Research question

What are the incidence and risk factors for poor ovarian response (POR) during repeat IVF?

Design

A retrospective analysis of 1224 consecutive patients who underwent at least two IVF stimulations in a single centre over a 6-year period. Risk factors from the initial treatment were assessed for association with POR during repeat IVF using logistic regression analysis. A simple, practical predictive model was constructed and evaluated for accuracy and calibration, based on the factors that demonstrated significant association with subsequent POR. POR during repeat IVF was defined as ≤3 retrieved oocytes or cancellation before retrieval following recruitment of ≤3 mature follicles.

Results

The risk of POR during repeat IVF was approximately 11.5%. A higher POR risk during repeat IVF is associated with a reduced oocyte yield during the initial treatment (≤3 oocytes: odds ratio [OR] 14, 95% confidence interval [CI] 6.42–30.24; 4–9 oocytes: OR 4.13, 95% CI 2.00–8.54; 10–15 oocytes: OR 1) and low ovarian reserve (anti-Müllerian hormone [AMH] <5.4 pmol/l: OR 3.54, 95% CI 2.24–5.59; AMH 5.4–25 pmol/l: OR 1). Women with low ovarian reserve who experience POR during the initial IVF have the highest risk of suffering POR again during repeat IVF (57% within 1 year). Other groups, such as women with unexpected POR or expected poor responders with suboptimal ovarian response during the initial IVF, are also at risk of exhibiting POR during a subsequent treatment (28% within 1 year).

Conclusions

As there is a clear association between POR and lower live birth rates, this practical model may help manage patients’ expectations during repeat IVF treatment.

中文翻译：

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重复试管婴儿期间卵巢反应不佳的风险

研究问题

重复试管婴儿期间卵巢反应不良 (POR) 的发生率和危险因素是什么？

设计

对 1224 名在 6 年内在单个中心接受至少两次 IVF 刺激的连续患者的回顾性分析。使用逻辑回归分析评估初始治疗的风险因素与重复试管婴儿期间 POR 的关联。基于证明与后续 POR 显着相关的因素，构建了一个简单实用的预测模型并评估其准确性和校准。重复试管婴儿期间的 POR 定义为 ≤ 3 个取回的卵母细胞或在募集 ≤ 3 个成熟卵泡后取回前取消。

结果

重复试管婴儿期间发生 POR 的风险约为 11.5%。重复 IVF 期间较高的 POR 风险与初始治疗期间卵母细胞产量降低有关（≤3 个卵母细胞：优势比 [OR] 14，95% 置信区间 [CI] 6.42-30.24；4-9 个卵母细胞：OR 4.13, 95 % CI 2.00–8.54；10–15 个卵母细胞：OR 1）和低卵巢储备（抗苗勒管激素 [AMH] <5.4 pmol/l：OR 3.54，95% CI 2.24–5.59；AMH 5.4–25 pmol/l：或 1)。在初次试管婴儿期间经历 POR 的卵巢储备低的女性在重复试管婴儿期间再次发生 POR 的风险最高（1 年内为 57%）。其他组，例如在初始 IVF 期间出现意外 POR 或预期反应不佳的卵巢反应不佳的女性，在后续治疗期间也有出现 POR 的风险（1 年内 28%）。

结论

由于 POR 与较低的活产率之间存在明显关联，因此这种实用模型可能有助于管理患者在重复 IVF 治疗期间的期望。