[Cumulative live birth rates after repeat IVF cycles in women with diminished ovarian reserve: a 7-year retrospective cohort of 3 740 patients].

Objective

To evaluate the cumulative live birth rate (CLBR) based on oocyte retrieval cycles in patients with diminished ovarian reserve (DOR) after repeat in vitro fertilization (IVF) and to explore the related influencing factors.

Methods

Data from 3 740 DOR patients (8 386 IVF cycles) treated at Reproductive Medicine Center, Henan Provincial People's Hospital from January 2017 to December 2022 (follow-up until December 31, 2023) were collected. Kaplan-Meier curves analysis was used to assess the trend of CLBR, and Cox proportional hazards regression model was applied to identify factors influencing CLBR.

Results

Among 3 740 patients with DOR, 981 cases achieved at least one live birth, CLBR was 26.23% (981/3 740). CLBR increased with the number of oocyte retrieval cycles, reaching 35.49% in the 3rd cycle and 50.40% in the 7th cycle. However, the CLBR growth rate declined after the 3rd cycle, with 92.35% (906/981) of live births occurring in the first 3 cycles. Factors associated with reduced CLBR included advanced maternal age, higher basal follicle stimulating hormone level, and a history of recurrent miscarriage (all P<0.01). Conversely, higher anti-Müllerian hormone (AMH) and antral follicle count were positively correlated with CLBR (all P<0.001). Notably, patients with AMH<0.68 μg/L had a significantly reduced CLBR (P<0.001).

Conclusions

Adhering to three IVF cycles significantly improves CLBR in DOR patients, with younger individuals benefiting particularly significantly. Factors such as age≥40 years, AMH<0.68 μg/L, and a history of recurrent miscarriage are associated with poorer CLBR. Beyond three cycles, the incremental gain in CLBR generally declines. It is recommended that younger patients persist with IVF treatment, while older patients should seek individualized counseling and consider alternative options.