Relative importance of the different components of the Bologna criteria for predicting poor ovarian response in assisted reproduction

Abstract

Introduction: The Bologna criteria published in 2011 defined poor ovarian response (POR) in women undergoing in-vitro fertilisation (IVF) treatment by 2 out of the 3 criteria: advanced maternal age and/or other clinical risk factor for POR (Bologna 1), 3 or less oocytes retrieved in a previous IVF cycle with conventional stimulation protocol (Bologna 2) and abnormal ovarian reserve test (Bologna 3). This retrospective analysis aims at evaluating the relative importance of the three criteria in prediction of POR and live-birth outcome. Methods: Data on 132 women undergoing the second IVF treatment cycle in Queen Mary Hospital, Hong Kong, between January 2012 and June 2015, who fulfilled the Bologna criteria for POR, were retrieved and analysed. In this study, women aged ≥40 years and/or having history of endometriosis or ovarian surgery were classified as Bologna 1; those having 3 or less oocytes retrieved in the previous IVF cycle stimulated with a starting gonadotrophin dose of 150 IU or above were taken as Bologna 2, while those with antral follicle count ≤6 were classified as Bologna 3. The number of retrieved oocytes and utilizable embryos, pregnancy rate as well as live-birth rate were the primary outcome measures. Results: Subjects with Bologna 1+2 (n=12) had significantly more retrieved oocytes and utilizable embryos compared to those with Bologna 2+3 (n=49) or Bologna 1+2+3 (=26) (p< 0.05), but not Bologna 1+3 (n=45). There was no significant between-group difference in pregnancy rate. However, those with Bologna 1+2+3 had significantly worse live-birth rate (0%) compared to those with Bologna 1+2 (33.3%, p< 0.05) or Bologna 1+3 (15.6%, p< 0.05). Conclusions: Poor ovarian responders fulfilling different combinations of the Bologna criteria had different IVF outcomes. The best ovarian response and live-birth rate were observed in those with Bologna 1+2 with normal antral follicle count, and the worse in those in those fulfilling all three criteria.