Évaluation de la prévalence et des facteurs prédictifs de mauvaise réponse en préservation élective de la fertilité

Research Question: to assess the prevalence and predictive factors of poor ovarian response in elective fertility preservation (EFP). Design: a retrospective multicenter cohort study was conducted on 1,038 EFP cycles, from 809 patients, performed between january 2022 and december 2024 at the university hospital centers of Bordeaux, Lille, Poitiers, and Tours. Poor response was defined as either discontinuation of stimulation due to an insufficient follicular development or vitrification of fewer than four mature oocytes. Results: at the time of oocyte retrieval, mean age was 34.8 (±1.6) years. On average, 7 (±5) mature oocytes were cryopreserved per cycle, and 24.3% of cycles were classified as poor responders. In univariate analysis, anti-müllerian hormone (AMH) level, antral follicle count (AFC), discordance between AMH and AFC (i.e. AMH < 1.2 ng/mL with AFC ≥ 5), endometriosis, active smoking, a history of poor response, and estradiol levels during stimulation were significantly associated with poor response. In multivariate analysis, ovarian reserve parameters and active smoking remained independent predictors, whereas the association with endometriosis was no longer significant after adjustment for ovarian reserve parameters. Conclusion: poor ovarian response is a frequent event in EFP. Our findings highlight the central role of ovarian reserve parameters and active smoking as independent predictors, while the impact of endometriosis appears to be mediated through ovarian reserve. The present study underlines the necessity for individualised counselling and reliable estimation of success rates, to guide shared decision-making in this preventive procedure for otherwise healthy women.