title: A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles.
abstract: OBJECTIVE
  To calculate the cumulative ongoing pregnancy rate in patients with a poor response in their first IVF cycle.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  In vitro fertilization unit of a university hospital.
  
  
  METHODS
  Two hundred twenty-five women who experienced a poor response in their first IVF or intracytoplasmic sperm injection cycle. These patients were divided into 64 expected (aged > or =41 years and/or elevated FSH level) and 161 unexpected poor responders (aged <41 years and FSH level not elevated).
  
  
  METHODS
  In vitro fertilization treatment with a long-suppression protocol with FSH-urofollitropin or recombinant FSH.
  
  
  METHODS
  Cumulative ongoing pregnancy rate. This rate was calculated in two ways to correct for dropouts: pessimistic (zero chance of pregnancy for the dropouts) and optimistic (the same chance for the dropouts as for patients who continued).
  
  
  RESULTS
  The cumulative ongoing pregnancy rate of women with an unexpected poor response in the first cycle was 37% (pessimistic) to 47% (optimistic) after three cycles. Women with an expected poor response had a cumulative ongoing pregnancy rate of 16% (pessimistic) to 19% (optimistic) after 3 cycles. Sixty-four percent of the unexpected poor responders and 31% of the expected poor responders had a normal response in the second cycle, most of them after receiving a higher dose of gonadotropins.
  
  
  CONCLUSIONS
  Most patients with an unexpected poor response in the first cycle had a normal response in the second cycle, leading to an acceptable cumulative ongoing pregnancy rate after three cycles. Patients with an expected poor response in the first cycle should be advised to withdraw from treatment after the first cycle because of a poor prognosis.
authors.affiliation: Department of Reproductive Medicine, Division of Perinatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands. e.r.klinkert@azu.nl
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Klinkert
authors.forename: Frank J M
authors.initials: FJ
authors.lastname: Broekmans
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.forename: Egbert R
authors.initials: ER
authors.lastname: Te Velde
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D005640:Follicle Stimulating Hormone