Heterogeneity Among Poor Ovarian Responders According to Bologna Criteria Results in Diverging Cumulative Live Birth Rates

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2020 May 7

PMID 32373068

Citations 5

Authors

Alessia Romito

Erlisa Bardhi

Joaquin Errazuriz

Christophe Blockeel

Samuel Santos-Ribeiro

Michel De Vos

Annalisa Racca

Shari Mackens

Annelore Van Der Kelen

Pierluigi Benedetti Panici

Alberto Vaiarelli

Herman Tournaye

Panagiotis Drakopoulos

Affiliations

Soon will be listed here.

Abstract

Does reproductive outcome differ among the various subgroups of poor ovarian responders according to the Bologna criteria? This was a retrospective, cohort study including poor ovarian responders according to Bologna criteria, undergoing an ICSI cycle from January 2011 until December 2017. Patients were divided into four groups: (1) age ≥ 40 years and abnormal ovarian response test, (2) age ≥ 40 years, abnormal ovarian reserve test and one previous poor response to stimulation, (3) age ≥ 40 years and one previous poor response, (4) abnormal ovarian reserve test and one previous poor response. Overall, 846 cycles in 706 Bologna poor ovarian responders were included: 310 cycles in group 1, 169 in group 2, 52 in group 3, and 315 in group 4. There were significant differences in age, antral follicle count, antimüllerian hormone, cycle cancellation rates, and number of retrieved oocytes between the four groups. Live birth and cumulative live birth rate differed significantly between groups and were highest in Group 4 [Live birth rate: 7.4% (1) vs. 4.1% (2) vs. 5.8% (3) vs. 13.4% (4), = 0.001 and Cumulative live birth rate: 8.3% (1) vs. 4.1 % (2) vs. 9.6% (3) vs. 16.8% (4) < 0.001]. The multivariate GEE analysis revealed that the number of MIIs and the Bologna criteria pattern were the variables which were significantly associated with cumulative live birth rate. Poor ovarian responders represent a heterogeneous population. The young subpopulation has a better clinical prognosis in terms of fresh and cumulative live birth rate.

Citing Articles

The role of recombinant LH in ovarian stimulation: what's new?.

Alviggi C, Vigilante L, Cariati F, Conforti A, Humaidan P Reprod Biol Endocrinol. 2025; 23(Suppl 1):38.

PMID: 40059197 PMC: 11892182. DOI: 10.1186/s12958-025-01361-8.

Efficacy of intra-ovarian injection of autologous platelet-rich plasma in women with poor responders: a systematic review and meta-analysis.

Vahabi Dastjerdi M, Sheibani S, Taheri M, Hezarcheshmeh F, Jahangirian J, Jazayeri M Arch Gynecol Obstet. 2024; 309(6):2323-2338.

PMID: 38589612 DOI: 10.1007/s00404-024-07442-0.

Comparison of luteal phase stimulation with follicular phase stimulation in poor ovarian response: a single-blinded randomized controlled trial.

Vahabi Dastjerdi M, Ansaripour S, Ataei M, Gharedaghi R, Hoseini S, Mohazzab A Contracept Reprod Med. 2024; 9(1):6.

PMID: 38368372 PMC: 10874545. DOI: 10.1186/s40834-024-00265-z.

Cumulative live birth rates for low-prognosis women over 5 years or 9 frozen-thawed embryo transfer cycles.

Chen D, Shen X, Wang L, Kuang Y BMC Pregnancy Childbirth. 2022; 22(1):233.

PMID: 35317752 PMC: 8939133. DOI: 10.1186/s12884-022-04511-7.

The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment.

Giannelou P, Simopoulou M, Grigoriadis S, Makrakis E, Kontogeorgi A, Pantou A Diagnostics (Basel). 2020; 10(9).

PMID: 32932955 PMC: 7555981. DOI: 10.3390/diagnostics10090687.

References

La Marca A, Grisendi V, Giulini S, Sighinolfi G, Tirelli A, Argento C . Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study. J Assist Reprod Genet. 2015; 32(6):931-7. PMC: 4491085. DOI: 10.1007/s10815-015-0476-4. View

van de Vijver A, Polyzos N, Van Landuyt L, De Vos M, Camus M, Stoop D . Cryopreserved embryo transfer in an artificial cycle: is GnRH agonist down-regulation necessary?. Reprod Biomed Online. 2014; 29(5):588-94. DOI: 10.1016/j.rbmo.2014.08.005. View

Ferraretti A, La Marca A, Fauser B, Tarlatzis B, Nargund G, Gianaroli L . ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011; 26(7):1616-24. DOI: 10.1093/humrep/der092. View

