Bourn Hall Clinic, High Street, Bourn Cambridge CB23 2TN, UK.
Bourn Hall Clinic, High Street, Bourn Cambridge CB23 2TN, UK.
Reprod Biomed Online. 2021 Apr;42(4):742-747. doi: 10.1016/j.rbmo.2020.12.001. Epub 2020 Dec 8.
What are the incidence and risk factors for poor ovarian response (POR) during repeat IVF?
A retrospective analysis of 1224 consecutive patients who underwent at least two IVF stimulations in a single centre over a 6-year period. Risk factors from the initial treatment were assessed for association with POR during repeat IVF using logistic regression analysis. A simple, practical predictive model was constructed and evaluated for accuracy and calibration, based on the factors that demonstrated significant association with subsequent POR. POR during repeat IVF was defined as ≤3 retrieved oocytes or cancellation before retrieval following recruitment of ≤3 mature follicles.
The risk of POR during repeat IVF was approximately 11.5%. A higher POR risk during repeat IVF is associated with a reduced oocyte yield during the initial treatment (≤3 oocytes: odds ratio [OR] 14, 95% confidence interval [CI] 6.42-30.24; 4-9 oocytes: OR 4.13, 95% CI 2.00-8.54; 10-15 oocytes: OR 1) and low ovarian reserve (anti-Müllerian hormone [AMH] <5.4 pmol/l: OR 3.54, 95% CI 2.24-5.59; AMH 5.4-25 pmol/l: OR 1). Women with low ovarian reserve who experience POR during the initial IVF have the highest risk of suffering POR again during repeat IVF (57% within 1 year). Other groups, such as women with unexpected POR or expected poor responders with suboptimal ovarian response during the initial IVF, are also at risk of exhibiting POR during a subsequent treatment (28% within 1 year).
As there is a clear association between POR and lower live birth rates, this practical model may help manage patients' expectations during repeat IVF treatment.
在重复体外受精（IVF）中，卵巢反应不良（POR）的发生率和风险因素是什么？
对在 6 年内于单一中心接受至少两次 IVF 刺激的 1224 例连续患者进行回顾性分析。使用逻辑回归分析评估初始治疗中的风险因素与重复 IVF 中 POR 的相关性。基于与随后的 POR 具有显著相关性的因素，构建并评估了一种简单实用的预测模型的准确性和校准度。
重复 IVF 中的 POR 定义为招募≤3 个成熟卵泡后，≤3 个获卵或取消取卵前的获卵≤3 个。
重复 IVF 中 POR 的风险约为 11.5%。重复 IVF 中 POR 风险较高与初始治疗中卵母细胞产量减少相关（≤3 个卵母细胞：比值比[OR]14，95%置信区间[CI]6.42-30.24；4-9 个卵母细胞：OR 4.13，95% CI 2.00-8.54；10-15 个卵母细胞：OR 1）和卵巢储备低（抗苗勒管激素[AMH]＜5.4 pmol/l：OR 3.54，95% CI 2.24-5.59；AMH 5.4-25 pmol/l：OR 1）。在初始 IVF 中经历 POR 的低卵巢储备女性在重复 IVF 中再次发生 POR 的风险最高（1 年内 57%）。其他组，如意外 POR 或初始 IVF 中卵巢反应欠佳的预期不良反应者，在随后的治疗中也有发生 POR 的风险（1 年内 28%）。
由于 POR 与较低的活产率之间存在明显关联，因此该实用模型可能有助于管理患者在重复 IVF 治疗期间的期望。
