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IVF outcome in poor responders failing to produce viable embryos in the preceding cycle

Published:March 13, 2013DOI:https://doi.org/10.1016/j.rbmo.2013.02.013

      Abstract

      This study postulated that poor-responder women failing to obtain viable embryos would represent a subgroup of subjects with extremely poor prognosis. To elucidate this aspect, women in this condition over a 4-year period were retrospectively identified and their IVF outcomes in subsequent cycles were evaluated. A total of 108 women satisfied the selection criteria and underwent at least one further IVF cycle. There were 19 women excluded because they opted for a mild approach using clomiphene citrate alone, leaving 89 women for data analyses. Four women had a live birth during this first cycle, corresponding to a delivery rate per started cycle of 4.5% (95% CI 1.5–10.0%). From a public health perspective, the mean cost per delivery was €124,540. Younger age emerged as the unique predictive factor of success. In conclusion, women with poor ovarian response failing to obtain viable embryos have extremely low chances of success in subsequent cycles. Considering the costs and risks of IVF, the appropriateness of pursuing treatments in these women is questionable. Younger women may represent a possible exception since their chances of delivery are higher.
      Predicting IVF success is challenging. The accuracy of instrumental or biochemical tests is deemed insufficient. On this basis, it has even been suggested that entering the first cycle of IVF without any prior testing may be the preferable strategy. Surprisingly, little attention has been paid to the value of the IVF outcome in predicting the success rate in subsequent cycles. In this study, we postulated that women displaying poor response to ovarian stimulation and failing to obtain viable embryos would represent a subgroup of subjects with extremely poor prognosis. We retrospectively identified women who underwent an IVF cycle using conventional maximal doses of gonadotrophins, with three or more oocytes retrieved and no viable embryos. The primary aim was to report success in terms of delivery rate. The secondary aims were to identify predictive factors of success and evaluate costs per delivery. A total of 89 women who underwent at least one further IVF cycle were included. Four women had a live birth, corresponding to a delivery rate per started cycle of 4.5%. Younger age emerged as the unique predictive factor of success. No delivery occurred in women older than 39 years. From a public health perspective, the mean cost per delivery was €124,540. In conclusion, women with poor ovarian response failing to obtain viable embryos have extremely low chances of success in subsequent cycles. Considering the costs and risks of IVF, the appropriateness of pursuing treatments in these women is questionable. Younger women may represent a possible exception since their chances of delivery are higher.

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