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An initial low response predicts poor outcome in in vitro fertilization/intracytoplasmic sperm injection despite

Zdravka Veleva¹, Ilkka Y Järvelä, Sinikka Nuojua-Huttunen

¹Department of Obstetrics and Gynecology, University of Oulu, Finland.

Fertility and Sterility

|May 4, 2005

Abstract

Objective:

To study the predictive value of initial low response (LR) in IVF/intracytoplasmic sperm injection (ICSI).

Design:

Retrospective analysis.

Setting:

Two Finnish fertility centers.

Patient(S):

A total of 3,846 IVF/ICSI cycles performed from 1994 to 2002.

Intervention(S):

Consecutive cycles in the same subject were identified. The study groups consisted of subjects who had three treatment cycles and at least one LR cycle (n = 80).

Main Outcome Measure(S):

Pregnancy rate (PR), total gonadotropin dose, and embryo quality.

Result(S):

Only 2.5% (2/80) of subjects had a LR in all three consecutive cycles. In 43 women an initial LR was followed by >/=1 normal response (NR) cycle, and in 35 women an initial NR was followed by >/=1 LR cycle. The PR/cycle was similarly low in women with an initial LR and an initial NR (10.1% vs. 16.2%). An increase in gonadotropin dose resulted in a higher number of oocytes in women with an initial LR (from 2.1 +/- 0.9 to 6.7 +/- 2.7) but the PR/cycle remained low, compared to the overall mean PR (27.2%). In cycles in which top quality embryos were transferred, subjects with an initial LR had a lower PR than women with an initial NR (17.8% vs. 41.2%).

Conclusion(S):

An initial LR is a predictor of poor outcome in subsequent cycles, even if ovarian response is improved by increasing the gonadotropin dose or a top quality embryo is replaced.

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