Outcomes in poor responders treated with in vitro fertilization/intracytoplasmic sperm injection according to bologna criteria
Keywords:infertility, poor ovarian response, in vitro fertilization
Purpose of the study was to evaluate the effectiveness of various approaches of artificial reproductive technologies (ART) in advanced maternal age patients with poor ovarian response (POR).
Materials and methods. This is retrospective cohort study of 455 patients with POR who have undergone an IVF and embryo transfer program at from June 2016 to June 2018. Researchers evaluated pregnancy rate (PR) per embryo transferand live birth rate (LBR) per embryo transferas in vitro fertilization (IVF) outcomes. The patients fulfilled Bologna criteria were divided into 5 groups: long protocol, ant-gonadotropin-releasing hormone protocol, freeze embryos transfer without preimplantation genetic diagnostic (PGS), freeze embryos transfer with PGS, natural cycle.
Results. There was no statistically significant difference in the age, Anti-Müllerian hormone level and duration of infertility between the groups. Despite different protocols of ovarian stimulation, there was no statistically significant difference in pregnancy rate in fresh cycles. At the same time, cancellation of transfer was significantly higher observed in natural cycles (p <0.001). PR and LBR were statistically significant higher in freeze embryo transfer group 29% and 12.1% vs 13.3% and 5,5% respectively (p<0.001 and p = 0.040). During the transfer of the embryo unexamined by PGS and after PGS the pregnancy rate did not differ (29.4% vs 28.2%, p <0.05), but LBR was statistically significant higher after euploid embryo transfer (8.2% without PGS vs 20.5% after PGS, p = 0.028).
Conclusion. The most effective approach in patients with a poor ovarian response was cycle segmentation, cryopreservation of embryos, PGS and transfer of an euploid embryo. This category
of patients requires a personalized approach to the treatment of infertility. The choice of protocol in ART program must be carried out with the full voluntary and informed consent of the patient, depending on their desires and capabilities, including financial.
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