Cumulative live birth rates do not increase after 4 complete cycles in women with poor ovarian response: a retrospective study of 1,825 patients.

Abstract Objective To investigate whether the cumulative clinical pregnancy rates (CCPR) and cumulative live birth rates (CLBR) increase accordingly as the oocyte retrieval cycle increases in women with poor ovarian response. Design Retrospective cohort study. Setting Single reproductive center in a tertiary hospital. Patient(s) Women diagnosed as POR according to the Bologna criteria and performed complete in vitro fertilization or intracytoplasmic sperm injection cycles between January 2014 to December 2018. Intervention(s) None. Main Outcome Measure(s) The conservative and optimistic estimations of CCPR/CLBR. Result(s) The conservative and optimistic estimates of CCPR peaked at the 6 th complete cycle, reaching 36.44% and 71.61%, respectively. But the conservative and optimistic estimates of CLBR peaked at the 4 th complete cycle, reaching 20.22% and 38.31%, respectively. The live birth rate per complete cycle of mild stimulation protocol was comparable to other protocols after adjusting for confounding factors. For patients ≤35 years, the live birth rate per complete cycle of progestin primed ovarian stimulation (adjusted odds ratio=0.51, 95% confidence interval: 0.30-0.87) and gonadotropin-releasing hormone antagonist protocol (adjusted odds ratio=0.45, 95% confidence interval: 0.24-0.81) were significantly lower than that of the mild stimulation. Conclusion(s) It is not advised to initiate more than 4 complete cycles for POR patients since CLBR do not increase after that. For POR patients ≤35 years, live birth rate per complete cycle increased in women with mild stimulation protocol.