An initial low response predicts poor outcome in in vitro fertilization/intracytoplasmic sperm injection despite improved ovarian response in consecutive cycles.

Objective: To study the predictive value of initial low response (LR) in IVF/intracytoplasmic sperm injection (ICSI).
Design: Retrospective analysis.
Setting: Two Finnish fertility centers.
Patient(s): A total of 3,846 IVF/ICSI cycles performed from 1994 to 2002.
Intervention(s): Consecutive cycles in the same subject were identified. The study groups consisted of subjects who had three treatment 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 initial 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 initial 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.