Errazuriz J, Drakopoulos P, Pening D, Racca A, Romito A, De Munck N . Pituitary suppression protocol among Bologna poor responders undergoing ovarian stimulation using corifollitropin alfa: does it play any role?. Reprod Biomed Online. 2019; 38(6):1010-1017. DOI: 10.1016/j.rbmo.2018.12.030. View

Polyzos N, Devroey P . A systematic review of randomized trials for the treatment of poor ovarian responders: is there any light at the end of the tunnel?. Fertil Steril. 2011; 96(5):1058-61.e7. DOI: 10.1016/j.fertnstert.2011.09.048. View

Gardner D, Schoolcraft W . Culture and transfer of human blastocysts. Curr Opin Obstet Gynecol. 1999; 11(3):307-11. DOI: 10.1097/00001703-199906000-00013. View

Mackens S, Santos-Ribeiro S, van de Vijver A, Racca A, Van Landuyt L, Tournaye H . Frozen embryo transfer: a review on the optimal endometrial preparation and timing. Hum Reprod. 2017; 32(11):2234-2242. DOI: 10.1093/humrep/dex285. View

Errazuriz J, Romito A, Drakopoulos P, Frederix B, Racca A, De Munck N . Cumulative Live Birth Rates Following Stimulation With Corifollitropin Alfa Compared With hp-hMG in a GnRH Antagonist Protocol in Poor Ovarian Responders. Front Endocrinol (Lausanne). 2019; 10:175. PMC: 6439614. DOI: 10.3389/fendo.2019.00175. View

Boza A, Oguz S, Misirlioglu S, Yakin K, Urman B . Utilization of the Bologna criteria: a promise unfulfilled? A review of published and unpublished/ongoing trials. Fertil Steril. 2017; 109(1):104-109.e2. DOI: 10.1016/j.fertnstert.2017.09.024. View

10.

Alviggi C, Andersen C, Buehler K, Conforti A, De Placido G, Esteves S . A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Fertil Steril. 2016; 105(6):1452-3. DOI: 10.1016/j.fertnstert.2016.02.005. View

11.

Busnelli A, Papaleo E, Del Prato D, La Vecchia I, Iachini E, Paffoni A . A retrospective evaluation of prognosis and cost-effectiveness of IVF in poor responders according to the Bologna criteria. Hum Reprod. 2014; 30(2):315-22. DOI: 10.1093/humrep/deu319. View

12.

Bozdag G, Polat M, Yarali I, Yarali H . Live birth rates in various subgroups of poor ovarian responders fulfilling the Bologna criteria. Reprod Biomed Online. 2017; 34(6):639-644. DOI: 10.1016/j.rbmo.2017.03.009. View

13.

Capalbo A, Hoffmann E, Cimadomo D, Ubaldi F, Rienzi L . Human female meiosis revised: new insights into the mechanisms of chromosome segregation and aneuploidies from advanced genomics and time-lapse imaging. Hum Reprod Update. 2017; 23(6):706-722. DOI: 10.1093/humupd/dmx026. View

14.

Younis J . The Bologna criteria for poor ovarian response; has the job been accomplished?. Hum Reprod. 2012; 27(6):1874-5. DOI: 10.1093/humrep/des118. View

15.

Franasiak J, Forman E, Hong K, Werner M, Upham K, Treff N . The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2013; 101(3):656-663.e1. DOI: 10.1016/j.fertnstert.2013.11.004. View

16.

Zegers-Hochschild F, Adamson G, Dyer S, Racowsky C, de Mouzon J, Sokol R . The International Glossary on Infertility and Fertility Care, 2017. Fertil Steril. 2017; 108(3):393-406. DOI: 10.1016/j.fertnstert.2017.06.005. View

17.

Glujovsky D, Pesce R, Fiszbajn G, Sueldo C, Hart R, Ciapponi A . Endometrial preparation for women undergoing embryo transfer with frozen embryos or embryos derived from donor oocytes. Cochrane Database Syst Rev. 2010; (1):CD006359. DOI: 10.1002/14651858.CD006359.pub2. View

18.

Ghobara T, Vandekerckhove P . Cycle regimens for frozen-thawed embryo transfer. Cochrane Database Syst Rev. 2008; (1):CD003414. DOI: 10.1002/14651858.CD003414.pub2. View

19.

Vaiarelli A, Cimadomo D, Ubaldi N, Rienzi L, Ubaldi F . What is new in the management of poor ovarian response in IVF?. Curr Opin Obstet Gynecol. 2018; 30(3):155-162. DOI: 10.1097/GCO.0000000000000452. View

20.

Drakopoulos P, Vuong T, Ho N, Vaiarelli A, Ho M, Blockeel C . Corifollitropin alfa followed by highly purified HMG versus recombinant FSH in young poor ovarian responders: a multicentre randomized controlled clinical trial. Hum Reprod. 2017; 32(11):2225-2233. DOI: 10.1093/humrep/dex296. View