Association between response to ovarian stimulation and miscarriage following IVF: an analysis of 124 351 IVF pregnancies (original) (raw)
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Human Reproduction, 2008
background: The increase in miscarriage rate with female age is attributed to a decline in oocyte quality. This age-related decrease of oocyte quality is accompanied by a decrease in oocyte quantity. Assessment of the number of oocytes by ovarian reserve tests (ORTs) may therefore also represent their quality. The objective of our study was to assess the predictive value of ORTs for miscarriage in subfertile women.
Fertility and Sterility, 2016
Women with history of recurrent miscarriage (RM; n ¼ 71) and sequentially selected age-matched fertile women who were seeking contraception (control; n ¼ 70). Intervention(s): Not applicable. Main Outcome Measures(s): Serum levels of FSH, LH, E 2 , and antim€ ullerian hormone (AMH); FSH/LH ratio; ovarian volumes; and antral follicle count (AFC). Result(s): The levels of FSH were 8.6 AE 3.7 U/L in the RM group and 7.1 AE 3.9 U/L in the control group; this difference was statistically significant. The levels of AMH were significantly lower in the RM group than in the control group (2.9 AE 1.7 ng/mL vs. 3.6 AE 1.7 ng/mL). The percentage of women with levels of FSH R11 U/L was significantly higher in the RM group than in the control group (18.3% vs. 4.3%). In the RM group, the percentage of women with levels of AMH %1 ng/mL was significantly higher than in the control group (19.7% vs. 5.7%). Conclusion(s): Recurrent miscarriage may be associated with diminished ovarian reserve. Larger prospective randomized controlled trials are warranted to better determine the predictive potential of ovarian reserve markers in recurrent miscarriage. (Fertil Steril Ò 2016;105:1236-40. Ó2016 by American Society for Reproductive Medicine.
TURKISH JOURNAL OF MEDICAL SCIENCES, 2019
Background/aim: Diminished ovarian reserve (DOR) represents a major challenge in reproductive medicine, as it is often associated with poor ovarian stimulation response, high cycle cancellation rate, and low pregnancy rate. The aim of the present study is to compare the clinical pregnancy rates in intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles in patients with different DOR etiologies. Materials and methods: Patient data were recorded with a computer-based program called Success Estimation Using a Ranking Algorithm (SERA). Overall, 459 patients were divided into 3 groups according to their DOR etiologies (Group A: idiopathic, n = 81; Group B: age-related, n = 294; Group C: previous ovarian surgery, n = 84). Results: Out of 459 stimulation cycles, 378 (82.4%) reached the oocyte retrieval stage, while 201 (43.8%) had embryo transfers. There was no significant difference between the patients with different DOR etiologies in terms of embryo transfer and cycle cancellation rate. The patients who had embryo transfer were 44 (52.4%) in Group A, 38 (46.9%) in Group B, and 119 (40.5%) in Group C. There were no significant differences between the three groups (P = 0.114). The percentages of women who had oocyte retrieval were 84.5% in Group A, 70% in Group B, and 80.3% in Group C (P = 0.104). While clinical pregnancy per transfer was 35.8% in Group A, 19.8% in Group B, and 29.5% in Group C, there was no statistically significant difference between the groups (P = 0.113). Conclusion: Although ovulation induction and ICSI-ET outcomes, including clinical pregnancy and live birth rates, were not significantly different with regards to the etiology of DOR, young women with DOR may benefit from assisted reproductive techniques.
Fertility and Sterility, 2008
Reproductive BioMedicine Online (2010) 20, 191-200 w w w . s c i e n c e d i r e c t . c o m w w w . r b m o n l i n e . c o m (P = 0.001). Due to interaction, this association became stronger with increasing female age. Among women <36 years, miscarriage rates between poor and normal responders did not differ, whereas among women 36 years poor responders had a statistically significant increased miscarriage rate compared with normal responders (P = 0.001). These results support the hypothesis of a relationship between quantitative ovarian reserve and oocyte quality. RBMOnline
Miscarriage risk for IVF pregnancies in poor responders to ovarian hyperstimulation
Reproductive BioMedicine Online, 2010
Reproductive BioMedicine Online (2010) 20, 191-200 w w w . s c i e n c e d i r e c t . c o m w w w . r b m o n l i n e . c o m (P = 0.001). Due to interaction, this association became stronger with increasing female age. Among women <36 years, miscarriage rates between poor and normal responders did not differ, whereas among women 36 years poor responders had a statistically significant increased miscarriage rate compared with normal responders (P = 0.001). These results support the hypothesis of a relationship between quantitative ovarian reserve and oocyte quality. RBMOnline
Fertility and Sterility, 2002
To identify and quantify predictors of poor ovarian response in in vitro fertilization (IVF). Design: Prospective study. Setting: Tertiary fertility center. Patient(s): One hundred twenty women undergoing their first IVF cycle. Intervention(s): Measurement of the number of antral follicles and the total ovarian volume by ultrasound, and of basal levels of FSH, E 2 , and inhibin B on cycle day 3. Main Outcome Measure(s): Ovarian response, and clinical and ongoing pregnancy rates.
