OBJECTIVE:

To determine whether in patients with low ovarian response the continuation of the in vitro fertilization procedure is associated with increased live birth rates versus conversion to intrauterine insemination.

METHODOLOGY:

Systematic search of studies with reported live birth rates in major databases. Quality assessment of studies was done using the Newcastle-Ottawa Scale (NOS) score. Subgroup analysis by follicular response was performed.

RESULTS:

Twenty-eight citations were retrieved from which 18 were chosen and only 7 including data from 3398 patient-cycles (in vitro fertilization: 2115; IUI: 1283) were analyzed. The mean NOS quality score was 9 versus cycle conversion to intrauterine insemination. Women with low ovarian response to stimulation, during an in vitro fertilization cycle, who continued with oocyte retrieval and embryo transfer were more likely to have a live birth: 9.2% versus 3.7% (OR 3.15 (95%CI: 2.26-4.41)). In analysis by follicular response, in vitro fertilization was superior, except when a monofollicular response was observed: 3.6% with in vitro fertilization vs 2.7% (OR 1.02 (95%CI: 0.37-2.84)).

CONCLUSION:

In patients with low ovarian response (≤ 4 follicles) during an in vitro fertilization cycle, persistence with in vitro fertilization is associated with higher odds of achieving a live birth versus conversion to intrauterine insemination, except in cycles with a monofollicular response, where conversion of the cycle to intrauterine insemination seems more judicious, since the odds of a live birth are similar and no surgical procedures or anesthesia are needed.

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