OVARIAN STIMULATION OUTCOMES IN WOMEN CLASSIFIED AS EXPECTED POOR OVARIAN RESPONDERS UNDERGOING AUTOLOGOUS ASSISTED REPRODUCTIVE TECHNOLOGY IN KUMASI, GHANA

Abstract

Introduction: Poor ovarian response (POR) in in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) programs refers to an insufficient response to standard superovulation regimens, resulting in few mature oocytes. This deficiency reduces oocyte yield, embryo yield, cumulative live birth rates, and overall, IVF/ICSI-embryo transfer effectiveness. Managing POR presents challenges in IVF/ICSI-embryo transfer programs, leading to emotional distress and financial burden, especially when IVF/ICSI-embryo transfer is self-funded. Fertility specialists and infertile couples require data to aid in counselling and decision-making for poor ovarian responders, especially for women reliably identified as expected POR. However, knowledge about POR in Africa, particularly in Ghana, is limited. Are the outcomes of OS in women with expected POR different between POSEIDON groups three and four? This study assessed the outcome of ovarian stimulation among women classified as expected POR undergoing autologous IVF or ICSI in Kumasi, Ghana. Methods: A multicenter prospective study involving 117 consecutively selected women with expected POR undergoing autologous IVF/ICSI-embryo transfer in six fertility centres in Kumasi was conducted from August 2023 to February 2024. The study participants were classified as expected POR using the Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. A pretested structured questionnaire was used to collect data on participants’ socio-demographic characteristics, obstetric and gynecological characteristics, and the outcomes of ovarian stimulation (OS). Data were analyzed and summarized using descriptive statistics including frequencies and percentages. The OS outcomes (i.e., number of oocytes retrieved, number of metaphase 11 oocytes, number of embryos formed, number of blastocytes obtained, cycle cancellation rates, positive pregnancy test and clinical pregnancy rates) were compared using chi-square and the students’ t-test with a p-value of <0.05 deemed statistically significant. Results: The proportion of expected POR among women who underwent autologous IVF/ICSI embryo transfer was 31.6% (n = 117). The age range of participants was 27-48 years, with the mean age being 37.5 (±3.7) years. Over two-thirds (68.4%) of the study participants had primary infertility and a median infertility duration of 6 years. Generally, the total cycle cancellation rate iv among the study participants was 38.5%, and out of this, 18.8% of them had their cycle cancelled before oocyte-pick up. About 21.4% of the women achieved clinical pregnancy. There was no statistically significant difference in OS outcomes (i.e., number of oocytes retrieved, number of metaphase 11 oocytes, number of embryos formed, number of blastocytes obtained, cycle cancellation rates, positive pregnancy test and clinical pregnancy rates) among the two groups of women with expected POR according to the POSEIDON criteria. Conclusion: The current study found that the proportion of expected POR among women who underwent autologous IVF/ICSI-embryo transfer in the fertility centres in Kumasi was low. Similarly, the proportion of the study participants who achieved clinical pregnancy was low. Additionally, there was a high cycle cancellation rate among the study participants. OS outcomes were similar in the two expected POR groups (POSEIDON groups 3 and 4).