Researchers in a 2020 study found no difference in euploidy rates or birth rates among women who were treated with different amounts of gonadotropins for different amounts of time.
For more background on egg quality, check out my Complete guide to egg quality.
Women over 35 begin to start seeing decreased success with IVF and increased miscarriage rates. Check out these stats from the CDC (2016 data):
These differences are largely attributed to egg aneuploidy. Normally eggs are supposed to have 23 chromosomes (half of the 46 we have in our body cells), but in aneuploid eggs this number is anything but 23. This might be due to reduced energy output by the mitochondria that can affect how some cellular machinery functions (namely those involved in separating chromosomes). This can cause errors.
So the goal for many is to overcome this by retrieving as many eggs as possible. That way there’s more opportunities for getting an egg that isn’t aneuploid. High egg yields require higher amounts of gonadotropins like FSH and this is associated with increased risk of complications, namely OHSS, and the possibility of reduced egg quality.
But does this have an effect on egg quality?
- Hong et al. (2019) compared aneuploidy rates between natural (unstimulated) and gonadotropin-stimulated cycles and found no difference. They also found no difference in sustained implantation rates (beyond 8 weeks).
- Labarta et al. (2012) compared oocyte donors that were stimulated or had natural cycles. There was no difference in aneuploidy rates.
- Sekhon et al. 2017 found no differences in aneuploidy rates in cumulative gonadotropin dose and the odds of aneuploidy when patients were stimulated for 12 or less days. With continued stimulation after 12 days, there was a slight increase in the odds of aneuploidy.
🔗 Original studies are referenced in this post or within the linked Remembryo posts.
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Irani et al. (2020), in their retrospective, single center study, looked at 2230 IVF cycles with PGT-A and 930 FET cycles between 2013 and 2017. They wanted to see if ovarian stimulation with high amounts of gonadotropins resulted in decreased egg quality (by measuring aneuploidy in the resulting embryos), or decreased live births.
For the first half of the study they compared euploidy rates – so the % of embryos that are euploid (and not aneuploid) – in 2230 PGT-A cycles. Overall the results based on age were:
- <35 years old: 55.4% euploid embryos
- 35-37: 44.8%
- 38-40: 32.4%
- 41-42: 18.2%
- >43: 8.5%
They looked at a number of different parameters that relate to high dose gonadotropin treatment (using Gonal-F/Follistim and/or Menopur) between the different age groups indicated above.
1) Duration of treatment. Here they compared embryos from women who were treated with gonadotropins for <10 days, 10-12 days, or >12 days. For each age group, the euploidy rates were similar within each group as indicated above and there were no significant differences.
2) Gonadotropin dosage. Here they compared embryos from women who were treated with <4000 IU of gonadotropin (in total over the duration of the stim treatment), 4000-6000 IU, or >6000 IU. No differences.
3) Number of oocytes retrieved. Here they compared embryos from women who had <10 eggs collected, 10-19 eggs collected, or >20 eggs collected. No differences.
4) Peak E2 levels. Here they compared embryos from women who had peak E2 levels <2000 pg/ml, 2000-3000 pg/ml, and >3000 pg/ml. No differences.
They also looked at live birth rates and found no significant differences in patients who had different gonadotropin dosages, duration of stimulation, number of oocytes retrieved, or peak estradiol levels for each of the age groups. Live birth rates ranged for each age group after transferring a euploid, generally between 50-65%.
Overall, they found no differences in terms of high gonadotropin stimulation and euploidy rates and live birth rates. This suggests that high gonadotropin doses, and its related measures, have no impact on egg quality.
Reference
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About Embryoman
Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.
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