Main characteristics of IVF / ICSI protocols in patients with suboptimal response to controlled ovarian stimulation

Abstract

HYPOTHESIS/AIMS OF STUDY: According to the number of oocytes retrieved in IVF/ICSI protocols, the ovarian response to controlled ovarian stimulation is divided into: poor (0–3 oocytes), suboptimal (4–9 oocytes), normal (10–15 oocytes) and excessive (>15 oocytes) response. However, the effectiveness of IVF / ICSI programs in women with a suboptimal response is poorly understood, since this cohort of patients is often fallen into the category of women with a normal response. The aim of this study was to determine the main characteristics of IVF / ICSI programs in patients with suboptimal response to be further compared to those in women with normal response to controlled ovarian stimulation.

STUDY DESIGN, MATERIALS AND METHODS: This retrospective study included 568 patients: 470 women with suboptimal response and 98 women with normal response to controlled ovarian stimulation. The comparative analysis comprised clinical and anamnestic data, as well as the main characteristics of assisted reproductive technology programs in the selected clinical groups.

RESULTS: It was found that patients with suboptimal response to controlled ovarian stimulation had significantly more frequent history of pelvic surgery (71.3 % vs. 55.1 %; p < 0.01) and pelvic inflammatory diseases (70.9% vs. 60.2%; p < 0.05). Parameters of ovarian reserve (serum anti-Müllerian hormone level and antral follicle count) in women with suboptimal response were significantly lower (p < 0.001). In addition, the number of mature oocytes, 2PN zygotes, good quality embryos (p < 0.001), as well as the clinical pregnancy rate in women with suboptimal response were found to be significantly lower than in patients with normal response to controlled ovarian stimulation (27.2% vs. 41.7%; p < 0.01). It was noted that concomitant uterine fibroids enhanced the negative impact on the effectiveness of IVF / ICSI programs in women with suboptimal response to controlled ovarian stimulation (OR = 0.5; 95% CI: 0.3–0.9; p = 0.03). ROC analysis identified predictors of suboptimal response to controlled ovarian stimulation, such as serum anti-Müllerian hormone level (AUC = 0.80) with the cut-off value of ≤2.57 ng / ml (sensitivity 74%, specificity 75%) and antral follicle count (AUC = 0.90) with the cut-off value of ≤10 follicles (sensitivity 80%, specificity 94%).

CONCLUSION: In women with suboptimal response to controlled ovarian stimulation, IVF / ICSI success rates are significantly reduced when compared to those in women with normal response. Concomitant uterine fibroids may further decrease the effectiveness of IVF / ICSI protocols in patients with suboptimal response. Predictors of suboptimal response include the serum anti-Müllerian hormone level and antral follicle count.

Keywords

suboptimal response / normal response / IVF / ICSI / controlled ovarian stimulation / clinical pregnancy rate

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