title: An initial low response predicts poor outcome in in vitro fertilization/intracytoplasmic sperm injection despite improved ovarian response in consecutive cycles.
abstract: OBJECTIVE
  To study the predictive value of initial low response (LR) in IVF/intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Two Finnish fertility centers.
  
  
  METHODS
  A total of 3,846 IVF/ICSI cycles performed from 1994 to 2002.
  
  
  METHODS
  Consecutive cycles in the same subject were identified. The study groups consisted of subjects who had three treatment cycles and at least one LR cycle (n = 80).
  
  
  METHODS
  Pregnancy rate (PR), total gonadotropin dose, and embryo quality.
  
  
  RESULTS
  Only 2.5% (2/80) of subjects had a LR in all three consecutive cycles. In 43 women an initial LR was followed by >/=1 normal response (NR) cycle, and in 35 women an initial NR was followed by >/=1 LR cycle. The PR/cycle was similarly low in women with an initial LR and an initial NR (10.1% vs. 16.2%). An increase in gonadotropin dose resulted in a higher number of oocytes in women with an initial LR (from 2.1 +/- 0.9 to 6.7 +/- 2.7) but the PR/cycle remained low, compared to the overall mean PR (27.2%). In cycles in which top quality embryos were transferred, subjects with an initial LR had a lower PR than women with an initial NR (17.8% vs. 41.2%).
  
  
  CONCLUSIONS
  An initial LR is a predictor of poor outcome in subsequent cycles, even if ovarian response is improved by increasing the gonadotropin dose or a top quality embryo is replaced.
authors.affiliation: Department of Obstetrics and Gynecology, University of Oulu, Finland.
authors.forename: Zdravka
authors.initials: Z
authors.lastname: Veleva
authors.forename: Ilkka Y
authors.initials: IY
authors.lastname: Järvelä
authors.forename: Sinikka
authors.initials: S
authors.lastname: Nuojua-Huttunen
authors.forename: Hannu
authors.initials: H
authors.lastname: Martikainen
authors.forename: Juha S
authors.initials: JS
authors.lastname: Tapanainen
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000628:therapy; D009865:Oocytes / Q000378:metabolism; D010053:Ovary / Q000378:metabolism*; D010062:Ovulation Induction / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric