Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
Hum Reprod. 2012 Dec;27(12):3481-6. doi: 10.1093/humrep/des318. Epub 2012 Aug 30.
What is the effect of natural cycle IVF in women with poor ovarian response according to the new ESHRE definition for poor ovarian responders: the Bologna criteria?
Although natural cycle IVF is a promising treatment option for normal responders, poor ovarian responders, as described by the Bologna criteria, have a very poor prognosis and do not appear to experience substantial benefits with natural cycle IVF.
Previous trials have shown that natural cycle IVF is an effective treatment for the general infertile population and might be an option for poor ovarian responders. However, none of the trials have examined the effect of natural cycle IVF in poor responders according to the Bologna criteria, the newly introduced definition by the ESHRE Working Group on Poor Ovarian Response Definition. In this trial, we examined the effect of natural cycle IVF in poor ovarian responders fulfilling the Bologna criteria.
STUDY DESIGN, SIZE, DURATION: In this retrospective cohort trial, 164 consecutive patients, undergoing 469 natural cycle IVFs between 2008 and 2011 were included. Patients were stratified as poor and normal responders: 136 (390 cycles) were poor ovarian responders according to the Bologna criteria, whereas 28 women (79 treatment cycles) did not fulfil the criteria and were considered as normal responders.
PARTICIPANTS/MATERIALS, SETTING, METHODS: All patients were monitored with hormonal analysis and ultrasound scan every second day, from Day 7 or 8 of the cycle onwards. When a follicle of >16 mm was observed, ovulation was triggered with 5000 IU of i.m. hCG and oocyte retrieval was performed 32 h later.
Live birth rates in poor responders according to the Bologna criteria were significantly lower compared with the control group of women; the live birth rate per cycle was 2.6 versus 8.9%, P = 0.006 and the live birth rate per treated patient was 7.4 versus 25%, P = 0.005. In poor responders according to the Bologna criteria, live birth rates were consistently low and did not differ among different age groups (≤ 35 years, 36-39 years and ≥ 40 years), with a range from 6.8 to 7.9%.
LIMITATIONS, REASONS FOR CAUTION: A limitation of our analysis is its retrospective design; however, taking into account that we included only consecutive patients treated with exactly the same protocol, the likelihood of selection bias might be considerably limited. In addition, the control group in our study refers to women of younger age and therefore the promising results among patients who did not fulfil the Bologna criteria apply only to women of younger age.
Our trial suggests that although natural cycle IVF is a promising treatment option for younger normal responders, its potential is very limited to poor ovarian responders as described by the Bologna criteria, irrespective of patient's age. This highlights the very poor prognosis of these women and therefore the urgent need for future trials to examine the effect of ovarian stimulation protocols in women with poor ovarian response as described by the Bologna criteria.
STUDY FUNDING/COMPETING INTEREST(S): No funding was used. There are no competing interests to declare.
根据新的 ESHRE 卵巢反应不良定义（即博洛尼亚标准），对于卵巢反应不良的患者，自然周期 IVF 的效果如何？
尽管自然周期 IVF 是正常反应者的一种有前途的治疗选择，但博洛尼亚标准定义的卵巢反应不良者的预后非常差，并且似乎不会从自然周期 IVF 中获得实质性益处。
先前的试验表明，自然周期 IVF 是治疗一般不孕人群的有效方法，也可能是卵巢反应不良者的一种选择。然而，没有一项试验研究了根据博洛尼亚标准（即 ESHRE 卵巢反应不良定义工作组新引入的标准），在卵巢反应不良者中进行自然周期 IVF 的效果。在这项试验中，我们研究了在满足博洛尼亚标准的卵巢反应不良者中进行自然周期 IVF 的效果。
研究设计、大小和持续时间：在这项回顾性队列试验中，纳入了 2008 年至 2011 年间接受 469 次自然周期 IVF 的 164 例连续患者。患者分为卵巢反应不良者和正常反应者：136 例（390 个周期）根据博洛尼亚标准为卵巢反应不良者，而 28 例女性（79 个治疗周期）不符合标准，被认为是正常反应者。
参与者/材料、设置和方法：所有患者均接受激素分析和超声扫描监测，从周期第 7 或 8 天开始，每隔一天监测一次。当观察到 >16mm 的卵泡时，用 5000IU 的肌内 hCG 触发排卵，32 小时后进行卵母细胞采集。
根据博洛尼亚标准，卵巢反应不良者的活产率明显低于对照组女性；每周期的活产率为 2.6%对 8.9%，P=0.006，每例治疗患者的活产率为 7.4%对 25%，P=0.005。在根据博洛尼亚标准的卵巢反应不良者中，活产率一直很低，并且在不同年龄组（≤35 岁、36-39 岁和≥40 岁）之间没有差异，范围为 6.8%至 7.9%。
局限性、谨慎的原因：我们分析的一个限制是其回顾性设计；然而，考虑到我们只纳入了接受完全相同方案治疗的连续患者，选择偏倚的可能性可能会大大降低。此外，我们研究中的对照组指的是年龄较小的女性，因此在不符合博洛尼亚标准的患者中，有希望的结果仅适用于年龄较小的女性。
我们的试验表明，尽管自然周期 IVF 是年轻正常反应者的一种有前途的治疗选择，但对于博洛尼亚标准定义的卵巢反应不良者，其潜力非常有限，无论患者的年龄如何。这突出了这些女性的预后非常差，因此迫切需要未来的试验来研究博洛尼亚标准定义的卵巢反应不良者的卵巢刺激方案的效果。
研究资金/利益冲突：未使用任何资金。没有利益冲突。
