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Expected poor response patients, defined as patients with an AFC <5, are likely not to benefit from a higher starting dose of gonadotrophins in IVF.

We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.

Objective: To calculate the cumulative ongoing pregnancy rate in patients with a poor response in their first IVF cycle. Design: Retrospective cohort study. Setting: In vitro fertilization unit of a university hospital. Patient(s): Two hundred twenty-five women who experienced a poor response in their first IVF or intracytoplasmic sperm injection cycle. These patients were divided into 64 expected (aged Ն41 years and/or elevated FSH level) and 161 unexpected poor responders (aged Ͻ41 years and FSH level not elevated). Intervention(s):In vitro fertilization treatment with a long-suppression protocol with FSH-urofollitropin or recombinant FSH. Main Outcome Measure(s): Cumulative ongoing pregnancy rate. This rate was calculated in two ways to correct for dropouts: pessimistic (zero chance of pregnancy for the dropouts) and optimistic (the same chance for the dropouts as for patients who continued). Result(s):The cumulative ongoing pregnancy rate of women with an unexpected poor response in the first cycle was 37% (pessimistic) to 47% (optimistic) after three cycles. Women with an expected poor response had a cumulative ongoing pregnancy rate of 16% (pessimistic) to 19% (optimistic) after 3 cycles. Sixty-four percent of the unexpected poor responders and 31% of the expected poor responders had a normal response in the second cycle, most of them after receiving a higher dose of gonadotropins. Conclusion(s):Most patients with an unexpected poor response in the first cycle had a normal response in the second cycle, leading to an acceptable cumulative ongoing pregnancy rate after three cycles. Patients with an expected poor response in the first cycle should be advised to withdraw from treatment after the first cycle because of a poor prognosis. (Fertil Steril 2004;81:1247Ϫ53.

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