Whether poor responses have worse perinatal prognosis (retrospective analysis of assisted reproductive technologies cycle)


  • G.V. Strelko
Keywords: perinatal outcomes, poor responders, assisted reproductive technologies, preterm labor, low birth weight

Abstract

The prevalence of poor ovarian response is 5.6–35.1% in women undergoing controlled ovarian stimulation in ART cycles. The frequency of delivery of poor responders after ART is on average from 9.9% to 23.8%. In clinical practice, the vast majority of poor responders are older women, which may have an effect on perinatal outcomes, respectively. Although numerous studies have reported that the fertility rate after ART in women of this age group is quite low, data on perinatal outcomes in this group of women is limited. Therefore, the aim of our study was to retrospectively analyze and compare perinatal outcomes in women with poor ovarian response to stimulation compared to control group (normal response to stimulation) in assisted reproductive technology programs. 278 women with infertility with a reduced response to stimulation (poor responders), who were the main group, were screened. Indications for the inclusion of women in the main group were the presence of at least two of the following criteria for a poor ovarian response according to the 2011 Bologna criteria and 93 infertile patients with a normal ovarian response to stimulation of the control group. Subsequently, retrospective study of perinatal effects such as preterm labor, low birth weight, gestational diabetes, preeclampsia in 50 women with infertility with reduced response to stimulation and 37 controls with normal response to stimulation in which pregnancy was diagnosed was performed. Variational-statistical processing of the results of the study was performed using the program “Statistica 6.0”. The study demonstrated a significantly lower pregnancy rate in poor responders compared with women from the control group — 50 (17.9%) vs. 37 (39.8%), respectively. Perinatal outcome were similar only to the statistically significant difference in the percentage of spontaneous abortions before 12 weeks of gestation — 9 (18%) vs. 4 (10.8%), respectively, in groups with no significant difference in the preterm labor frequency — 10 (20.8%) and 6 (18.1%) of the low weight of the child at birth — 9 (18.7%) versus 5 (15.1%), respectively, in poor responders patients and in women with normal ovarian response. The frequency of complications such as gestational diabetes and high blood pressure were not significantly different in both clinical groups — 3 (6.25%) versus 2 (6.1%) and 5 (10.4%) versus 3 (9.1%) respectively. Thus, he poor responders in ART programs have a significantly lower pregnancy rate and a higher incidence of pregnancy loss up to 12 weeks compared with women who had a normal response to ovarian stimulation without a significant difference in the rates of various complications of pregnancy and perinatal outcomes. Wide randomized multicentric trials are needed to find out the causal relationships with regard to the effect on pregnancy, miscarriage, perinatal effects of controlled ovarian stimulation regimens, embryotransfers in fresh or cryo cycles etc.

References

1. Aleksandrova, N. V. & Marchenko, L. A. (2007). Sovremennye podhody k ocenke ovarialnogo rezerva u zhenshin s prezhdevremennoj nedostatochnostyu yaichnikov [Modern approaches to the assessment of ovarian reserve in women with premature ovarian failure]. Problemyi reproduktsii – Reproducts problems, 2, 22−29.

2. Babenko, I. V. (2013). Diferentsiyniy psdhsd do lskuvannya bezplidnosti v dopomszhnih reproduktivnih tehnologsyah u poganih vsdpovsdachiv [Differential approach to the treatment of infertility in auxiliary reproductive technologies from bad responders]. PediatiIya, akusherstvo ta ginekologiya – Pediatrics, Obstetrics and Gynecology, 76 (4), 69−72.

3. Dankovich, N. A. & Vorobey-Vihovskaya, V. N. Prichinyi i formyi besplodiya. Sovremennyie vozmozhnosti diagnostiki i lecheniya [Causes and forms of infertility. Modern possibilities of diagnosis and treatment]. Zdorove zhenschinyi – Woman's health, 3, 192−197.

4. Kvinan, D. T., Khobbins, D. S. & Sponh, K. U. (2009). Protokoly dlia vahitnostei vysokoho ryzyku [Protocols for the vigilance of the temple dagger]. Kyiv: Feniks. ISBN 978-966-651-649-0.

5. Maslii, Yu. V., Sudoma, I. O. & Livshyts, H. B. (2006). Biokhimichni markery yaiechnykovoho rezervu u patsiientiv iz syndromom slabkoi vidpovidi na stymuliatsiiu honadotropinamy v tsyklakh dopomizhnykh reproduktyvnykh tekhnolohii [Biochemical markers of ovarian reserve in patients with a weak response to stimulation of gonadotropins in auxiliary reproductive technologies cycles]. Zdorove zhenshiny – Woman's health, 3 (27), 126−131.

