F-178 Total Follicle Stimulating Hormone (FSH) Dose is Negatively Correlated With Live Births in a Donor Recipient Model With Fresh Transfer:An Analysis of 8627 Cycles From the Society for Assisted Reproductive Technology (SART) Registry.

摘要

Introduction: Oocyte donation has optimized our understanding of ovarian stimulation and the factors that contribute to a successful in vitro fertilization (IVF) cycle. Previous research in autologous cycles has noted that with increasing FSH dose, live birth rates were significantly decreased. The objective of our study is to evaluate if this relationship holds true within the donor/recipient population. Methods: National IVF data from 2014-2016 for fresh donor transfers was requested from SART. We excluded donors ≥32 years old, recipients > 50 years old, recipient BMI > 50 kg/m~2, total FSH < 600 or > 6000 IU, days of stimulation < 6 or > 26 days, and cycles utilizing preimplantation genetic testing. Total FSH dose, days of stimulation, and daily dose were investigated for their associations with live birth, clinical pregnancy, and miscarriage using logistic regression models while adjusting for recipient age, donor age, number of embryos transferred, recipient BMI, number of oocytes retrieved, sperm source, stage of transfer, and type of stimulation. Multivariable odds ratios (OR), 95% confidence intervals (CI), and p values (p) were reported. P<0.05 was considered statistically significant. Results: A total of 8627 donor cycles were analyzed. The mean donor age was 25.8 years ± 2.8 and underwent an average of 16 days ± 4.3 of stimulation with a mean total FSH dose of 2521.3 IU ± 1003.2 and average daily dose of 167.1 IU ± 75.1. The mean age and median BMI in the recipient population was 40.9 years ±5.0 and 24.5 kg/m~2(25~th, 75~th percentiles: 21.9, 28.7), respectively. The live birth rate was 56.7%. For every 500-unit increase in FSH dose, there was a 3% reduction in the odds of both a live birth (OR = 0.97; 95% CI = 0.95, 0.99; p = 0.007) and a clinical pregnancy (OR = 0.97; 95% CI = 0.95, 0.99; p = 0.005). Days of stimulation and average daily dose were not significantly associated with live birth (OR = 1.00; 95% CI = 0.99, 1.01; p = 0.60 and OR per 75 IU unit increase = 0.97; 95% CI = 0.93, 1.01; p = 0.17, respectively) or clinical pregnancy (OR = 0.99; 95% CI = 0.98, 1.00; p = 0.15 and OR per 75 IU unit increase = 0.97; 95% CI = 0.93, 1.02; p = 0.21, respectively) after adjusting for potential confounders. No significant association was found between miscarriage rates and total FSH dose, days of stimulation, and average daily dose. Conclusion: This is the first report of a negative association of total FSH dosage on fresh IVF live births, controlling for the source of oocytes and independent of endometrial receptivity. Using a large national database, IVF programs are advised to avoid excessive FSH dosing for oocyte donors, not only for safety, but also for optimal fresh IVF success.