Characterization of a suboptimal IVF population and clinical outcome after two IVF cycles

Abstract

The number of oocytes retrieved in in vitro fertilization (IVF) cycles is an independent factor influencing pregnancy rate (PR), and optimal number of oocytes would be between 10 and 15. This has led to the hypothesis that the identification of a suboptimal group of responders beforehand (4–9 oocytes retrieved) would allow physicians to optimize their PR. A retrospective observational study counting on 735 women doing an IVF treatment in our center was performed. Multivariable logistic regression was used to analyze the relationship between anti-Mullerian hormone (AMH) and antral follicle count (AFC), within suboptimal and optimal responders. We also analyzed the outcome of those patients with an estimated high probability of having an optimal response and the second cycles of those who did not get pregnant in the first cycle to observe the main significant traits that made them change from one group of responders to the other. Main results are that suboptimal responders account for almost half of our patients. Ovarian reserve markers (AMH and AFC) are significantly different in optimal and suboptimal responders, even when adjusted by age. There is a significant difference in the cumulative PR between both groups. Interestingly, 18.9% shifted from suboptimal to optimal response, and 36.9% from optimal to suboptimal.

Chinese abstract

虽然体外受精（IVF）周期中获取的卵母细胞数是影响妊娠率（PR）的独立因素, 最佳卵母细胞数为10〜15之间。这导致了这样一个假设, 事先确定一个次优的应答组（获得4-9个卵母细胞）, 允许医师优化其PR。对我们中心735例接受IVF的患者进行了一项回顾性观察研究。用多变量logistic回归分析次优和最佳应答者的抗苗勒管激素（AMH）和窦卵泡数（AFC）之间的关系。我们还分析了那些估计具有高概率最佳反应的患者的结果, 以及在第一个周期中没有怀孕的那些患者的第二个周期的情况, 观察使他们从一组反应者变为其他组。主要结果是, 次优应答者几乎占我们一半的患者。卵巢储备指标（AMH和AFC）在最佳和次优反应者中显著不同, 即使按年龄调整后也不同。两组之间的累积PR存在显著差异。有趣的是, 18.9%从次优转变为最优反应, 36.9%由最优转为次优。

Keywords:

• Suboptimal response
• ovarian response
• ovarian reserve
• cumulative pregnancy rate

Acknowledgements

The authors thank Dr. N. Polyzos for his helpful and critical reading of the manuscript.

Disclosure statement

None of the authors has any conflict of interest to declare.