Lack of Predictive Value of Ovarian Reserve Tests for Pregnancy Likelihood. The Huge Difference Between Quantity and Quality (original) (raw)

Performance of different ovarian reserve markers for predicting the numbers of oocytes retrieved and mature oocytes

Maturitas, 2007

Objective: To assess the performance of different ovarian reserve tests for predicting the total numbers of oocytes retrieved and mature oocytes. Methods: A retrospective study was performed on 71 women undergoing their first IVF/intracytoplasmic sperm injection treatment. Basal ovarian reserve screening was performed on days 2-3 of a spontaneous cycle. Patients were down-regulated with the GnRH agonist, whereas ovarian stimulation was carried out with recombinant FSH, starting from day 2 to 3 of the cycle. The main outcome measures were the numbers of oocytes retrieved and mature oocytes. Results: The total number of oocytes was positively correlated with AFC (p < 0.0001) and E 2 levels post-GnRH (p < 0.004), whereas there was an inverse correlation with age (p < 0.0001). The number of mature oocytes also correlated with AFC (p < 0.008) and E 2 levels post-GnRH (p < 0.009), and inversely with age (p < 0.0004). Univariate linear regression of square root of number of oocytes (SQNO) shows that acceptable predictors of number oocytes, based on model significance and R 2 are AFC (R 2 = 0.215), age (R 2 = 0.24) and E 2 variation (R 2 = 0.09). The following model is proposed to predict the number of mature oocytes: ln(MO) = ln(NO) − 2.09 + 0.028 AGE + 0.03 BMI. Conclusion(s): The number of antral follicles and patient age appear to be good markers of ovarian response in IVF treatments. Additional information is provided by stimulated E 2 levels.

A systematic review of tests predicting ovarian reserve and IVF outcome

Cardiovascular Research, 2006

The age-related decline of the success in IVF is largely attributable to a progressive decline of ovarian oocyte quality and quantity. Over the past two decades, a number of so-called ovarian reserve tests (ORTs) have been designed to determine oocyte reserve and quality and have been evaluated for their ability to predict the outcome of IVF in terms of oocyte yield and occurrence of pregnancy. Many of these tests have become part of the routine diagnostic procedure for infertility patients who undergo assisted reproductive techniques. The unifying goals are traditionally to find out how a patient will respond to stimulation and what are their chances of pregnancy. Evidence-based medicine has progressively developed as the standard approach for many diagnostic procedures and treatment options in the field of reproductive medicine. We here provide the first comprehensive systematic literature review, including an a priori protocolized information retrieval on all currently available and applied tests, namely early-follicular-phase blood values of FSH, estradiol, inhibin B and anti-Müllerian hormone (AMH), the antral follicle count (AFC), the ovarian volume (OVVOL) and the ovarian blood flow, and furthermore the Clomiphene Citrate Challenge Test (CCCT), the exogenous FSH ORT (EFORT) and the gonadotrophin agonist stimulation test (GAST), all as measures to predict ovarian response and chance of pregnancy. We provide, where possible, an integrated receiver operating characteristic (ROC) analysis and curve of all individual evaluated published papers of each test, as well as a formal judgement upon the clinical value. Our analysis shows that the ORTs known to date have only modest-to-poor predictive properties and are therefore far from suitable for relevant clinical use. Accuracy of testing for the occurrence of poor ovarian response to hyperstimulation appears to be modest. Whether the a priori identification of actual poor responders in the first IVF cycle has any prognostic value for their chances of conception in the course of a series of IVF cycles remains to be established. The accuracy of predicting the occurrence of pregnancy is very limited. If a high threshold is used, to prevent couples from wrongly being refused IVF, a very small minority of IVF-indicated cases (~3%) are identified as having unfavourable prospects in an IVF treatment cycle. Although mostly inexpensive and not very demanding, the use of any ORT for outcome prediction cannot be supported. As poor ovarian response will provide some information on OR status, especially if the stimulation is maximal, entering the first cycle of IVF without any prior testing seems to be the preferable strategy.

