Abstract
This study aimed to identify the independent predictors of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes among patients with diminished ovarian reserve (DOR), focusing on factors that predict the retrieval of oocytes (cumulus-oocyte complexes [COC]), day 3 (D3) available cleavage-stage embryos, clinical pregnancy during the IVF/ICSI fresh embryo transfer cycle, and viable blastocyst formation. We retrospectively analyzed 1,403 IVF/ICSI cycles involving 1,039 patients diagnosed with DOR, of which 441 cycles underwent fresh embryo transfer. Patients were categorized into groups based on their IVF/ICSI outcomes, which included oocyte retrieval, obtaining D3-available cleavage-stage embryos, clinical pregnancies, and viable blastocyst formation. Univariate and multivariate logistic regression analyses were performed to identify factors influencing IVF/ICSI outcomes. The predictive model incorporated the receiver operating characteristic curve to evaluate the predictive performance of the identified factors for IVF/ICSI outcomes. Anti-Mullerian hormone (AMH) was identified as a more effective independent predictor for oocyte retrieval than antral follicle count (AFC) and basal follicle-stimulating hormone (FSH), whereas AFC demonstrated superior predictive accuracy for obtaining D3-available cleavage-stage embryos, with prediction thresholds of 0.345 ng/mL and 3.5, respectively. D3 top-quality cleavage-stage embryos were a more reliable independent predictor of clinical pregnancy than age for patients aged below 40 years, whereas age showed greater predictive reliability in those aged 40 years or above. Additionally, D3-available cleavage-stage embryos were the sole predictor of viable blastocyst formation. In conclusion, AMH and AFC were more reliable than basal FSH at predicting the retrieval of oocytes and D3-available cleavage-stage embryos. Acquiring a D3 top-quality cleavage-stage embryo suggests potential for clinical pregnancy, but for patients aged 40 years or older, even access to such embryos does not mitigate the significant effects of age on clinical pregnancy outcomes. If none of the three to four D3 available cleavage-stage embryos are of top quality, culturing them to the blastocyst stage may improve clinical outcomes by yielding viable blastocysts.