Influencing factors of cumulative live birth rate in patients with poor ovarian response undergoing in vitro fertilization

Abstract

Objective To investigate the cumulative live birth rate (CLBR) and its influencing factors of multiple cycles in vitro fertilization (IVF) in patients with poor ovarian response (POR). Methods From 2002 to 2016, a total of 3391 women with POR undergoing IVF-embryo transfer (ET) in Reproductive Medicine Center of Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology were analyzed retrospectively. Live birth rates per initiated cycle and CLBR for multiple IVF cycles were calculated. The conservative CLBR and optimistic CLBR were measured by Kaplan-Meier (KM) curve. The influencing factors of CLBR were analyzed by logistic multiple regression. Results The CLBR after 6 IVF cycles were 14.9% for the conservative estimate and 35.3% for the optimistic estimate. CLBR declined with increasing age. At age > 43 years, CLBR decreased sharply (4.4%). After adjusting for antral follicle count (AFC), basal follicle stimulating hormone (FSH) level, IVF cycle number and ovarian stimulation protocols, the CLBR of > 38 years old women was significantly lower than that of < 35 years old women (P<0.01). After adjusting for age, AFC, basal FSH level, and IVF cycle number, compared with the standard long regimen, the single cycle CLBR of antagonist regimen and luteal stimulating regimen were higher (OR=1.47, 95% CI=1.13-1.90, P=0.004; OR=1.42, 95% CI=1.01-2.01, P=0.04); natural cycles were associated with the lowest CLBR among all the protocols, and this difference was significant compared with the other protocols (all P<0.05). Conclusion For women with POR, the CLBR declined with increasing age. Women with advanced age (> 38 years) achieved a significantly lower CLBR than that in young POR women ( 43 years. Natural cycle IVF is of no benefit for these patients. Key words: Cumulative live birth rate; Fertilization in vitro; Embryo transfer; Poor ovarian response; Bologna criteria