Poor response in ART is associated with pregnancy complications

Abstract

Introduction : It is generally accepted that obstetric and perinatal complications such as gestational diabetes, preeclampsia and IUGR are more common in older women. The results of studies that investigated this issue were inconclusive. The term "poor responder" refers to patients with diminished ovarian reserve, usually older women. Our study aimed to study whether there is an association between poor ovarian response in artificial reproductive technology and pregnancy complications. Material and methods: Retrospective, case-control study , at a tertiary, university-affiliated IVF centre, from 2011 to 2017. Patients who conceived and delivered after ART treatment were analysed. 75 poor responders (≤3 oocytes retrieved) after stimulation with gonadotropins (study group) were matched by day of ovum pick-up (OPU) to 75 normo-responders (≥4 oocytes retrieved). Main outcome measures were incidence of preeclampsia, gestational diabetes mellitus (GDM) and neonatal birth weight. Results: There were no significant differences in maternal age, gravidity, parity, BMI, gestational age at delivery, mode of delivery and Apgar score between groups. Poor responders had higher incidence of GDM (27% compared to 6.8%, P=0.001) and of intrauterine growth restriction (IUGR) (13.5% compared to 4.1%, P=0.04) than did normo-responders. Although poor responder patients experienced higher incidence of preeclampsia (8.1% compared to 5.4%), this did not achieve statistically significance (P=0.74). Poor responders with GDM were of similar age (34.6 ± 5.6 vs. 34.4 ± 5.1, P=0.8) and BMI (27.8 ± 6 vs. 24.8 ± 5.4, P=0.06) as poor responders without GDM. However, normo-responders with GDM were older (34.6 ± 3.7 vs. 32.4 ± 5.8, P=0.01) and had higher BMI (29.5 ± 0.6 vs. 22.9 ± 4.7, P=0.008) than normo-responders without GDM. Conclusions: Poor responders had higher incidence of GDM and IUGR compared to women with normal ovarian response. Poor response in ART is an independent risk factor for GDM and IUGR. This finding may have wider implications on the mother and the fetus, and appropriate counselling should be considered.