Obstet Gynecol Sci.  2017 Jan;60(1):46-52. 10.5468/ogs.2017.60.1.46.

In vitro fertilization outcome in women with diminished ovarian reserve

• Yun BH
• Kim G
• Park SH
• Noe EB
• Seo SK
• Cho S
• Choi YS
• Lee BS

• KMID: 2383207
• DOI: http://doi.org/10.5468/ogs.2017.60.1.46

Abstract

OBJECTIVE
This study aimed to identify factors that affect in vitro fertilization (IVF) outcomes in women with diminished ovarian reserve (DOR).
METHODS
We reviewed 99 IVF cycles in 52 women with DOR between September 2010 and January 2015. DOR was defined as serum anti-Müllerian hormone level of <1.1 ng/dL or serum follicle-stimulating hormone level of ≥20 mIU/mL. Total 96 cycles in 50 patients were evaluated after excluding fertility preservation cases.
RESULTS
The clinical pregnancy rate was 11.5% per cycle, and the total cancellation rate was 34.4%. Clinical pregnancy rate was significantly associated with the antral follicle count and the cause of the DOR. Age, serum anti-Müllerian hormone and follicle-stimulating hormone levels, antral follicle count, peak estradiol level, and the cause of DOR were significantly associated with cycle cancellation. However, history of previous ovarian surgery remained as a significant factor of clinical pregnancy (model 1: odds ratio [OR] 10.17, 95% confidence interval [CI] 1.46 to 70.84, P=0.019; model 2: OR 10.85, 95% CI 1.05 to 111.71, P=0.045). In cancellation models, idiopathic or previous chemotherapy group showed borderline significance (model 1: OR 3.76, 95% CI 0.83 to 17.04, P=0.086; model 2: OR 3.15, 95% CI 0.84 to 11.84, P=0.09).
CONCLUSION
DOR caused by previous ovarian surgery may show better pregnancy outcome, whereas that caused by chemotherapy could significantly increase the cycle cancellation rate. Furthermore, patients with DOR who previously received gonadotoxic agents may show reduced efficacy and increased risk of IVF cycle cancellation.

Keyword

Diminished ovarian reserve; Fertilization in vitro

MeSH Terms

Drug Therapy
Estradiol
Female
Fertility Preservation
Fertilization in Vitro*
Follicle Stimulating Hormone
Humans
In Vitro Techniques*
Odds Ratio
Ovarian Reserve*
Pregnancy
Pregnancy Outcome
Pregnancy Rate
Estradiol
Follicle Stimulating Hormone

Reference

1. Cohen J, Chabbert-Buffet N, Darai E. Diminished ovarian reserve, premature ovarian failure, poor ovarian responder: a plea for universal definitions. J Assist Reprod Genet. 2015; 32:1709–1712.

2. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L, et al. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011; 26:1616–1624.

3. Roustan A, Perrin J, Debals-Gonthier M, Paulmyer-Lacroix O, Agostini A, Courbiere B. Surgical diminished ovarian reserve after endometrioma cystectomy versus idiopathic DOR: comparison of in vitro fertilization outcome. Hum Reprod. 2015; 30:840–847.

4. Bonilla-Musoles F, Castillo JC, Caballero O, Perez-Panades J, Bonilla F Jr, Dolz M, et al. Predicting ovarian reserve and reproductive outcome using antimullerian hormone (AMH) and antral follicle count (AFC) in patients with previous assisted reproduction technique (ART) failure. Clin Exp Obstet Gynecol. 2012; 39:13–18.

5. Brodin T, Hadziosmanovic N, Berglund L, Olovsson M, Holte J. Antimullerian hormone levels are strongly associated with live-birth rates after assisted reproduction. J Clin Endocrinol Metab. 2013; 98:1107–1114.

6. Reijnders IF, Nelen WL, IntHout J, van Herwaarden AE, Braat DD, Fleischer K. The value of Anti-Müllerian hormone in low and extremely low ovarian reserve in relation to live birth after in vitro fertilization. Eur J Obstet Gynecol Reprod Biol. 2016; 200:45–50.

7. El-Toukhy T, Khalaf Y, Hart R, Taylor A, Braude P. Young age does not protect against the adverse effects of reduced ovarian reserve: an eight year study. Hum Reprod. 2002; 17:1519–1524.

8. Gonzalez-Foruria I, Penarrubia J, Borras A, Manau D, Casals G, Peralta S, et al. Age, independent from ovarian reserve status, is the main prognostic factor in natural cycle in vitro fertilization. Fertil Steril. 2016; 106:342–347.e2.

9. Das M, Shehata F, Son WY, Tulandi T, Holzer H. Ovarian reserve and response to IVF and in vitro maturation treatment following chemotherapy. Hum Reprod. 2012; 27:2509–2514.

10. Chan JL, Johnson LN, Efymow BL, Sammel MD, Gracia CR. Outcomes of ovarian stimulation after treatment with chemotherapy. J Assist Reprod Genet. 2015; 32:1537–1545.