Changing ovarian stimulation parameters in a subsequent cycle does not increase the number of euploid embryos

Capsule:
Euploidy outcomes were compared in patients that underwent two ovarian stimulation cycles with preimplantation genetic screening; no specific intervention increased the number of euploid embryos within the same patient any more than simply repeating a similar stimulation cycle.

Authors:
Brooke Hodes-Wertz, M.D., M.P.H., David H. McCulloh, Ph.D., Alan S. Berkeley, M.D., Jamie A. Grifo, M.D., Ph.D.

Volume 103, Issue 4, Pages 947-953

Abstract:

Objective:
To compare the euploidy outcome in patients that underwent 2 ovarian stimulation cycles with trophectoderm biopsy.

Design:
Retrospective repeated-measures cohort study.

Setting:
University-based fertility center.

Patient(s):
A total of 116 patients, from 2011 through 2013, that underwent 2 ovarian stimulation cycles followed by trophectoderm biopsy with array comparative genomic hybridization.

Intervention(s):
Days of stimulation, average diameter of the 2 lead follicles on day of trigger, dose of gonadotropins, type of cycle (gonadotropin-releasing hormone [GnRH] antagonist, GnRH-antagonist plus clomiphene citrate [CC], microdose GnRH agonist).

Main Outcome Measure(s):
Number of euploid embryos.

Result(s):
Patients were analyzed based on whether they had ≥1 euploid embryos in their first cycle vs. none. There was no increase in the number of euploid embryos with more days of stimulation or increases in the dose of gonadotropins in either group. Significantly more euploid embryos were seen in patients who had no euploid embryo(s) in the first cycle (Group 0) that had CC added to a GnRH-antagonist cycle (1.11 more euploid embryos) or were triggered when follicle sizes were 2 mm larger (0.40 euploid embryos), but these increases were not significant compared with a control group. Patients with euploid embryo(s) in the first cycle (Group 1) had significantly more euploid embryos when daily dose was increased by 75–149 international units, but this relationship was not significant compared with a control group with no increase in daily dose.

Conclusion(s):
No specific intervention increased the number of euploid embryos within the same patient any more than simply repeating a similar stimulation cycle. An attempt was made to control for interpatient variability, but individual patients have considerable intercycle variability.

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