Unexpected poor response to ovarian stimulation in the in vitro fertilization program and possibilities of its overcoming

• Svetlana G. Perminova
• Irina S. Belova
• Guzel V. Savostina
• Elena S. Sannikova

Abstract

The aim of the study was to evaluate the expediency of using the FORT (follicular output rate), FOI (follicle-to-oocyte index) and OSI (ovarian sensitivity index) indices as predictors of an unpredictable hypo-response to ovarian stimulation (OS) in the in vitro fertilization program (IVF).

Material and methods. In the study 210 OS cycles in patients with an unexpected poor ovarian response to OS (POSEIDON groups 1 and 2) and in patients from the comparison group were analyzed. OS parameters were assessed by using the FORT, FOI, OSI indices.

Results. FORT, FOI and OSI indices in women of main groups were significantly lower than in the comparison groups of patients of the same age (p<0.001). The ROC analysis was performed to determine the predictive value of these marker. The results showed that the FORT, FOI and OSI indices are significantly more accurate in predicting the response to OS than the levels of AMH, FSH and AFC. At the final stage of the work, patients of the main groups (POSEIDON 1 and 2) underwent OS cycles with dose adjustment of gonadotropins in accordance with the values of FORT, FOI and OSI indices. Among women in the POSEIDON 1 group, adjustment of the OS protocol made it possible to obtain a sufficient number of oocytes in 39 (79.6%) patients, and among women in the POSEIDON 2 group – in 32 (65.3%) patients.

Conclusion. The FORT, FOI and OSI indices are prognostically significant markers of a poor ovarian response to gonadotropic stimulation. Using these markers in medical practice will help develop personalized approaches to OS to obtain more oocytes in future IVF programs.

Keywords:poor ovarian response; POSEIDON groups; infertility; diminished ovarian reserve

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