Treatment algorithms for high responders: What we can learn from randomized controlled trials, real-world data and models

Drakopoulos, Panagiotis; Khalaf, Yakoub; Esteves, Sandro C.; Polyzos, Nikolaos P.; Sunkara, Sesh Kamal; Shapiro, Daniel B.; Rizk, Botros; Ye, Hong; Costello, Michael; Koloda, Yu.A.; Salle, Bruno; Lispi, Monica; D’Hooghe, Thomas; Marca, Antonio La

doi:10.1016/j.bpobgyn.2022.102301

Cited by 6 publications

(2 citation statements)

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“…Additionally, it has been shown that the incidence of adverse pregnancy outcomes is positively related to age [18]. Additionally, we examined only fresh ETs, owing to the low prevalence of surplus embryos for cryopreservation in poor responders, and to better examine the effect of the hormonal milieu on obstetric and perinatal outcomes in the different groups of ovarian response, since a hyper-response is known to significantly increase the risk for ovarian hyperstimulation and thromboembolic events [13,19,20].…”

Section: Participantsmentioning

confidence: 99%

“…Patients were classified as poor, normal, and high responders. Poor responders were defined as those receiving daily FSH ≥ 150 IU yielding ≤ 3 oocytes, based on standard definitions accepted in clinical practice [21]; high responders as those with ≥16 oocytes retrieved, regardless of FSH dosage [20]; and normal responders as those with 4-15 aspirated oocytes (ranging between a poor and a high response), regardless of FSH dosage. Demographic, clinical, and laboratory cycle outcome parameters, as well as treatment variables on the day of ovulation triggering, were compared between poor, normal, and high responders.…”

Section: Ovarian Stimulationmentioning

confidence: 99%

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Poor Response to Gonadotropin Stimulation and Perinatal Outcomes in Fresh In Vitro Fertilization Embryo Transfer Cycles—A Retrospective Cohort Study

Hochberg,

Wertheimer,

Zlatkin

et al. 2024

JCM

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Objective: The objective was to examine the association between poor ovarian response to gonadotropin stimulation for in vitro fertilization (IVF) and adverse perinatal outcomes in singleton gestations in young patients. Methods: This was a retrospective cohort study including women aged 17–39 who underwent fresh embryo transfer and delivered a singleton neonate at a single center (pre-implantation genetic testing excluded) (2007–2022). Patients were classified as one of the following categories: poor responders—daily follicle-stimulating hormone (FSH) ≥ 150 IU yielding ≤ 3 retrieved oocytes; normal responders—4–15 oocytes; and high responders with ≥16 oocytes. The primary outcome was a composite of pre-eclampsia (mild or severe), small-for-gestational-age, gestational diabetes mellitus, and preterm birth (<37 weeks). We compared maternal and neonatal outcomes between the three groups. Multivariable logistic regression was used to control for confounders. Results: Overall, 507 women met the inclusion criteria. Of them, there were 44 (8.68%) poor responders, 342 (67.46%) normal responders, and 121 (23.87%) high responders. Poor responders, compared to normal and high responders, were characterized by a higher maternal age (34.64 ± 4.01 vs. 31.4 ± 5.04 vs. 30.01 ± 4.93, p < 0.001, respectively) and total FSH dosage (3028.41 ± 1792.05 IU vs. 2375.11 ± 1394.05 IU vs. 1869.31 ± 1089.63 IU, p < 0.001). The perinatal outcomes examined, including cesarean delivery (CD) rate and the composite outcome, were comparable between groups. Using multivariable logistic regression and adjusting for ovarian response group, maternal age, nulliparity, and estradiol level and endometrial thickness before ovulation triggering, poor response was not associated with CD rate or the composite outcome, with maternal age associated with CD (p = 0.005), and nulliparity with the composite outcome (p = 0.007). Similar results were obtained when comparing poor responders to each other group separately or to all other responders. Conclusions: Poor ovarian response is not associated with increased adverse maternal or neonatal outcomes.

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