Human Reproduction, 2004
BACKGROUND: Poor ovarian response limits IVF success but assessing interventions is dif®cult because of the wide variation in de®nition. This study attempts to derive objective de®nitions of poor response. METHODS: A retrospective study of a consecutive series of 1190 patients aged <40 years undergoing their ®rst IVF/ICSI cycle was undertaken. Factors adversely affecting implantation, including advanced female age, were excluded. Clinical outcome in cycles reaching oocyte retrieval (n = 1036) were evaluated with respect to gonadotrophin dose used and oocyte number. Cancelled cycles (n = 154) were analysed in relation to the stimulation dose at cancellation and outcome of their subsequent cycle. RESULTS: Cycle cancellation for patients on b300 IU FSH/day compared to those on a lower dose was associated with a signi®cantly worse outcome in the subsequent cycle. If <3000 IU FSH/cycle were administered, clinical pregnancy rates remained favourable if <4 eggs were recovered (29 versus 33% for b5 eggs). By contrast, if b3000 IU FSH was required, the pregnancy rate was 25% if b5 eggs were recovered but declined to 7% if <4 were obtained. CONCLUSIONS: De®nitions of poor response should include the degree of ovarian stimulation used. A low oocyte number is only detrimental if the cumulative dose is >3000 IU FSH. Cancellation at b300 IU FSH/day is associated with a signi®cantly worse prognosis and could de®ne poor response.
Human reproduction (Oxford, England), 2015
Is there a relation between the number of oocytes retrieved following ovarian stimulation and obstetric outcomes of preterm birth (PTB) and low birthweight (LBW) following IVF treatment? There is an increased risk of PTB (<37 weeks gestation) and LBW (<2500 g) following IVF in women with a high number (>20) of oocytes retrieved. Pregnancies resulting from assisted reproductive treatments (ART) are associated with a higher risk of pregnancy complications compared with spontaneously conceived pregnancies. Whether ovarian ageing in women with poor ovarian response is associated with an increased risk of adverse obstetric outcomes is debated. It is also unclear if an excessive response and high egg numbers following ovarian stimulation have an association with adverse obstetric outcomes. Observational study using anonymized data on all IVF cycles performed in the UK from August 1991 to June 2008. Data from 402 185 IVF cycles and 65 868 singleton live birth outcomes were analyse...
Expected poor ovarian response in predicting cumulative pregnancy rates: a powerful tool
Reproductive biomedicine online, 2008
Poor ovarian response in IVF cycles is associated with poor pregnancy rates. Expected poor responders may represent the worst prognostic group. Data were used from 222 patients starting the first of three IVF treatment cycles. The predictability of ongoing pregnancy after three cycles was analysed using survival analysis and hazard rate ratios. If first cycle poor responders were also predicted to have a poor response, they were classified as expected poor responders. The predicted pregnancy rate in cycles 2 and 3 for women with an observed poor response in the first cycle was approximately 24% for women aged 30 years and approximately 14% for women aged 40 years. For women with an expected poor response these rates were 12% and 6%, respectively. In contrast, women aged 40 years with an unexpected poor response still had a predicted cumulative pregnancy rate of 24%. Age as a sole predictor of cumulative pregnancy does not help to identify poor prognosis cases. Cumulative pregnancy r...
Predicting IVF outcome in poor ovarian responders
Background 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). Methods A retrospective study included 751 IVF/ICSI treatment cycles which yielded up to three retrieved oocytes, at a tertiary referral hospital between January 2016 to February 2020. A logistic regression analysis was used to adjust for confounders. Results Clinical pregnancy and LB rate per cycle were significantly higher among women younger versus older than 40 years (9.8% and 6.8% versus 4.5% and 2.1%, p < 0.01, res...