A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles.
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.
Klinkert
Ellen R
ER
Department of Reproductive Medicine, Division of Perinatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands. e.r.klinkert@azu.nl
Broekmans
Frank J M
FJ
Looman
Caspar W N
CW
Te Velde
Egbert R
ER
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
D005640:Follicle Stimulating Hormone