Pregnancy rate in IVF patients with unexpected poor response to ovarian stimulation

Abstract

Objective

To evaluate whether an unexpected poor response (cases with ≤3 oocytes) leads to a reduction in the pregnancy rate in IVF cycles compared to a suboptimal response (controls with 4-9 oocytes) in women with adequate ovarian reserve.

Methods

A nested case-control study performed in a retrospective cohort of couples undergoing IVF at the Infertility Unit of the ASST Lariana. Cases and controls had adequate ovarian reserve and were matched 1:1 for female age and number of previous cycles. Cumulative clinical pregnancy rate per oocyte retrieval was the main outcome.

Results

Overall, 113 cases and 113 matched controls were included; the median number of available oocytes was 2 and 6, respectively. The cumulative pregnancy rate per cycle was significantly reduced in cases compared to controls with a crude odds ratio = 0.45 [95% Confidence Interval: 0.28-0.82]. A binomial logistic model indicated that an increase in one oocyte increases the odds for cumulative pregnancy rate per cycle by 1.27 in women with 9 oocytes or less. The cumulative pregnancy rates per cycle in cases and controls, according to female age were respectively: 29% versus 54% in patients aged <35 years (p = 0.036); 22% versus 43% in patients aged 36-39 years (p = 0.048) and 11% versus 13% in patients 40-45 years old (p = 0.72). Patients belonging to older age groups showed decreasing probability of cumulative clinical pregnancy rates both among cases and controls group (p < 0.05).

Conclusions

The number of available oocytes significantly affects the probability of success in IVF cycles with unexpected impaired ovarian response.

摘要

目的

评估在卵巢储备充足的女性中, 非预期卵巢低反应（≤3个卵母细胞的病例组）是否会导致IVF周期的妊娠率低于次优反应（4-9个卵母细胞的对照组）。

方法

一项巢式病例对照研究在ASST Lariana不孕不育中心接受IVF的夫妇的回顾性队列中进行。病例组和对照组均有充足的卵巢储备, 在女性年龄和既往周期数方面1：1匹配。每个卵母细胞的累积临床妊娠率为主要结局。

结果

总体而言, 113例患者和113名匹配的对照组纳入研究；可用卵母细胞的中位数分别为2个和6个。与对照组相比, 病例组的每个周期的累积妊娠率显著降低, 粗略优势比=0.45[95%可信区间：0.28-0.82]。二项Logistic模型表明, 有9个或更少卵子的女性中, 一个卵子的增加会使每个周期的累积妊娠率增加1.27。按女性年龄分组, 病例组和对照组的每周期累积妊娠率分别为：<35岁组29% vs. 54%（p=0.036）, 36-39岁组22% vs. 43%（p=0.048）, 40-45岁组11% vs.13%（p=0.72）。在病例组和对照组中, 年龄较大的患者的累积临床妊娠率均降低（p<0.05）。

结论

在非预期卵巢低反应的IVF周期中, 可用卵母细胞的数量显著影响成功的概率。

Keywords:

• Poor ovarian response
• Poseidon classification
• Bologna criteria
• in vitro fertilization
• ovarian stimulation
• AMH

关键词:

• 卵巢反应差
• 波塞冬分级
• 博洛尼亚标准
• 体外受精
• 卵巢刺激
• AMH

Acknowledgements

The authors are grateful to the patients for their contribution and to the central laboratory staff for carrying out the diagnostic tests.

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data

From the corresponding author upon reasonable request.

Funding

The author(s) reported there is no funding associated with the work featured in this article.