Live-birth rates in very poor prognosis patients, who are defined as poor responders under the Bologna criteria, with nonelective single embryo, two-embryo, and three or more embryos transferred.
OBJECTIVE
To determine live-birth rates (LBRs) at various ages in very poor prognosis patients, who are defined as poor responders under the Bologna criteria.


METHODS
Retrospective cohort study.


METHODS
Academically affiliated private fertility center.


METHODS
Among 483 patients, who under the Bologna criteria (three or fewer oocytes, >40 years of age, and/or antimüllerian hormone [AMH] <1.1 ng/mL [2/3 criteria minimum]) were poor responders, 278 (381 fresh IVF cycles) qualified for the study because they had at least one embryo on day 3 for transfer.


METHODS
IVF cycles in women with low functional ovarian reserve, involving androgen and CoQ10 supplementation and ovarian stimulation with daily gonadotropin dosages of 300-450 IU of FSH and 150 IU of hMG in microdose agonist cycles.


METHODS
Age-specific LBRs per ET.


RESULTS
Ages did not differ between nonelective (ne) single ET (SET), ne2-ET, and ne ≥ 3-ET cycles (41.3 ± 3.9, 41.7 ± 3.1, and 42.4 ± 2.1 years, respectively). Patients with neSETs demonstrated significantly lower AMH and higher FSH levels and required higher gonadotropin dosages than ne2-ET and ne ≥ 3-ET patients. LBRs declined with age. Above age 42, three or more embryos are required to achieve reasonable LBRs and two or more to avoid futility under American Society for Reproductive Medicine (ASRM) guidelines.


CONCLUSIONS
Very poor prognosis patients can still achieve acceptable pregnancy rates at least till their mid-40s if they reach ET. The degree to which egg donation is emphasized as the only treatment option in such patients, therefore, requires reconsideration. Above age 42, at least two, and preferably three embryos, are however required to exceed futility, as defined by ASRM.
Center for Human Reproduction, New York, New York; Foundation for Reproductive Medicine, New York, New York; Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, New York. Electronic address: ngleicher@thechr.com.
Norbert
N
Gleicher
Center for Human Reproduction, New York, New York; Department of Obstetrics and Gynecology, Mount Sinai St. Lukes-Roosevelt Hospital, New York, New York.
Mario V
MV
Vega
Center for Human Reproduction, New York, New York.
Sarah K
SK
Darmon
Center for Human Reproduction, New York, New York; Vienna University School of Medicine, Vienna, Austria.
Andrea
A
Weghofer
Center for Human Reproduction, New York, New York.
Yan-Guan
YG
Wu
Center for Human Reproduction, New York, New York.
Qi
Q
Wang
Center for Human Reproduction, New York, New York.
Lin
L
Zhang
Center for Human Reproduction, New York, New York; Department of Molecular and Integrative Physiology, University of Kansas School of Medicine, Wichita, Kansas.
David F
DF
Albertini
Center for Human Reproduction, New York, New York; Foundation for Reproductive Medicine, New York, New York; Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York.
David H
DH
Barad
Center for Human Reproduction, New York, New York; Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, North Carolina.
Vitaly A
VA
Kushnir
D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D005298:Fertility; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D054315:Oocyte Retrieval; D010053:Ovary / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012307:Risk Factors; D056826:Single Embryo Transfer / Q000009:adverse effects; D016896:Treatment Outcome
D015415:Biomarkers; D005300:Fertility Agents, Female; D054304:Anti-Mullerian Hormone
Poor prognosis patients; futility; live birth rates; poor responders in vitro fertilization (IVF)