Hochberg Alyssa, Wertheimer Avital, Zlatkin Rita, Sapir Onit, Krispin Eyal, Schohat Tzippy, Altman Eran, Ben-Haroush Avi, Shufaro Yoel
IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel.
The Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
J Clin Med. 2024 May 19;13(10):2985. doi: 10.3390/jcm13102985.
The objective was to examine the association between poor ovarian response to gonadotropin stimulation for in vitro fertilization (IVF) and adverse perinatal outcomes in singleton gestations in young patients. This was a retrospective cohort study including women aged 17-39 who underwent fresh embryo transfer and delivered a singleton neonate at a single center (pre-implantation genetic testing excluded) (2007-2022). Patients were classified as one of the following categories: poor responders-daily follicle-stimulating hormone (FSH) ≥ 150 IU yielding ≤ 3 retrieved oocytes; normal responders-4-15 oocytes; and high responders with ≥16 oocytes. The primary outcome was a composite of pre-eclampsia (mild or severe), small-for-gestational-age, gestational diabetes mellitus, and preterm birth (<37 weeks). We compared maternal and neonatal outcomes between the three groups. Multivariable logistic regression was used to control for confounders. Overall, 507 women met the inclusion criteria. Of them, there were 44 (8.68%) poor responders, 342 (67.46%) normal responders, and 121 (23.87%) high responders. Poor responders, compared to normal and high responders, were characterized by a higher maternal age (34.64 ± 4.01 vs. 31.4 ± 5.04 vs. 30.01 ± 4.93, < 0.001, respectively) and total FSH dosage (3028.41 ± 1792.05 IU vs. 2375.11 ± 1394.05 IU vs. 1869.31 ± 1089.63 IU, < 0.001). The perinatal outcomes examined, including cesarean delivery (CD) rate and the composite outcome, were comparable between groups. Using multivariable logistic regression and adjusting for ovarian response group, maternal age, nulliparity, and estradiol level and endometrial thickness before ovulation triggering, poor response was not associated with CD rate or the composite outcome, with maternal age associated with CD ( = 0.005), and nulliparity with the composite outcome ( = 0.007). Similar results were obtained when comparing poor responders to each other group separately or to all other responders. Poor ovarian response is not associated with increased adverse maternal or neonatal outcomes.
目的是研究年轻患者体外受精（IVF）时促性腺激素刺激下卵巢反应不良与单胎妊娠不良围产期结局之间的关联。这是一项回顾性队列研究，纳入了17至39岁在单一中心接受新鲜胚胎移植并分娩单胎新生儿的女性（排除植入前基因检测）（2007 - 2022年）。患者被分为以下类别之一：反应不良者 - 每日卵泡刺激素（FSH）≥150 IU且获卵数≤3个；正常反应者 - 获卵数4 - 15个；高反应者 - 获卵数≥16个。主要结局是子痫前期（轻度或重度）、小于胎龄儿、妊娠期糖尿病和早产（<37周）的综合情况。我们比较了三组之间的母婴结局。采用多变量逻辑回归来控制混杂因素。总体而言，507名女性符合纳入标准。其中，有44名（8.68%）反应不良者，342名（67.46%）正常反应者，121名（23.87%）高反应者。与正常反应者和高反应者相比，反应不良者的特征是产妇年龄较大（分别为34.64±4.01岁 vs. 31.4±5.04岁 vs. 30.01±4.93岁，P<0.001）以及总FSH剂量较高（3028.41±1792.05 IU vs. 2375.11±1394.05 IU vs. 1869.31±1089.63 IU，P<0.001）。所检查的围产期结局，包括剖宫产（CD）率和综合结局，在各组之间具有可比性。使用多变量逻辑回归并调整卵巢反应组、产妇年龄、未生育情况以及排卵触发前的雌二醇水平和子宫内膜厚度后，反应不良与CD率或综合结局无关，产妇年龄与CD有关（P = 0.005），未生育情况与综合结局有关（P = 0.007）。将反应不良者分别与其他每组或所有其他反应者进行比较时，得到了类似的结果。卵巢反应不良与母婴不良结局增加无关。
