Miscarriage risk for IVF pregnancies in poor responders to ovarian hyperstimulation

Haadsma, Maaike L; Groen, Henk; Mooij, Thea M; Burger, Curt W; Broekmans, Frank JM; Lambalk, Cornelis B; Leeuwen, Flora E van; Hoek, Annemiek; on behalf of The OMEGA Project Group,

doi:10.1016/j.rbmo.2009.11.005

« Previous Next »Reproductive BioMedicine Online
Volume 20, Issue 2 , Pages 191-200, February 2010

Miscarriage risk for IVF pregnancies in poor responders to ovarian hyperstimulation

Maaike L Haadsma
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
- Corresponding author.
Henk Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
Thea M Mooij
- Department of Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
Curt W Burger
- Department of Obstetrics and Gynaecology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
Frank JM Broekmans
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
Cornelis B Lambalk
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
Annemiek Hoek
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
on behalf of The OMEGA Project Group
- R Schats (Vrije Universiteit Medical Center Amsterdam), NS Macklon (University Medical Center Utrecht), JSE Laven (Erasmus Medical Center Rotterdam), CAM Jansen (Diaconessenhuis Voorburg), FM Helmerhorst, N Naaktgeboren (Leiden University Medical Center), BJ Cohlen (Isala Clinics Zwolle), DDM Braat, JAM Kremer, WNP Willemsen (Radboud University Nijmegen Medical Center), RSGM Bots (St Elisabeth Hospital Tilburg), AHM Simons (University Medical Center Groningen), F van der Veen (Academic Medical Center Amsterdam), JLH Evers (Academic Hospital Maastricht), and PA van Dop (Catharina Hospital Eindhoven).

Received 10 April 2009; received in revised form 26 May 2009; accepted 14 October 2009. published online 25 December 2009.

Declaration: The authors report no financial or commercial conflicts of interest.

Abstract

The increasing miscarriage rate with advancing female age is attributed to a decline in oocyte quality. A poor response to ovarian hypestimulation is often an expression of a decrease in oocyte quantity. Although oocyte quality and quantity both decrease as a result of ovarian ageing, it is unclear whether these two processes are related to each other. To investigate the relationship between oocyte quantity and quality, we compared miscarriage rates between IVF treated women with a poor and normal response, respectively. Data were studied from a retrospective nationwide cohort of Dutch women undergoing IVF treatment from 1983 to 1995. Women achieving an ongoing pregnancy after their first complete IVF cycle (n=1468) were compared with those experiencing miscarriage (n=357) with respect to their ovarian response. Logistic regression analysis showed a statistically significant association between poor response (fewer than four retrieved oocytes) and miscarriage (P=0.001). Due to interaction, this association became stronger with increasing female age. Among women <36years, miscarriage rates between poor and normal responders did not differ, whereas among women ⩾36years poor responders had a statistically significant increased miscarriage rate compared with normal responders (P=0.001). These results support the hypothesis of a relationship between quantitative ovarian reserve and oocyte quality.

Keywords: IVF, miscarriage, ovarian reserve, poor response, pregnancy loss

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Maaike Haadsma graduated from the Faculty of Medicine of the University of Groningen, the Netherlands. In 2004 she joined the department of Obstetrics and Gynaecology of the University Medical Center Groningen, the Netherlands, where she started her research in the field of ovarian ageing. In March 2010 she will defend her PhD thesis on the clinical relation between oocyte quantity and oocyte quality. Maaike Haadsma is currently working as a clinical geneticist in training at the department of Genetics in the same hospital.