The Oocyte/Antral Follicle Count Index: Does Maximizing Oocyte Yield Translate Into Better Assisted Reproductive Technology Outcomes?

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OBJECTIVES: Whether aspiration of more oocytes than the antral follicle count (AFC) is beneficial for the current and future products of assisted reproductive technologies (ART) cycles. METHODS: Data of the first oocyte aspiration for intracytoplasmic sperm injection performed between 2018 and 2022 in attempt to conceive (ICSI, n = 399) or for planned oocyte vitrification (fertility preservation [FP], n = 283) was retrieved. Each group was divided into 2 subgroups according to their "oocyte/AFC index" (OAFCI): <1 and ≥1. Primary measures were clinical pregnancy rates (CPR) and live birth rates (LBR). Secondary measures were oocyte maturity rates, fertilization rates, and number of cryopreserved oocytes/embryos. RESULTS: Oocyte maturity was unaffected by the OAFCI in the ICSI group, but was slightly lower in the FP group when OAFCI ≥1 (0.79 versus 0.84, p = .005). OAFCI ≥1 was associated with a higher number of cryopreserved embryos (ICSI, 3.9 versus 2.3, p < .001) and vitrified oocytes (FP, 13.4 versus 6.4, p < .001). The OAFCI had no impact on CPR (22.8% versus 28%, p = .27) nor LBR (19.8% versus 24.8%, p = .33). On multivariate analysis controlling for age, gonadotropin dosage, and duration of stimulation, OAFCI ≥1 was associated with a higher number of cryopreserved embryos (aOR 1.2, 95% CI 1.1-1.3, p < .001) in the ICSI group and higher vitrified oocytes (aOR 1.2, 95% CI 1.1-1.2, p < .001) and lower maturity index (aOR 0.2, 95% CI 0.05-0.75, p = .018) in the FP group. CONCLUSIONS: Aspirating more oocytes than the AFC does not influence the outcome of the fresh cycle but cryopreservation of more oocytes and embryos might translate into higher cumulative pregnancy rates later on.

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