Diminished ovarian reserve in the United States assisted reproductive technology population: diagnostic trends among 181,536 cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System

Abstract

Objective To evaluate trends in DOR assignment in the SART CORS database and to evaluate its accuracy in predicting poor ovarian response (POR) as defined in ESHRE’s ‘Bologna Criteria’ (2011). Design Retrospective cohort study. Setting Not applicable. Patients 181,536 fresh, autologous ART cycles reported to SART by US clinics in 2004 and 2011 (earliest and most recent available reporting years). Intervention(s) None. Main Outcome Measure(s) DOR assignment was the primary exposure. POR, defined as cycle cancellation for poor response or <4 oocytes retrieved following conventional gonadotropin stimulation (>149 IU FSH daily), was the primary outcome. Secondary outcomes were live birth and number of oocytes retrieved. DOR prevalence, power of DOR and FSH (</≥12 mIU/mL) to predict POR, and live birth in POR cycles were also calculated. Results DOR prevalence increased from 19 to 26% from 2004 to 2011. Among cycles clinically assigned as DOR, incidence of POR decreased from 32 to 30%, and live birth improved from 15 to 17%. Comparing basal FSH ≥12 versus clinical assignment of DOR, basal FSH had a higher specificity (92.2% vs.81.6%) and PPV (38.3%vs.30.9%) for predicting POR. Live birth among POR cycles was 4%. Conclusions DOR diagnosis is increasing, and accuracy remains poor, despite the availability of additional diagnostic parameters such as antral follicle count and anti-mullerian hormone. POR entailed poor outcomes, but the majority of patients clinically assigned as DOR did not experience POR. Development and utilization of more accurate predictors of POR are needed to minimize patient distress resulting from over-diagnosis.

Non-ART pregnancy predictive factors in infertile patients with peritoneal superficial endometriosis

“…Our result is in accordance with other studies that have reported lower non-ART pregnancy [35,36]. However the management of DOR and endometriosis related to infertility remains a matter of debate because of the heterogeneity of DOR definition and the poor benefit of ART management [37].…”

Gestational carrier in assisted reproductive technology

“…The database allows several infertility diagnoses to be selected for each patient, which could lead to misclassification of our subgroup analysis of LB outcomes by infertility diagnosis. Previous studies using the SART data clearly show that LBRs do vary by diagnosis (40), with uterine factor and decreased ovarian reserve having the poorest prognosis for LB.…”

Does freeze‐all policy affect IVF outcome in poor ovarian responders?

“…POR represent a challenging group of patients 25,28 , and the present study showed that there is no benefit of the freeze-all policy over fresh ET in POR patients undergoing the GnRH antagonist protocol for COS. Nowadays, there is evidence of increasing prevalence of POR 29 with a poor IVF prognosis [20][21][22] . In the present study, IRs were lower than 10%, both in the fresh ET and freeze-all groups, in accordance with previous studies published on POR [20][21][22][23]30 .…”