Abstract
ObjectiveTo investigate ovarian sensitivity in subgroups of patients with a low prognosis, as defined by the POSEIDON criteria, undergoing in vitro fertilization treatment and measures to improve ovarian sensitivity in these patients.DesignWe conducted a retrospective cohort analysis.SettingThe study was conducted at an IVF clinic in a public hospital.PatientsA total of 32,128 fresh IVF cycles from January 2014 to October 2018 at a single IVF clinic were included in the analysis. Patients with a low prognosis were categorized into four groups based on the POSEIDON criteria.InterventionsNone.Main Outcome MeasureThe primary outcome measures were the follicular output rate (FORT) and the follicle-to-oocyte index (FOI).ResultsThe FORTs in the order from the highest to the lowest were 1.18 in group 3, 0.98 in group 4, 0.76 in group 1, and 0.68 in group 2. The trend in the FOI values was consistent with that in the FORTs. Among patients with poor ovarian sensitivity, 58.41% of patients with FORTs ≥ 0.30 in the second cycle underwent an adjustment to the ovarian stimulation (OS) protocol and 41.59% underwent an adjustment to the gonadotropin (Gn) starting dose. Among patients with normal ovarian sensitivity, 43.56% of those with FORTs ≥ 0.80 in the second cycle underwent an adjustment to the OS protocol and 56.44% underwent an adjustment to the Gn starting dose.ConclusionOvarian sensitivity was the highest in group 3 (young women with poor ovarian reserve), followed by groups 4 (women at advanced age with poor ovarian reserve) and 1 (young women with good ovarian reserve), and it was the lowest in group 2 (women at advanced age with good ovarian reserve). For patients with poor ovarian sensitivity, it is preferred to recommend an adjustment to the OS protocol, while for those with normal ovarian sensitivity, adjusting the Gn starting dose is preferred.
Highlights
The definition for patients with low ovarian response was different in the past, but these patients have received great attention
Patients with low prognosis: Group 1 (n = 1,787 cycles): age < 35 years; antral follicle count (AFC) ≥ 5; number of oocytes retrieved in the previous cycle ≤ 9
For patients with 0.30 ≤ FORT < 0.80, 43.56% of patients with FORTs ≥ 0.80 in the second cycle underwent an adjustment to the ovarian stimulation (OS) protocol and 56.44% underwent an adjustment to the Gn starting dose
Summary
The definition for patients with low ovarian response was different in the past, but these patients have received great attention. The Bologna criteria [1], proposed in 2011, defined the population of women with poor ovarian response (POR) as a single patient population, ignoring their heterogeneity and the impact of age-related oocyte quality. The Bologna criteria were the first clear criteria to identify poor responders, they could not indicate the most effective treatment or the underlying causes of low response. The incidence of patients with low prognosis attending a fertility center might vary between clinics and countries, but studies indicate that 47% of patients who undergo Assisted Reproductive Technology (ART) fit into one of the POSEIDON categories [3]
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