How does pathology influence cumulative pregnancy rate in poor responder patients?

Abstract

We have conducted this observational retrospective study with the aim to see how different causes of infertility and associated pathologies influence the pregnancy rate in poor responder patients, according to Poseidon criteria. We included 332 women who met the POSEIDON criteria and underwent 438 controlled ovarian stimulation protocols and compared the cumulative pregnancy rate according to associated pathologies. We identified that 53% of the patients had dysmenorrhea, 36.4% had tubal pathology, 12.3% had a history of ovarian surgery, 13.6% had endometriosis, 4.8% had autoimmune thyroiditis, 8.4% had thrombophilia, 5.1% had uterine leiomyoma, and 18.7% had submucous leiomyoma, endometrial polyps or uterine synechia. In 47.7% of the couples, we identified a male infertility factor. The biochemical pregnancy rate was 33.6% and the clinical pregnancy rate was 26.9%. Life birth rate was 18.5%. We compared the pregnancy rate in all 332 patients and observed that no pathology had a significant influence on cumulative pregnancy rate (p>0.05). We also compared the pregnancy rate according to POSEIDON groups and we observed that no pathology had a significant influence on cumulative pregnancy rate (p>0.05), except for POSEIDON 1B group, where endometriosis had a negative effect on cumulative pregnancy rate (37.5% versus 84.8%; p=0.013). When comparing the cumulative pregnancy rate according to age and AMH (antimüllerian hormone), we observed that patients with an AMH≥1.2 ng/ml and maternal age below 35 years old had a significant higher pregnancy rate than patients with AMH<1.2 ng/ml (45.4% versus 25.8%) and maternal age ≥35 years old (49.1% versus 29.7%; p<0.001). We can conclude that age and AMH are the main influencing factors of cumulative pregnancy rate in poor responder patients. The associated pathology has a low or no impact on pregnancy rate in poor responder patients.