442 Low ovarian response to stimulation and adverse perinatal outcome in fresh IVF embryo transfer cycles

Abstract

Unlike maternal age, it is unclear whether the ovarian reserve alone has an impact on the obstetric outcome of pregnancies resulting from assisted reproductive technologies. We aimed to study the association between low ovarian response to gonadotropin stimulation and adverse perinatal outcome in singleton gestations. A retrospective cohort study of 382 women who underwent in-vitro fertilization and fresh embryo transfer and delivered a singleton neonate at a single center (pre-implantation genetic testing excluded). We examined the association between low ovarian response and adverse obstetric/perinatal outcomes. Patients were classified as: low responders - daily FSH≥300IU yielding ≤4 oocytes; normal responders 5-15 oocytes aspirated; high responders >15 oocytes aspirated; and sub-optimal treatment-daily FSH<300IU yielding ≤4 oocytes. Primary outcome was a composite of pre-eclampsia, gestational diabetes, small-for-gestational-age and delivery under 37 weeks. We compared maternal and neonatal outcomes between low responders and other groups. 27 women(7%) were categorized as low responders, 355(93%) as normal, high responders, or sub-optimal treatment. Maternal baseline characteristics were similar between groups except for increased maternal age and cycle number in low responders (36.15±3.74vs.30.7±4.9,p=<.0001, 4.52±2.76vs.3.04±2.66,p=0.0006, respectively). There were no differences in gestational age at delivery, birthweight, and the rates of preeclampsia, gestational diabetes, cesarean delivery and post-partum hemorrhage, or the composite outcome. Interestingly, low responders were more likely to give birth to males (74.07% vs. 49.86%,p=0.01522). Using multivariate logistic regression, the only two parameters found to be nearly-significantly associated with the composite outcome were low endometrial thickness on the day of ovulation triggering (p=0.0538) and nulliparity (p=0.0533). Low ovarian response was not associated with adverse maternal or neonatal outcome, despite a higher maternal age in this group.View Large Image Figure ViewerDownload Hi-res image Download (PPT)