Cumulative live birth rates among over 13,000 poor ovarian responders from 2015 to 2023: a retrospective cohort study assessing the efficacy of natural cycle and controlled ovarian stimulation.

BACKGROUND

Natural cycle in vitro fertilization (NC-IVF) represents a convenient and safe assisted reproductive technology, making it particularly advantageous for patients with poor ovarian response (POR). This research evaluates the effectiveness of NC-IVF for women with POR, aiming to inform personalized treatment decisions.

METHOD

This retrospective cohort study encompassed 13,013 cycles involving women diagnosed with poor ovarian response according to the Bologna criteria. These patients underwent either natural cycles or controlled ovarian stimulation cycles. The primary outcome measure was the cumulative live birth rates, and the secondary outcomes included laboratory and clinical outcomes.

RESULTS

A total of 1073 natural cycles and 11,940 COS cycles were analyzed, with 5956 undergoing low-dose gonadotropin treatment and 5984 receiving high-dose gonadotropin. The basic characteristics were comparable among the three groups. In both fresh and frozen embryo transfer cycles, clinical pregnancy rates, implantation rates, and live birth rates were comparable across all three groups. Furthermore, no statistically significant differences were observed in cumulative live birth rates or time to first live birth between the groups examined. Expenditures in the natural cycle group were substantially lower than those in both COS cohorts. Importantly, further analysis indicated that there were no significant differences among the three groups concerning either pregnancy complications or neonatal outcomes.

CONCLUSION

Our findings indicate that for women demonstrating a poor ovarian response, NC treatment yields comparable pregnancy and live birth rates when compared to controlled ovarian stimulation methods. The natural cycle represents a safe, effective, and economically viable treatment option for this patient population.