Oocyte Yield and Live Birth Rate after Follitropin Delta Dosing and Fresh Embryo Transfer: an Individual Patient Data Meta-Analysis

Research question What number of retrieved oocytes is associated with the optimum chance to achieve a live birth for women undergoing ovarian stimulation with individualised follitropin delta? Design Individual patient data meta-analysis of 1772 patients from five randomised controlled trials using individualised follitropin delta for ovarian stimulation with fixed daily dosing based on serum anti-Müllerian hormone (AMH) and body weight. Outcomes of live birth rate (LBR) and ovarian hyperstimulation syndrome (OHSS) were evaluated in relation to the number of oocytes retrieved, including subgroup analyses based on number of oocytes retrieved, age and AMH levels. Results The analysis included patients treated with follitropin delta who had ≥1 oocyte retrieved. The mean number of oocytes retrieved was 10.4 and the overall LBR was 32.1%. Predicted LBR increased with the number of oocytes retrieved, reaching above 34% in the range 8-14 oocytes, peaking at 34.9% for 11 oocytes. Beyond 14 oocytes, LBR gradually declined. By number of oocytes retrieved (grouped), the LBR was 27.8%, 33.6% and 30.9% at 1-7, 8-14 and ≥15 oocytes, respectively. LBR decreased with increasing age (32.7%, 30.7% and 23.4% at <35, 35-37 and 38-42 years, respectively). The incidence of OHSS (any grade) increased from 2.1% to 5.2% to 17.0% at 1-7, 8-14 and ≥15 oocytes retrieved. Conclusions After ovarian stimulation with individualised follitropin delta, the LBR in the fresh cycle was highest in the range of 8-14 oocytes retrieved, peaking at 11 oocytes. The results support the appropriateness of the follitropin delta dosing algorithm.