Effect of stimulation phase length (SPL) on IVF/ICSI outcomes: a prospective study

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Aim/Objectives: To determine whether SPL influences number of follicles on trigger day, oocyte retrieved at ovum pick up, grade A/B oocyte cumulus complex (OCC), M2 oocytes, fertilisation-rate, cleavage-rate, endometrial thickness, and clinical-pregnancy-rate (CPR) in IVF/ICSI cycles. Settings/Design: A prospective observational study conducted over a period of six months at an IVF/ICSI centre. Methods/Material: 152 patients enrolled for IVF/ICSI cycles except those undergoing frozen embryo transfer, donor oocyte/sperm, and surrogacy program. 16 patients were further excluded due to cycle cancellation and data of 136 patients were analysed. Individualised patient treatment with individualised controlled ovarian stimulation planned for each patient according to their clinical, ultrasound, and hormonal profile. The study parameter (stimulation phase length (SPL)) was further subdivided into short (<10 days), medium (10-12 days), and long (>12 days) and its associations with outcome parameters studied. Statistics: SPSS program for windows, version 17.0 used. Continuous variables compared using ANOVA. Spearman’s correlation was used to find the association among various variables. Categorical variables were compared using Chi square test. P < 0.05 indicates significant difference. Results: The number of follicles and oocytes retrieved were significantly higher in medium SPL (P < 0.05). But there were no significant differences in number of grade A/B OCC or M2 oocytes among all three SPL groups (P > 0.05). There was no association between SPL and fertilisation rate, cleavage rate, or endometrial thickness. The CPR was 41.91% (57/136). The CPR was 31.6%, 46.7%, and 37.5% in short, medium, and long SPL, respectively. Though CPR appears higher in medium SPL but it is not statistically significant (P > 0.05). Conclusions: Optimising SPL between 10 and 12 days may serve as non-invasive marker for follicle/oocyte quantity but not quality. SPL cannot predict IVF/ICSI outcomes.