Cumulative live birth rates for low-prognosis women over 5 years or 9 frozen-thawed embryo transfer cycles

Abstract

Background For heterogeneous populations of low-prognosis women, it remains unclear as to how long individuals should continue undergoing ART when attempting to have a baby, as there have been insufficient studies to date tracking the cumulative live birth rates (CLBRs) for these women over the entire course of their ART treatment, particularly over extended time periods. Methods This was a retrospective analysis of 17,698 women at a tertiary care academic medical center who had begun undergoing IVI/ICSI cycles using a progestin-primed ovarian stimulation (PPOS) approach between January 2013 and January 2019. Low-prognosis patients were stratified into four groups based upon POSEIDON criteria, with patients exhibiting normal or high ovarian reserves and response to stimulation (defined as AFC ≥5, > 9 oocytes retrieved) being included as controls (group 5). The CLBR within 5 years or 9 FET cycles from the ovum pick-up (OPU) day of the first cycle was the primary endpoint for this study, including all repetitive oocyte retrieval cycles and subsequent FET cycles. Optimistic and conservative approaches were used for the analysis of CLBRs and the depiction of cumulative incidence curves. Results Under both optimistic and conservative model analyses, normal and good responders exhibited the highest CLBR within 5 years or 9 FET cycles, followed by younger unexpected poor responders, younger expected poor responders, older unexpected poor responders, and older expected poor responders. Upward trends in CLBRs were evident across the five groups with the prolongation of time or an increase in FET cycle counts. Within the first 2 years or 3 FET cycles, the CLBRs rose rapidly, followed by more moderate increases over the following 2–3.5 years or 4–6 cycles, with expected poor responders exhibiting the most obvious improvements. All Patients reached a CLBR plateau after 3.5 years or 6 FET cycles. Conclusions All low-prognosis women should undergo ART treatment for a minimum of 2 years or 3 FET cycles, and exhibit better outcomes when extending ART treatment to 3.5 years or 6 FET cycles (particularly for POSEIDON groups 3 and 4), but should consider ceasing further treatment thereafter due to a lack of apparent benefit.

Analysis of cumulative outcomes and influencing factors of patients with discrepancies between age and AMH levels in the early follicular phase prolonged protocol

“…Chen et al. found in their study that the CLBR showed a significant upward trend with the prolongation of time or the increase in the number of FET ( 33 ). This suggests that, although older high-AMH group patients may have decreased CPR and LBR due to decreased oocyte quality as they get older, with the increase in the number of transplantation cycles, they may achieve cumulative outcomes comparable to those in young patients.…”

The role of age and AMH on cumulative live birth rates over multiple frozen-thawed embryo transfer cycles: a study based on low prognosis patients of POSEIDON 3 and 4 groups

“…The COX regression analysis confirmed that in FET cycles, POSEIDON criteria was an independent factor positively associated with CLBR. Until now, only one large cohort study on CLBR in FET cycles was published which analyzed the CLBR within 5 years or 9 FET cycles in groups based on POSEIDON criteria [ 14 ]. The CLBR over 5 years estimated by optimistic analytical method was 0.75 (0.71–0.78) in POSEIDON group 3, almost the same as that of control group with 0.79 (0.78–0.80) and much higher than 0.41 (0.37–0.46) in POSEIDON group 4.…”

The Role of Age and AMH On Cumulative Live Birth Rates Over Multiple Frozen-thawed Embryo Transfer Cycles: A Study Based On Low Prognosis Patients Of POSEIDON 3 and 4 Groups

“…The COX regression analysis con rmed that in FET cycles, POSEIDON criteria was an independent factor positively associated with CLBR. Until now, only one large cohort study on CLBR in FET cycles was published which analyzed the CLBR within 5 years or 9 FET cycles in groups based on POSEIDON criteria [14]. The CLBR over 5 years estimated by optimistic analytical method was 0.75 (0.71-0.78) in POSEIDON group 3, almost the same as that of control group with 0.79 (0.78-0.80) and much higher than 0.41 (0.37-0.46) in POSEIDON group 4.…”