The Prediction And Effects On Pregnancy Outcome Of Poor Ovarian Response In Vitro Fertilization-embryo Transfer

As a result of temporary social trends,more and more young women present poor or low response to usual gonadotrophin stimulation protocol applied among in vitro fertilization-embryo transfer.The most dominant reason for poor ovarian response is the decline of ovarian reserve.The term of ovarian reserve,as a predictor of fertility,is referred to the quantity and quality of reserved follicles in ovary.Diminished fertility subsequently to the decline of ovulational ability and fallen quality of follicle cells is called the decrease of ovarian reserve.Before ovarian stimulating,it is crucial to predict the occurrence of poor ovarian response and subsequently,to deliver proper stimulating protocols.Purpose To explore the predictor of clinical pregnancy and possible aetiology of poor ovarian response(POR) in in vitro fertilization-embryo transfer(IVF-ET).Method All retrieval oocyte cycles finished in our center between Jan 1,2007 and Dec 30,2008 were retrospectively analyzed.Poor ovarian responses were observed in 118 patients of 123 cycles undergoing IVF or ICSI,according to the number of ooeytes retrieved and the level of estrogen.Other 123 cycles,during which oocytes retrieved almost simultaneously,were selected as controls.Age,basic endocrine level,previous operation history of ovary/ovarian duct,basic antral follicle count,amount and duration of gonadotrophin(Gn) stimulating hormone applied,fertility rate,high-quality embryo rate,trandferred high-quality embtyo rate,implantation rate and clinical pregnancy rate were compared between the poor ovarian response group and the control group.Some predictive indicators for poor ovarian response were also analyzed.All data were analyzed with SPSS 16.0 software,and are presented as mean±SD.T-test or Mann-Whitney test was applied for measurement data andχ2 test for enumeration data. P＜0.05 was considered significant.Logistic regression analysis was used for prediction of the probability of occurrence of an event.The clinical Value of this trial was checked by analyzing the area under the ROC curve.And the accuracy of prediction was also tested using Youden index.Results The rate of previous operation history,basic FSH(bFSH),ratio of bFSH/bLH and total amount of applied Gn in poor ovarian response group were significantly higher than those in control group.Basic antral follicle count,peak value of E₂ before oocytes retrieval and clinical fertility rate in poor ovarian response group were significantly lower than those in control group.Basic antral follicle count and bFSH level were most correlative with the occurrence of poor ovarian response,and low basic antral follicle count was one of high risk factors for poor ovarian response.Basic E₂ level did not have any predictive value for occurrence of poor ovarian response. Basic FSH(bFSH) and ratio of bFSH/bLH had medium predictive value,and basic antral follicle count was shown more valuable in predicting poor ovarian response. Combined bFSH and basic antral follicle count can improve the prediction of poor ovarian response.The infertility RR of poor ovarian response over control is 1.26.The high-quality embryo rate in poor ovarian response group was higher than that in control group.And there were no significant difference between two groups in fertility rate, transferred high-auality embryo rate and implantation rate.Conclusion This trial suggested that previous ovary operation history,high bFSH level and low basic antral follicle count were high risk factors for poor ovarian response. Basic antral follicle count was much valuable in predicting the occurrence of poor ovarian response,and basic FSH(bFSH) and ratio of bFSH/bLH owned some value in predicting this disorder.Once poor ovarian response occurs,the risk of infertility increases significantly.But it is not recommended to give up the cycle in women less than 40 years old.