FSH dose is negatively correlated with number of oocytes retrieved: analysis of a data set with ~650,000 ART cycles that previously identified an inverse relationship between FSH dose and live birth rate

Abstract

Purpose: To evaluate whether total FSH dose was negatively correlated with number of oocytes retrieved in a large data set where previously, a negative correlation between FSH dose and live birth rate was identified.

Methods: Data from 650,637 fresh autologous in vitro fertilization (IVF) cycles reported to the Society for Assisted Reproductive Technology between 2004 and 2012 were included. Logistic regression analysis was performed to determine if the relationship between total FSH dose used during ART with number of oocytes retrieved was impacted by the patient's health prognosis, age, BMI, ovarian stimulation protocol, or infertility diagnosis.

Results: The number of oocytes retrieved was negatively correlated with FSH dose (P < 0.0001). Regardless of patient prognosis, age, BMI, ovarian stimulation protocol, and infertility diagnosis, the highest number of oocytes retrieved was in the 1001-2000 IU FSH group, and was 36-51% lower in the > 5000 IU compared with the optimal, 1001-2000 IU, FSH groups. Overall, ~80% of patients received FSH doses outside of the optimal FSH dose. Moreover, 61% of good prognosis patients (excludes individuals likely prescribed higher FSH doses) received doses exceeding the optimal dose range.

Conclusion: The inverse relationship between FSH dose and the number of oocytes retrieved independent of patient age or health implies that excessive FSH doses during ART may be detrimental to oocyte retrieval.

Keywords: FSH; Oocyte retrieval; Ovarian stimulation.

Fig. 1

Relationship between total FSH dose (IU) and number of oocytes retrieved in patients undergoing fresh autologous IVF cycles for the overall data set (all patients; top panel) and parsed by patient prognosis (good and negative prognosis; bottom panel). Good prognosis patients were selected based on the following criteria: < 35 years, body mass index < 30 kg/m², no diagnosis of diminished ovarian reserve, or endometriosis. Negative prognosis patients were selected based on the following criteria: either ≥ 35 years and/or body mass index ≥ 30 kg/m² and/or diagnosis of diminished ovarian reserve, or endometriosis. FSH dose categories included < 1000, 1001–2000, 2001–3000, 3001–4000, 4001–5000, and > 5000 IU. FSH dose category was significantly negatively correlated with the number of oocytes retrieved in all analyses (P < 0.0001). The figure also depicts (red line and text) the decrease in the number of oocytes retrieved in the highest (> 5000 IU) FSH dose category compared to the category with the highest number of oocytes retrieved (1001–2000 IU). The number of patients included in each analysis (N =) is depicted on the appropriate graph

Fig. 2

Relationship between total FSH dose (IU) and number of oocytes retrieved in patients undergoing fresh autologous IVF cycles, parsed by patient age (< 35 years, 35–40 years, and > 40 years). FSH dose categories included < 1000, 1001–2000, 2001–3000, 3001–4000, 4001–5000, and > 5000 IU. FSH dose category was significantly negatively correlated with the number of oocytes retrieved in all patient age categories (P < 0.0001). The figure also depicts (red line and text) the decrease in the number of oocytes retrieved in the highest (> 5000 IU) FSH dose category compared to the category with the highest number of oocytes retrieved (1001–2000 IU). The number of patients included in each analysis (N =) is depicted on the appropriate graph

Fig. 3

Relationship between total FSH dose (IU) and number of oocytes retrieved in patients undergoing fresh autologous IVF cycles, parsed by patient BMI (< 18.5, 18.5–24.9, 25.0–29.9, and ≥ 30). FSH dose categories included < 1000, 1001–2000, 2001–3000, 3001–4000, 4001–5000, and > 5000 IU. FSH dose category was significantly negatively correlated with the number of oocytes retrieved in all patient BMI categories (P < 0.0001). The figure also depicts (red line and text) the decrease in the number of oocytes retrieved in the highest (> 5000 IU) FSH dose category compared to the category with the highest number of oocytes retrieved (1001–2000 IU). The number of patients included in each analysis (N =) is depicted on the appropriate graph

Fig. 4

Relationship between total FSH dose (IU) and number of oocytes retrieved in patients undergoing fresh autologous IVF cycles, parsed by the three ovarian stimulation protocols (agonist suppression, agonist flare, and antagonist suppression) most common in the data set. FSH dose categories included < 1000, 1001–2000, 2001–3000, 3001–4000, 4001–5000, and > 5000 IU. FSH dose category was significantly negatively correlated with the number of oocytes retrieved in all ovarian stimulation protocol categories (P < 0.0001). The figure also depicts (red line and text) the decrease in the number of oocytes retrieved in the highest (> 5000 IU) FSH dose category compared to the category with the highest number of oocytes retrieved (1001–2000 IU). The number of patients included in each analysis (N =) is depicted on the appropriate graph

Fig. 5

Relationship between total FSH dose (IU) and number of oocytes retrieved in patients undergoing fresh autologous IVF cycles, parsed by cycles where patients were recorded as having a positive diagnosis for either endometriosis, PCOS, diminished ovarian reserve, tubal disease, unexplained infertility, and those seeking ART for other reasons. FSH dose categories included < 1000, 1001–2000, 2001–3000, 3001–4000, 4001–5000, and > 5000 IU. FSH dose category was significantly correlated with the number of oocytes retrieved in each of the categories (P < 0.0001). The figure also depicts (red line and text) the decrease in the number of oocytes retrieved in the highest (> 5000 IU) FSH dose category compared to the category with the highest number of oocytes retrieved (1001–2000 IU). The number of patients included in each analysis (N =) is depicted on the appropriate graph