Cumulative live birth rates in low-prognosis women

Abstract

STUDY QUESTION Do cumulative live birth rates (CLBRs) over multiple IVF/ICSI cycles confirm the low prognosis in women stratified according to the POSEIDON criteria? SUMMARY ANSWER The CLBR of low-prognosis women is ~56% over 18 months of IVF/ICSI treatment and varies between the POSEIDON groups, which is primarily attributable to the impact of female age. WHAT IS KNOWN ALREADY The POSEIDON group recently proposed a new stratification for low-prognosis women in IVF/ICSI treatment, with the aim to define more homogenous populations for clinical trials and stimulate a patient-tailored therapeutic approach. These new criteria combine qualitative and quantitative parameters to create four groups of low-prognosis women with supposedly similar biologic characteristics. STUDY DESIGN, SIZE, DURATION This study analyzed the data of a Dutch multicenter observational cohort study including 551 low-prognosis women, aged <44 years, who initiated IVF/ICSI treatment between 2011 and 2014 and were treated with a fixed FSH dose of 150 IU/day in the first treatment cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Low-prognosis women were categorized into one of the POSEIDON groups based on their age (younger or older than 35 years), anti-Müllerian hormone (AMH) level (above or below 0.96 ng/ml), and the ovarian response (poor or suboptimal) in their first cycle of standard stimulation. The primary outcome was the CLBR over multiple complete IVF/ICSI cycles, including all subsequent fresh and frozen-thawed embryo transfers, within 18 months of treatment. Cumulative incidence curves were obtained using an optimistic and a conservative analytic approach. MAIN RESULTS AND THE ROLE OF CHANCE The CLBR of the low-prognosis women was on average ~56% over 18 months of IVF/ICSI treatment. Younger unexpected poor ( n = 38) and suboptimal ( n = 179) responders had a CLBR of ~65% and ~68%, respectively, and younger expected poor responders ( n = 65) had a CLBR of ~59%. The CLBR of older unexpected poor ( n = 41) and suboptimal responders ( n = 102) was ~42% and ~54%, respectively, and of older expected poor responders ( n = 126) ~39%. For comparison, the CLBR of younger ( n = 164) and older ( n = 78) normal responders with an adequate ovarian reserve was ~72% and ~58% over 18 months of treatment, respectively. No large differences were observed in the number of fresh treatment cycles between the POSEIDON groups, with an average of two fresh cycles per woman within 18 months of follow-up. LIMITATIONS, REASONS FOR CAUTION Small numbers in some (sub)groups reduced the precision of the estimates. However, our findings provide the f...

Predictors of live birth rate in women with diminished ovarian reserve

“…Leijdekkers et al . reported that the conservative CLBR after 18 months reached 58% in patients younger than 35 years and 37% in those aged 35 years or older; the optimal CLBR reached 60% and 41% for the same age groups, respectively—all higher than those in our study.…”

Embryo incubation and assessment by time-lapse system versus conventional incubators in Chinese women with diminished ovarian re serve undergoing IVF/ICSI : a study protocol for a randomized controlled trial

“…According to the literature (18) and the data of our centre, live birth rates among women with DOR in the control arm were around 25.0%. Based on other studies within fertility care as well as the discussion by gynaecologist and epidemiologists, we assume that the minimal clinical important difference to make time-lapse system preferable over conventional incubator would be 10.0%.…”

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

“…They have found about 56% CLBR in poor-prognosis ART/IVF patients over 18 months with variations between the various POSEIDON groups, primarily attributable to the effect of age. Young patients who were classified, according to the POSEDON stratification, as unexpected poor responders (group 1 reached a CLBR of about 65%, whereas the young expected poor responders (group 3) achieved only 59% CLBR (23). In comparison the older unexpected poor responders (group 2) achieved a CLBR of only 42%, and the older expected poor responders (group 4) only 39% (23).…”

“…It may, in addition, enable the fertility specialist to more accurately advise their patients regarding their treatment prognosis. Indeed, the first relevant indication and confirmation of the low prognosis of POR, stratified according to the POSEIDON criteria, has been recently published (23). In this Dutch multicenter study of 551 poor prognosis patients, cumulative live birth rates (CLBRs) over 18 months and several IVF/ICSI cycles was correlated to the POSEIDON groups (23).…”

“…Indeed, the first relevant indication and confirmation of the low prognosis of POR, stratified according to the POSEIDON criteria, has been recently published (23). In this Dutch multicenter study of 551 poor prognosis patients, cumulative live birth rates (CLBRs) over 18 months and several IVF/ICSI cycles was correlated to the POSEIDON groups (23). They have found about 56% CLBR in poor-prognosis ART/IVF patients over 18 months with variations between the various POSEIDON groups, primarily attributable to the effect of age.…”