Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study

Abstract

Purpose to compare the baseline characteristics and chance of live birth in the different categories of poor responders identified by the combinations of the Bologna criteria and establish whether these groups comprise a homogenous population. Methods database containing clinical and laboratory information on IVF treatment cycles carried out at the Mother-Infant Department of the University Hospital of Modena between year 2007 and 2011 was analysed. This data was collected prospectively and recorded in the registered database of the fertility centre. Eight hundred and thirty women fulfilled the inclusion/ exclusion criteria of the study and 210 women fulfilled the Bologna criteria definition for poor ovarian response (POR). Five categories of poor responders were identified by different combinations of the Bologna criteria. Results There were no significant differences in female age, AFC, AMH, cycle cancellation rate and number of retrieved oocytes between the five groups. The live birth rate ranged between 5.5 and 7.4 % and was not statistically different in the five different categories of women defined as poor responders according to the Bologna criteria. Conclusion The study demonstrates that the different groups of poor responders based on the Bologna criteria have similar IVF outcomes. This information validates the Bologna criteria definition as women having a uniform poor prognosis and also demonstrates that the Bologna criteria poor responders in the various subgroups represent a homogenous population with similar pre-clinical and clinical outcomes.

Heterogeneity Among Poor Ovarian Responders According to Bologna Criteria Results in Diverging Cumulative Live Birth Rates

“…Following the publication of the BC in 2011, very few studies have been conducted to investigate their validity (23). Our results are in contrast with previous reports finding similar fresh LBR in different subgroups of BC PORs (13,24). In particular, La Marca et al (13) included 210 PORs in a retrospective analysis and showed similar LBR ranging from 5.5 to 7.4% in all groups defined as follows: group 1 (two cycles with <4 oocytes) vs. group 2 (age > 40 years + cycle with <4 oocytes), vs. group 3 (age > 40 + abnormal markers of ovarian reserve), vs. group 4 (cycle with <4 oocytes + abnormal markers of ovarian reserve) vs. group 5 (cycle with <4 oocytes + age > 40 + abnormal markers of ovarian reserve).…”

“…Our results are in contrast with previous reports finding similar fresh LBR in different subgroups of BC PORs (13,24). In particular, La Marca et al (13) included 210 PORs in a retrospective analysis and showed similar LBR ranging from 5.5 to 7.4% in all groups defined as follows: group 1 (two cycles with <4 oocytes) vs. group 2 (age > 40 years + cycle with <4 oocytes), vs. group 3 (age > 40 + abnormal markers of ovarian reserve), vs. group 4 (cycle with <4 oocytes + abnormal markers of ovarian reserve) vs. group 5 (cycle with <4 oocytes + age > 40 + abnormal markers of ovarian reserve). Similar findings were reported by Busnelli et al (24), in a retrospective analysis of 362 women allocated to five subgroups generated using BC, specifically: (i) anamnestic risk factors and one previous poor ovarian response; (ii) anamnestic risk factors and an abnormal ORT; (iii) an abnormal ORT and one previous poor ovarian response; (iv) anamnestic risk factors, an abnormal ORT and one previous poor ovarian response; (v) two episodes of poor ovarian response after maximal stimulation.…”

“…However, there is evidence that even within the BC population, a significant degree of heterogeneity still persists (11). Indeed, several patterns or subgroups of PORs can be distinguished within the BC based on possible combinations of risk factors, ORT results, and IVF attempts (11)(12)(13). These subpopulations clearly encompass diverse baseline characteristics and the prognostic potential of these naturally emerging subgroups, as well as their reproductive outcomes, remain unclear and urge further investigation.…”

Does freeze‐all policy affect IVF outcome in poor ovarian responders?

“…POR represent a challenging group of patients 25,28 , and the present study showed that there is no benefit of the freeze-all policy over fresh ET in POR patients undergoing the GnRH antagonist protocol for COS. Nowadays, there is evidence of increasing prevalence of POR 29 with a poor IVF prognosis [20][21][22] . In the present study, IRs were lower than 10%, both in the fresh ET and freeze-all groups, in accordance with previous studies published on POR [20][21][22][23]30 . Previously, Ç elik et al 31 evaluated the use of the freeze-all strategy in POR according to the Bologna criteria; the authors did not observe differences in IVF outcome when comparing fresh ET and elective frozen-thawed ET, corroborating the findings of the present study.…”

“…Poor ovarian responders (POR) represent 9-24% of patients undergoing IVF treatment; these individuals have very low pregnancy rates ranging from 3-14% [18][19][20][21][22][23] . Although several strategies have been proposed to optimize the ovarian response and the number of retrieved oocytes, there is no consensus regarding the treatments that are beneficial to POR [24][25][26] .…”