6. Maslii, Yu. V., Sudoma, I. O. & Livshyts, H. B. (2006). Etiopatohenetychni chynnyky syndromu slabkoi vidpovidi yaiechnykiv v tsyklakh dopomizhnykh reproduktyvnykh tekhnolohii [Ethiopathogenetic factors of weak ovarian response syndrome in auxiliary reproductive technologies cycles]. Zdorove zhenshiny – Woman's health, 4 (28), 152−157.

7. Mishieva, N. G. (2010). Besplodie u zhenshin pozdnego reproduktivnogo vozrasta: principy diagnostiki i lecheniya v zavisimosti ot ovarialnogo rezerva. (Dis. d-ra med. nauk). [Infertility in women of late reproductive age: principles of diagnosis and treatment depending on the ovarian reserve]. Federalnoe gosudarstvennoe uchrezhdenie Nauchnyj centr akusherstva, ginekologii i perinatologii, Moskva.

8. Sidelnikova, V. M. (2009). Endokrinologiya beremennosti v norme i pri patologii [Pregnancy endocrinology in health and disease]. Moskva : MEDpress-inform. ISBN. 5-98322-470-0.

9. Yuzko, O. M., Yuzko, T. A. & Rudenko, N. G. (2013). Stan ta perspektyvy vykorystannia dopomizhnykh reproduktyvnykh tekhnolohii pry likuvanni bezpliddia v Ukraini [Status and prospects of the use of auxiliary reproductive technologies in the treatment of infertility in Ukraine]. Zdorove zhenshiny – Woman's health, 8, 26−30. Vziato z http://nbuv.gov.ua/UJRN/Zdzh_2013_8_8.

10. Benaglia, L., Somigliana, E., Vighi, V., Ragni, G., Vercellini, P. & Fedele, L. (2010). Rate of severe ovarian damage following surgery for endometriomas. Human Reproduction, 25 (3), 678–682. doi: 10.1093/humrep/dep464.

11. Ben-Rafael, Z., Bider, D., Dan, U., Zolti, M., Levran, D. & Mashiach, S. (1991). Combined gonadotropin releasing hormone agonist/human menopausal gonadotropin therapy (GnRH-a/hMG) in normal, high, and poor responders to hMG. Journal of In Vitro Fertilization and Embryo Transfer, 8 (1), 33–36. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1826724.

12. Faddy, M. J., Gosden, R. G., Gougeon, A., Richardson, S. J. & Nelson, J. F. (1992). Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Human Reproduction, 7 (10), 1342–1346. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1291557.

13. Ferraretti, A. P., La Marca, A.B., Fauser, C. J. M., Tarlatzis, B., Nargund, G. & Gianaroli, L. (2011). ESHRE consensus on the definition of “poor response” to ovarian stimulation for in vitro fertilization: the Bologna criteria. Human Reproduction, 26 (7), 1616–1624. doi: 10.1093/humrep/der092.

14. Jenkins, J. M., Davies, D. W., Devonport, H., Anthony, F. W. & Gadd, S. C. (1991). Comparison of “poor” responders with “good” responders using a standard buserelin/human menopausal gonadotrophin regime for in-vitro fertilization. Human Reproduction, 6 (7), 918–921.

15. Keay, S. D., Liversedge, N. H., Mathur R. S. & Jenkins J. M. (1997). Assisted conception following poor ovarian response to gonadotrophin stimulation. The British Journal of Obstetrics and Gynaecology, 104 (5), 521–527. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9166190.

16. Kolibianakis, E. M., Venetis, C. A., Diedrich, K., Tarlatzis, B. C. & Griesinger, G. (2009). Addition of growth hormone to gonadotrophins in ovarian stimulation of poor responders treated by in-vitro fertilization: a systematic review and meta-analysis. Human Reproduction Update, 15, (6), 613–622. doi: 10.1093/humupd/dmp026.

17. Polyzos, N. P. & Devroey, P. (2011). A systematic review of randomized trials for the treatment of poor ovarian responders: is there any light at the end of the tunnel. Fertility and Sterility, 96 (5), 1058–1061. doi: 10.1016/j.fertnstert.2011.09.048.

18. Surrey, E. S. & Schoolcraft, W. B. (2000). Evaluating strategies for improving ovarian response of the poor responder undergoing assisted reproductive techniques. Fertility and Sterility, 73 (4), 667–676. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10731523.

19. Ziegler, D., Borghese, B. & Chapron, C. (2010). Endometriosis and infertility: pathophysiology and management. The Lancet, 376 (9742), 730–738. doi: 10.1016/S0140-6736(10)60490-4.
Published
2018-09-28
How to Cite
Strelko, G. (2018). Whether poor responses have worse perinatal prognosis (retrospective analysis of assisted reproductive technologies cycle). Reports of Vinnytsia National Medical University, 22(3), 503-508. https://doi.org/https://doi.org/10.31393/reports-vnmedical-2018-22(3)-22