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.
Keywords
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Article info
Publication history
Published online: March 13, 2013
Accepted:
February 26,
2013
Received in revised form:
February 22,
2013
Received:
October 19,
2012
Declaration: The authors report no financial or commercial conflicts of interest.Footnotes
Edgardo Somigliana graduated in Medicine in Milan in 1994 and completed his residency in obstetrics and gynaecology in 1999. In 2006, he completed a PhD in prenatal medicine. Since 2001, he has been working as a clinical assistant in obstetrics and gynaecology at the Fondazione Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena in Milan. His major scientific interests are infertility and endometriosis. He is author or co-author of more than 150 articles in international journals.
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Copyright
© 2013 Reproductive Healthcare Ltd. Published by Elsevier Inc. All rights reserved.
