Elsevier

Fertility and Sterility

Volume 104, Issue 6, December 2015, Pages 1435-1441
Fertility and Sterility

Original article
Live-birth rates in very poor prognosis patients, who are defined as poor responders under the Bologna criteria, with nonelective single embryo, two-embryo, and three or more embryos transferred

https://doi.org/10.1016/j.fertnstert.2015.08.023Get rights and content
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Objective

To determine live-birth rates (LBRs) at various ages in very poor prognosis patients, who are defined as poor responders under the Bologna criteria.

Design

Retrospective cohort study.

Setting

Academically affiliated private fertility center.

Patient(s)

Among 483 patients, who under the Bologna criteria (three or fewer oocytes, >40 years of age, and/or antimüllerian hormone [AMH] <1.1 ng/mL [2/3 criteria minimum]) were poor responders, 278 (381 fresh IVF cycles) qualified for the study because they had at least one embryo on day 3 for transfer.

Intervention(s)

IVF cycles in women with low functional ovarian reserve, involving androgen and CoQ10 supplementation and ovarian stimulation with daily gonadotropin dosages of 300–450 IU of FSH and 150 IU of hMG in microdose agonist cycles.

Main Outcome Measure(s)

Age-specific LBRs per ET.

Result(s)

Ages did not differ between nonelective (ne) single ET (SET), ne2-ET, and ne≥3-ET cycles (41.3 ± 3.9, 41.7 ± 3.1, and 42.4 ± 2.1 years, respectively). Patients with neSETs demonstrated significantly lower AMH and higher FSH levels and required higher gonadotropin dosages than ne2-ET and ne≥3-ET patients. LBRs declined with age. Above age 42, three or more embryos are required to achieve reasonable LBRs and two or more to avoid futility under American Society for Reproductive Medicine (ASRM) guidelines.

Conclusion(s)

Very poor prognosis patients can still achieve acceptable pregnancy rates at least till their mid-40s if they reach ET. The degree to which egg donation is emphasized as the only treatment option in such patients, therefore, requires reconsideration. Above age 42, at least two, and preferably three embryos, are however required to exceed futility, as defined by ASRM.

Key Words

Poor prognosis patients
poor responders in vitro fertilization (IVF)
live birth rates
futility

Cited by (0)

N.G. and D.H.B. are coinventors on a number of U.S. patents claiming therapeutic benefits from androgen supplementation in women with low functional ovarian reserve. Both receive royalties from Fertility Nutraceuticals, LLC, in which N.G. also holds shares. They report no other potential conflicts. M.V.V. has nothing to disclose. S.K.D. has nothing to disclose. A.W. has nothing to disclose. Y.-G.W. has nothing to disclose. Q.W. has nothing to disclose. L.Z. has nothing to disclose. D.F.A. has nothing to disclose. V.A.K. has nothing to disclose.

M.V.V. completed this work in fulfillment of a senior residency elective in reproductive endocrinology and infertility at the Center for Human Reproduction.

This study was funded by intramural funds from the Center for Human Reproduction and by grants from the Foundation for Reproductive Medicine.