Demographic characteristics and clinical profile of poor responders in IVF / ICSI: A comparative study

Abstract

BACKGROUND:Ovarian response varies considerably among individuals and depends on various factors. Poor response in IVF yields lesser oocytes and is associated with poorer pregnancy perspective. Cycle cancellation due to poor response is frustrating for both clinician and the patient. Studies have shown that women conceiving after poor ovarian response have more pregnancy complications like PIH and preeclampsia than women with normal ovarian response. In addition, poor ovarian response could be a predictor of early menopause. This paper studies various demographic and clinical profiles of poor responders and tries to look at the known and unknown factors which could contribute to poor ovarian response in IVF.MATERIALS AND METHODS:Data were collected retrospectively from 104 poor responders who had less than four oocytes at retrieval and compared with 324 good responders for factors like age, BMI, type of sub fertility, duration of sub fertility, environmental factors like stress at work, smoking, pelvic surgery, chronic medical disorder, indication of IVF, basal FSH, mean age of menopause in their mothers etc.RESULTS:Among the poor responders, 60.57% were above 35 years of age compared to 36.41% in control group, which is statistically significant. Mean age of menopause in mother was found to be four years earlier in poor responder group. Male factor and unexplained infertility were significantly (P<0.05) higher in good responders (P<0.05). Significant proportion (31.73%) of women in study group had undergone some pelvic surgery (P<0.05).CONCLUSION:Apart from age, prior pelvic surgery also could be used as predictors for poor ovarian response. Heredity also plays a major role in determining ovarian response.

Risk factors for inadequate response to ovarian stimulation in assisted reproduction cycles: systematic review

“…In 2010, a demographic study was conducted analyzing 104 patients who had POR compared to 324 controls. A significant association was observed between pelvic surgery and insufficient ovarian response, and in the POR group, the most common procedure was endometrioma excision [72].…”

miR-4463 regulates aromatase expression and activity for 17β-estradiol synthesis in response to follicle-stimulating hormone

“…Although the manifestations of POR are quite diverse, patients with POR are typically classified as having low ovarian reserve or normal ovarian reserve but an inherently low gonadotropin response [ 29 , 30 ]. Ovaries that respond poorly to hyperstimulation during IVF cycles induce the presence of a reduced number of FSH-sensitive follicles, which are most frequently associated with the condition of poor ovarian reserve, eventually leading to low success rates in pregnancy [ 31 , 32 ]. Because of individual variations between patients in the ovarian response, predicting the ovarian response to exogenous gonadotropin is the most important step in ovulation induction.…”

“…It has been reported that the functional expression of FSHR is an important indicator of POR, as aberrant FSHR activity has been found to lead to poor proliferation and differentiation of GCs and reduced production of 17β-estradiol [ 7 ]. FSHR polymorphisms have been reported to significantly affect the ovarian response to FSH stimulation [ 31 , 41 ]. This might imply that the FSH-FSHR axis plays a pivotal role in determining the status of GC growth and 17β-estradiol production at the center of physiological ovarian function.…”

Cytoplasmic abnormalities of mature oocytes have a significant effect on fertilization in Bologna poor responders

“…Etiological factors associated with a poor response to controlled ovarian hyperstimulation (COH) are advanced age, iatrogenic or accidental ovarian damage, previous ovarian surgery, serious endometriosis, and numerical and/or structural chromosomal aberrations (3)(4)(5). Currently, obtaining enough oocytes in the ART cycles of poor responder infertile women is the most important challenge.…”