Increased starting doses of exogenous gonadotropins do not improve IVF-ET outcomes in expected poor ovarian responders

Abstract

Background To evaluate whether increasing the starting dose of exogenous gonadotropins (Gn) improves in vitro fertilization and embryo transfer (IVF-ET) outcomes in patients with the expected poor ovarian response (POR), as defined by antral follicles count (AFC) ≤ 9. The outcomes of IVF-ET in patients with expected POR between January 2016 and December 2021 were compared retrospectively. A total of 2448 IVF cycles were studied, including 709 with a starting Gn dose of 150 IU (Group A), 1006 with 225 or 300 IU (Group B), and 733 with 375 or 450 IU (Group C). The cumulative live birth rate was the primary outcome, with secondary outcomes including the number of oocytes retrieved, the number of normal fertilization, the number of transferable embryos, positive pregnancy, clinical pregnancy, pregnancy loss, ectopic pregnancy of fresh embryo transfer, and cycle cancellation rate. Multivariate logistic regression analysis was used to control the confounding factors.Results The cumulative live birth rates (28.2% in group A vs. 23.6% in group B vs. 17.9% in group C, P < 0.001) were statistically significant. The relationship between cumulative live birth rate and grouping was investigated using multivariate logistic regression. The odds ratio (OR) of group B versus group A was 0.887, 95% confidence interval (CI) 0.655–1.174, P = 0.378, and the OR of group C versus group A was 0.77, 95% CI 0.545–1.089, P = 0.139. The total number of retrieved oocytes was 4.49 ± 3 in group A, 4.53 ± 2.8 in group B, and 3.91 ± 2.6 in group C. P < 0.001 indicated that the differences were statistically significant. Multivariate logistic regression was used to investigate the relationship between the number of retrieved oocytes and grouping. The OR of group B versus group A was 0.993, 95% CI 0.713–1.383, P = 0.966, and the OR of group C with group A was 0.881, 95% CI 0.614–1.264, P = 0.492.Conclusions Increasing the starting dose of Gn did not increase the number of oocytes retrieved or the cumulative live birth rate in POR patients.