IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, 52621, Tel- Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel.
BMC Womens Health. 2022 Sep 30;22(1):395. doi: 10.1186/s12905-022-01964-y.
Poor responders to ovarian stimulation are one of the most challenging populations to treat. As a failed cycle can cause a considerable emotional and economical loss, adequate fertility counseling addressing patients' expectations are highly important when facing patients with poor ovarian response. The study aimed to evaluate reproductive outcomes and to identify factors associated with live birth (LB) after fresh autologous IVF/intracytoplasmic sperm injection (ICSI) cycles of patients fulfilling the Bologna criteria for poor ovarian response (POR).
A retrospective study included 751 IVF/ICSI treatment cycles which yielded up to three retrieved oocytes, at a tertiary referral hospital between January 2016 and February 2020. A logistic regression analysis was used to adjust for confounders.
Clinical pregnancy and LB rate per cycle were significantly higher among women younger versus older than 40 years (9.8% and 6.8% vs 4.5% and 2.1%, p < 0.01, respectively). Patients who achieved LB were significantly younger, had higher number of oocytes retrieved, fertilization rate and top-quality embryos (p < 0.05). Multivariable regression analysis identified patient's age (OR 0.90; 95% CI 0.845-0.97; p = 0.005) and mean number retrieved oocytes (OR 1.95; 95% CI 1.20-3.16; p = 0.007) as factors significantly associated with the probability of a LB.
The woman's age and the number of retrieved oocytes are both independent predicting factors of live birth in poor ovarian responders. Considering the risks, the high financial investment and poor reproductive outcomes involved in IVF treatments, raises questions regarding the adequacy of providing treatments in these patients' population. POR younger than 40 years may represent a possible exception due to acceptable probability for a LB.
卵巢刺激反应不良是最具挑战性的治疗人群之一。由于失败的周期可能会导致相当大的情感和经济损失，因此在面对卵巢反应不良的患者时，充分的生育咨询以满足患者的期望非常重要。本研究旨在评估生殖结局，并确定符合卵巢反应不良（POR）博洛尼亚标准的患者进行新鲜自体体外受精/胞浆内单精子注射（ICSI）周期后活产（LB）的相关因素。
本回顾性研究纳入了 2016 年 1 月至 2020 年 2 月在一家三级转诊医院进行的至多可获得 3 个取卵的 751 个 IVF/ICSI 治疗周期。采用逻辑回归分析调整混杂因素。
与年龄大于 40 岁的女性相比，年龄小于 40 岁的女性的临床妊娠和活产率/周期显著更高（分别为 9.8%和 6.8%比 4.5%和 2.1%，p<0.01）。获得活产的患者明显更年轻，取卵数、受精率和优质胚胎数更高（p<0.05）。多变量回归分析确定患者年龄（OR 0.90；95%CI 0.845-0.97；p=0.005）和平均取卵数（OR 1.95；95%CI 1.20-3.16；p=0.007）是与活产概率相关的独立预测因素。
女性年龄和取卵数是卵巢反应不良患者活产的独立预测因素。考虑到风险、IVF 治疗中涉及的高财务投资和不良生殖结局，这引发了关于在这些患者人群中提供治疗的适当性的问题。年龄小于 40 岁的 POR 可能是一个例外，因为活产的可能性可以接受。
