The probability of successful IVF outcome after poor ovarian response

Abstract

Background: To evaluate the relationship between age and poor ovarian response to pregnancy and cancellation rate after IVF stimulation.

Methods: Poor ovarian response was defined as <or=5 follicles at ovum pick up (OPU). Out of 1,706 consecutive OPUs performed during 2003/2004, 290 poor responders were identified. This cohort of poor responders was divided into two groups, 'older' and 'younger', with a cut-off at the median age of 37 years. The pregnancy and cancellation rates after OPU were analysed.

Results: Women aged >37 years, who were poor responders, had a significantly lower pregnancy rate per OPU (3.0%) compared to normal to high responders in the same age group (22.1%, p<0.05). Also, 43.6% of women >37 years, who were classified as poor responders, did not receive an embryo transfer (ET), compared to 13.2% of normal to high responders in this age group (p<0.05). Poor responders who were <or=37 years had a significantly lower pregnancy rate/OPU compared to normal to high responders who were <or=37 years (14.0 versus 34.5%, p<0.05) and a higher cancellation rate (40.1 versus 10.5%). Logistic regression analyses showed strong correlations between treatment outcome and the number of oocytes, age, and the mean and cumulative FSH dose given. The variable with the strongest impact on negative outcome was an interactive term between mean age and mean-FSH dose (p=5.0 x 10(-5)), indicating that women >37 years, who receive high doses of FSH have a significantly poorer treatment outcome than can be explained by either age or FSH dose alone.

Conclusions: Poor ovarian response after IVF stimulation requires thorough counselling prior to OPU, regardless of the woman's age. In poor responders >37 years of age, especially those who require high FSH doses, we suggest that the decision whether or not to proceed to OPU should include the couple after thorough counselling, even though the chance of successful outcome is extremely low.