How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach.

OBJECTIVE To study how many infertility patients would complete an average-sized family (achieve ≥2 live births) after a single, complete in vitro fertilization (IVF) cycle. DESIGN A retrospective cohort study. SETTING University-affiliated private infertility practice. PATIENT(S) Women undergoing IVF. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The outcome of 1 or ≥2 live births after a single retrieval cycle, followed by use of all embryos in subsequent frozen cycles in relation to oocyte number. RESULT(S) The pregnancy rate was statistically significantly higher when ≥15 oocytes were retrieved (289 of 699, 41.3%) than <15 oocytes (518 of 1,419, 36.5%). When investigating the outcome of ≥2 live births and assuming that all remaining frozen embryos were used, we found that 498 of 2,226 (22.4%) patients would achieve ≥2 live births. We performed multivariate analysis, and the area under the receiver operating characteristic curve for the model was 0.802. When controlling for multiple factors we found that as the number of oocytes retrieved increased, the chance of at least two live births increased, with odds ratio 1.08 (8% live birth increase per additional oocyte). CONCLUSION(S) We demonstrate that one fresh cycle with high oocyte yield is an optimal way to plan IVF treatment. With modern cryopreservation methods, the concept of "one-and-done" could safely achieve ≥2 live births with just one stimulation cycle in almost a quarter of our patients.