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Objective: To study the predictive value of initial low response (LR) in IVF/i ntracytoplasmic sperm injection (ICSI). Design: Retrospective analysis. Setting: Two Finnish fertility centers. Patient(s): A total of 3,846 IVF/ICSI cycles per formed from 1994 to 2002. Intervention(s): Consecutive cycles in the same subjec t were identified. The study groups consisted of subjects who had three treatmen t cycles and at least one LR cycle (n = 80). Main Outcome Measure(s): Pregnancy rate (PR), total gonadotropin dose, and embryo quality. Result(s): 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 in itial 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 ini tial NR (17.8%vs. 41.2%). Conclusion(s): 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.
Setting: Two Finnish fertility centers. Patient (s): A total of 3,846 IVF / ICSI cycles Objective: To study the predictive value of initial low response (LR) in IVF / i ntracytoplasmic sperm injection per forming from 1994 to 2002. The study groups consisted of subjects who had three treatmen t cycles and at least one LR cycle (n = 80). Main Outcome Measure ( Results (s): Only 2.5% (2 out of 80) of subjects had a LR in all three consecutive cycles. In 43 women an initial LR was followed by <1 LR cycle. The PR / cycle was been low in women with an in itial LR and an initial NR (10.1% vs. 16.2%) <1 normal response (NR) cycle, and in 35 women an initial NR was followed by < . 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 rema In cycles in which top quality embryos were transferred, subjects with an initial LR had a lower PR than women with an inial tRR (17.8% vs. 41.2%). Conclusion (s): 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.