Abstract
The objective of this study was to evaluate the prognosis of patients with a first
treatment cycle that was defined as a poor ovarian response cycle according to the
new ESHRE consensus criteria. The first documented cycle of poor response for a patient
and all the cycles that followed were retrospectively analysed. Factors that were
associated with ongoing pregnancy rates were assessed using multivariate analysis.
In total, this study evaluated 1014 patients that underwent 2819 consecutive IVF cycles.
As expected, patients with poor response cycles were older and had less oocytes retrieved
and less embryos transferred. Multivariate analysis for ongoing pregnancy rates adjusted
for patient and the cycle characteristics revealed that the intracytoplasmic sperm
injection (ICSI) procedure was associated with a significant increase of 40% in ongoing
pregnancy rate (adjusted success ratio 1.40, 95% CI 1.00–1.96). Age over 41 years and additional cycles with poor response, were associated with significantly
less ongoing pregnancy rate. However, the cumulative pregnancy rates were 29.5% and
36.4% following five and seven cycles, respectively. In conclusion, performing ICSI
may improve the ongoing pregnancy rates in poor responders. Further studies are needed
to establish the number of cycles recommended in these patients.
Patients with poor ovarian response cycles are currently the most challenging group
of fertility patients. We are yet far from understanding the factors which cause reduced
ovarian response and further away from finding a solution to this painful problem.
In this work, we present that with current available treatment modalities, the results
can be improved. We show that performing intracytoplasmic sperm injection and implementation
of additional number of treatment cycles may improve the ongoing pregnancy rates of
patients with a first treatment cycle that is defined as a poor ovarian response cycle.
In addition, we investigated the cumulative pregnancy rates in this group and the
effect of performing a number of treatment cycles.
Keywords
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Article info
Publication history
Published online: September 17, 2012
Accepted:
September 4,
2012
Received in revised form:
July 26,
2012
Received:
February 23,
2012
Declaration: The authors report no financial or commercial conflicts of interest.Footnotes
Dr Ettie Maman is a senior physician in the IVF unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Israel. She graduated from Ben Gurion University, School of Medicine in Beer Sheba, Israel, in 1998. She completed her residency in obstetrics and gynaecology at the Department of Obstetrics and Gynecology, Sheba Medical Center. She worked as a research fellow at the Samuel Lunenfeld Research Institute, Mt Sinai Hospital, Toronto, Ontario, Canada. She joined the Sheba Medical Center IVF programme in 2006 and her research interests are related to infertility, in-vitro maturation and stem cells.
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Copyright
© 2012 Reproductive Healthcare Ltd. Published by Elsevier Inc. All rights reserved.
