The poor responder in IVF: is the prognosis always poor? A systematic review

Abstract

BACKGROUND In IVF treatment a considerable proportion of women are faced with a low number of oocytes retrieved. These poor responders have reduced pregnancy rates compared with normal responders. However, this may not be applicable to all poor responders. This review aims at identifying patient characteristics and ovarian reserve tests (ORT) that will determine prognosis for pregnancy in poor responders. METHODS A systematic search was conducted in PubMed, Embase, Cochrane and SCOPUS databases in April 2010. Studies regarding patient characteristics or ORT in poor responders and their pregnancy prospects were included. All included papers were summarized in descriptive tables. RESULTS Nineteen studies were included. Pooled data of six studies comparing poor and normal responders demonstrated clearly lower pregnancy rates in poor responders (14.8 versus 34.5%). Ten studies indicated that older poor responders have a lower range of pregnancy rates compared with younger (1.5-12.7 versus 13.0-35%, respectively). Four studies showed that pregnancy prospects become reduced when fewer oocytes are retrieved (0-7% with 1 oocyte versus 11.5-18.6% with 4 oocytes). Five studies concerning pregnancy rates in subsequent cycles suggested a more favourable outcome in unexpected poor responders, and if ≥2 oocytes were retrieved. CONCLUSIONS Poor responders are not a homogeneous group of women with regards to pregnancy prospects. Female age and number of oocytes retrieved in particular will modulate the chances for pregnancy in current and subsequent cycles. Applying these criteria will allow the identification of couples with a reasonable prognosis and balanced decision-making on the management of poor responders.

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

“…Globally, women who are poor responders have a lower pregnancy rate than normally responding women [19,[22][23][24]. Even in young poor responders IVF results are low but acceptable [25].…”

“Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial

“…These patients may be defined as "expected poor responders", and represent a subgroup of IVF patients in which several different COH regimens have been used trying to optimize oocyte yield. Unfortunately, to date no convincing evidence to support the use of a specific COH protocol has been provided, and the overall COH results in these challenging patients remain disappointing [2,3].…”

Can serum estradiol levels on the fourth day of IVF/ICSI cycle predict outcome in poor responder women?

“…Various screening tests have been introduced to predict poor ovarian responders before initiation of ovulation induction to tailor the treatment strategy and doses of medication to that patient. Previous ART cycle outcomes, age, antral follicle count, ovarian volume, day 3 FSH, E2, inhibin, anti-Müllerian hormone (AMH), and dynamic ovarian reserve tests are currently used as predictive tests for determining ovarian response to COH [Koshy et al 2013;Muasher et al 1988;Mutlu et al 2013;Oudendijk et al 2012;Smotrich et al 1995;Watt et al 2000]. However, apart from the actual ovarian follicular response to ovarian stimulation itself, none of the predictive tests for ovarian reserve have been found to be sufficiently accurate for predicting the ovarian response.…”