Live birth rates in various subgroups of poor ovarian responders fulfilling the Bologna criteria

Abstract

The European Society of Human Reproduction and Embryology published Bologna criteria to generate a definition of poor ovarian responders (PORs). However, there are few data on whether PORs are homogenous for ovarian response or live birth rates (LBRs). In this retrospective study, 821 patients fulfilling Bologna criteria and undergoing intracytoplasmic sperm injection were stratified into four groups: Group A: female age ≥40 with a previous poor response (cycle cancelled or ≤3 oocytes) (105 patients, 123 cycles); Group B: female age ≥40 with an antral follicle count (AFC) < 7 (159 patients, 253 cycles); Group C: AFC <7 with a previous poor response (350 patients, 575 cycles); and Group D: female age ≥40 with an AFC <7 and previous poor response (207 patients, 306 cycles). Cluster data analysis was performed. Although median number of oocytes was higher in Group B (P < 0.001), higher implantation (P = 0.024) and LBR per embryo transfer (P < 0.001) or cycle (P = 0.001) were noted in Group C. We conclude that, once a patient fulfils Bologna criteria, prognosis is poor, with fewer than 10% recorded LBRs per cycle. However, the LBRs are not homogenous and 'young proven' PORs have the most favourable pregnancy outcome.

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

“…In contrast with the aforementioned findings, our results are in line with those described by Bozdag et al, who demonstrated LBR of 2.3-8.7% per started IVF cycle in BC PORs, with "young proven" PORs having the most favorable reproductive outcomes (12). Nonetheless, our primary endpoint was cumulative LBR, which is a more relevant clinical outcome, while Bozdag et al assessed only fresh LBR (12).…”

“…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.…”

“When All Seems Lost”: The Ultralong Estrogen Priming (ULEP) Cycle Offers Good Pregnancy Outcomes in Poor Responder Patients

“…The control group, which was matched for age and the number of previous failed IVF cycles, showed a much poorer ongoing pregnancy rate of 6% per cycle. The control group pregnancy rates are similar to those reported in other large studies of poor responders at 2%-8% per cycle (Bozdag et al, 2017;La Marca et al, 2015).…”

Live birth rates in different subgroups of poor ovarian responders according to Bologna criteria and POSEIDON group classification

“…The marker of success according to the POSEIDON stratification is the number of retrieved oocytes required to obtain at least one euploid embryo for transfer in each individual patient [7]. Some studies evaluated live birth rates in different subgroups of POR patients fulfilling the Bologna criteria and found similar live birth in different subgroups [10,1,11,12]; furthermore, these studies reported that the independent significant variables related to the live birth rate were women' age [10,11] and the number of oocytes retrieved [12]. Only one study compared the live birth rates in different subgroups of POR patients on the basis of the POSEIDON classification and reported that the live birth rates (LBR) were significantly higher in POSEIDON group 1 and 2 compared with the other groups; the authors assumed that good ovarian reserve in these groups lead to a better ART outcome [9].…”