Our data show that the prevalence of poor ovarian response in Chinese is 11.9%. Previous ovarian surgery is associated with poor ovarian responses. The pregnancy rate of women with poor ovarian response is low in IVF-ET, especially the decline in clinical pregnancy rate of women aged >40 years became accelerated. Correct identification of those who are at risk for POR prior to stimulation is helpful in tailoring the best stimulation protocol to individual patients. Chronological age significantly improved the prediction of clinical pregnancy of poor ovarian responders.

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OBJECTIVE: Despite the dramatic shift towards blastocyst stage embryo transfer (ET) over the last decade, only a small number of studies have evaluated its use in frozen-thawed embryo transfer (FET) cycles. The objective of this study was to compare treatment outcomes in blastocyst vs. cleavage stage embryos in FET cycles using the Society for Assisted Reproductive Technology Clinic Online Report System (SARTCORS) database. We hypothesize that blastocyst stage FET's have increased pregnancy rates and improved pregnancy outcomes. DESIGN: A retrospective study. MATERIALS AND METHODS: An IRB approved review of FET cycles was performed on cycles between 2004 through 2013 using data from the SARTCORS. Only frozen, autologous cycles were included, while fresh IVF cycles were excluded. Only cycles with treatment and pregnancy outcomes were included. Demographic data was collected and compared between the blastocyst and cleavage stage FET groups. Data analysis was performed using multivariate and logistic regression, and chi-squared and independent sample t-tests (SAS software). RESULTS: A total of 256,287 FET cycles were analyzed. There were significant differences in the demographic characteristics between blastocyst vs. cleavage stage FET patients in terms of age, BMI, gravidity, parity, maximum serum FSH, and prior IVF cycles, but differences were not large enough to be clinically meaningful. Cleavage stage FET cycles had more smokers (7.2% vs. 5.25%), as well as fewer elective single ET's (5.4% vs. 20.2%) compared to the blastocyst FET cycles (p < 0.0001). Blastocyst FET's had significantly increased pregnancy rates (60.6% vs. 41.0%), clinical intrauterine gestations (48.5% vs. 32%), and live birth rates (37.9% vs. 24.7%) compared to cleavage stage FET's (p < 0.001). This improved success for blastocyst stage FET was achieved using both fewer embryos thawed (cleavage vs. blastocyst, 3.4 vs. 2.4 p < 0.001) and fewer embryos transferred (cleavage vs. blastocyst, 2.3 vs. 1.8 p < 0.001). Additionally, even after controlling for maternal age at freeze, BMI, smoking, prior IVF cycles, maximum serum FSH, and number of embryos transferred to the uterus, blastocyst stage FET resulted in a 54% increased odds of having a live birth compared to cleavage stage FET (OR 1.54, CI 1.49, 1.60). CONCLUSIONS: Blastocyst stage FET cycles have significantly higher rates of pregnancy and live birth overall compared to cleavage stage embryos. Blastocyst stage FET also have greater efficiency of pregnancy success per embryo available. The national trend to replace cleavage stage FET with blastocyst stage FET is well justified.