and then declined at, depending on female age: <30 years: six to 11 oocytes (LBR 31–34%); 30–34 years: 11–16 oocytes (LBR 29–30%); 35–39 years: nine to 17 oocytes (LBR 21–24%); and 40–44 years: 15–17 oocytes (LBR 11–12%). The incidence of OHSS increased significantly with the number of oocytes retrieved, from 1.2% with 15 oocytes retrieved to 9.3% with 30 or more oocytes retrieved (P < 0.001).

Conclusion

The optimal number of oocytes at which maximum LBR was observed in a fresh aspiration cycle was highly dependent on age. Because of the observational nature of the results, a cause–effect relationship between the number of oocytes retrieved and LBR should not be assumed; evidence from well-designed randomized control trials is required before clinical advice can be suggested.

中文翻译：

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女性年龄与使新鲜活产率最大化的最佳卵母细胞数量有关：对 256,643 个新鲜 ART 周期的分析

研究问题

对于不同年龄的女性，在新鲜自体辅助生殖技术 (ART) 周期后观察到最大活产率的最佳卵母细胞数量是多少？

设计

 2009 年至 2015 年期间在澳大利亚和新西兰进行的所有新鲜自体 ART 抽吸周期 ( n = 256,643) 的回顾性队列研究。主要结果指标是活产率 (LBR)（在妊娠 20 周或超过每个新鲜吸入周期）。周期根据女性年龄（<30、30-34、35-49、40-44 和≥45 岁）和卵巢反应（1-3、4-9、10-14、15-19、20-25）分组和≥25 个卵母细胞）。次要结局是需要住院治疗的卵巢过度刺激综合征 (OHSS) 的发生率。

结果

在不同的卵母细胞产量下，每个新鲜抽吸周期的 LBR 达到峰值然后下降，取决于女性年龄：<30 岁：6 到 11 个卵母细胞（LBR 31-34%）；30-34 岁：11-16 个卵母细胞（LBR 29-30%）；35–39 岁：9 到 17 个卵母细胞（LBR 21–24%）；40-44 岁：15-17 个卵母细胞（LBR 11-12%）。OHSS 的发生率随着取卵数量的增加而显着增加，从取卵 15 个的 1.2% 到取卵 30 个或更多的 9.3%（P < 0.001）。

结论

在新鲜吸引周期中观察到最大 LBR 的最佳卵母细胞数量高度依赖于年龄。由于结果的观察性质，不应假设取回的卵母细胞数量与 LBR 之间存在因果关系；在提出临床建议之前，需要来自设计良好的随机对照试验的证据。