April 5th, 2020

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Severity of Diminished Ovarian Reserve and Chance of Success with Assisted Reproductive Technology
Authors:  Jennifer Fay Kawwass, M.D., Sheree L. Boulet, Dr.P.H., M.P.H., Heather S. Hipp, M.D., Donna R. Session, M.D., Dmitry M. Kissin, M.D., M.P.H., and Denise J. Jamieson, M.D., M.P.H., for the National ART Surveillance System Group
  OBJECTIVE: To describe the relationship between severe diminished ovarian reserve (DOR) and assisted reproductive technology outcomes.

STUDY DESIGN: Retrospective cohort including all United States’ fertility centers reporting to the CDC National ART Surveillance System, 2004–2012. Among women aged <41 (504,266 fresh autologous IVF cycles), we calculated cancellation rate/cycle and pregnancy rate/transfer, stratified by age, by maximum follicle-stimulating hormone (FSH). Cancellation rate per cycle and pregnancy, live birth, and miscarriage rates per transfer were compared among women with and without DOR. We used multivariable log binomial regression, stratified by age, to calculate adjusted relative risk (aRR) for the association between DOR and these outcomes and, within DOR groups, between stimulation type and outcomes.

RESULTS: Cancellation rate/cycle increased with increasing FSH and with DOR severity. For women aged <35 who underwent transfer, aRR for pregnancy and live birth indicated slightly reduced likelihood of these outcomes (severe vs. no DOR); confidence intervals approached the null. Among women with severe DOR, stimulation type was not associated with likelihood of pregnancy or live birth per transfer in any group except women ages 38–40.

CONCLUSION: Women with severe DOR are at significantly increased risk of cancellation; however, those who undergo transfer have pregnancy and live birth chances similar to those of women without DOR after controlling for cycle characteristics.
Keywords:  assisted reproductive techniques, assisted reproductive technology, fertilization in vitro, ovarian reserve, pregnancy outcome, pregnancy rate
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