47 - The Prediction and Management of Poor Responders in ART

Summary

INTRODUCTION

Although the first successful in vitro fertilization (IVF) reported in 1978 resulted from a natural (unstimulated) cycle, it became subsequently clear that ovarian stimulation resulted in a higher number of oocytes retrieved and higher pregnancy rates (1). In the following years, various stimulation protocols were suggested and used in patients treated with IVF and intracytoplasmic sperm injection (ICSI). Today, controlled ovarian stimulation prior to IVF or ICS is the universally accepted practice. However, in some instances, the female partner's response to ovarian stimulation is less than optimal, resulting in the retrieval of a small number of oocytes. These patients have been termed poor responders.

Poor responders have a higher incidence of cycle cancellation, lower fertilization, and lower pregnancy and implantation rates. In a study by Saldeen et al, poor responders, defined as those from whom less than five oocytes were retrieved, and who were above thirty-seven years of age, had a significantly lower pregnancy rate per ovum pick-up (OPU) compared to normal responders in the same age-group (3.0 versus 22.1 percent, p < 0.05). In addition, 43.6 percent of these women did not receive an embryo transfer (ET), compared to 13.2 percent of normal responders in the same age-group (p < 0.05). Poor responders who were thirty-seven years of age or younger had a significantly lower pregnancy rate per OPU compared to normal responders of the same age-group (14.0 versus 34.5 percent, p < 0.05) together with a higher cancellation rate (40.1 versus 10.5 percent) (2).