Multi-marker assessment of ovarian reserve predicts oocyte yield after ovulation induction

Human Reproduction, 2010

background: Many hormone and ultrasound measurements have been assessed as possible markers of ovarian reserve and to identify potential poor responders to ovulation induction. The objective of this study is to determine whether multiple biomarkers measured in blood samples collected immediately before commencement of ovulation induction for IVF can predict the outcome of ovarian stimulation. methods: We conducted a prospective observational study, including 356 unselected women undergoing ovulation induction/IVF at two centers. Anti-Müllerian hormone (AMH), inhibin B and FSH were measured before commencement of ovulation induction. The main outcome measures were the number of oocytes retrieved and pregnancy outcome. results: Univariate analyses showed that age, FSH, inhibin B and AMH were significant predictors for poor oocyte yield. AMH presented the highest receiver operating characteristic area under the curve (ROC AUC) of 0.827 indicating a good discriminating potential for predicting poor ovarian response, followed by FSH with an ROC AUC of 0.721. In the multivariate analysis, the variables age, FSH and AMH remained significant and the resulting model provided a high ROC AUC of 0.819. Women with an ovarian reserve test of ,0.3 have more than a 75% chance of having their treatment cycle canceled, but a value over 0.73 indicates a 38% chance of pregnancy. Number of oocytes and oocyte yield per unit FSH administered were correlated with log model for no pregnancy (r ¼ 20.217, P , 0.001 and r ¼ 20.367, P , 0.001, respectively) but had limited predictive value. conclusions: A derived estimate of ovarian reserve demonstrated superior ability for predicting oocyte yield after ovulation induction when compared with any single endocrine marker (AMH, inhibin B, FSH).

Reliability of Ovarian Reserve Markers in Predicting IVF Outcomes

International Journal of Intelligent Computing and Technology (IJICT), 2019

Fertility varies significantly even among the age of women depend upon the Oocyte number and quality decline with age. It has measures developed to predict response to ovarian stimulation and reproductive potential. To evaluate the ovarian reserve can identify the patients who may experience poor response or hyper-response to exogenous gonatropthins and can aid in the personalization of treatment to achieve good response and minimize risk. Both AMH and AFC have good predictive value. AMH level becoming the gold standard biomarker to evaluate the ovarian reserve and to predict the ovarian response to stimulation.

Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve

Fertility and Sterility, 2002

To identify and quantify predictors of poor ovarian response in in vitro fertilization (IVF). Design: Prospective study. Setting: Tertiary fertility center. Patient(s): One hundred twenty women undergoing their first IVF cycle. Intervention(s): Measurement of the number of antral follicles and the total ovarian volume by ultrasound, and of basal levels of FSH, E 2 , and inhibin B on cycle day 3. Main Outcome Measure(s): Ovarian response, and clinical and ongoing pregnancy rates.

Use of ovarian reserve parameters for predicting live births in women undergoing in vitro fertilization

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013

Objective: To examine common clinical determinants, including patient age; levels of anti-Mü llerian hormone (AMH), inhibin B, and follicle-stimulating hormone (FSH); antral follicle count (AFC); and number of oocytes retrieved, to predict live births in women undergoing in vitro fertilization. Study design: Women undergoing cycles of intracytoplasmic sperm injection (ICSI) for the first time were reviewed retrospectively, and serum levels of AMH, inhibin B, and FSH, as well as AFC (days 1 and 4 of pre-ICSI menstrual period) and patient age were analyzed as determinants of live birth rates. Results: Of the patients studied, 35.71% (891/2495) became pregnant, with live births achieved in 32.20% (806/2495) of cycles initiated and in 46.37% (806/1738) of embryo transfers. Clinical pregnancy rate was 35.71% (891/2495) for cycles initiated and 51.26% (891/2318) for embryo transfers. Univariate analysis revealed that the odds of live birth significantly decreased with increasing age, declining AMH or inhibin B concentrations, and fewer oocytes retrieved. At AMH levels greater than 5.7 ng/ml, the odds of live birth were 3.18 times greater than for AMH levels less than 1.9 ng/ml [95% confidence interval (CI), 1. 89-5.43]. Using multivariate logistic regression, only AMH (OR = 1.89; 95% CI, 1.00-3.60; p < 0.05) and AFC (OR = 1.86; 95% CI, 1.02-3.40; p < 0.05) showed statistically significant associations with live birth. Area under the curve for ROC (ROC AUC ) indicated that AMH (AUC = 0.60) surpassed AFC (AUC = 0.59), number of oocytes retrieved (AUC = 0.59), inhibin B (AUC = 0.55), FSH (ROC AUC = 0.54) and chronological age (ROC AUC = 0.53) in predicting live birth. Conclusions: In this assessment of various indices (i.e., age; levels of AMH, inhibin B, and FSH; AFC; and quantity of oocytes retrieved) for predicting live births for IVF patients, AMH, AFC and the quantity of oocytes retrieved constituted the most reliable determinants. ß

Biomedgrid LLC - Lack of Predictive Value of Ovarian Reserve Tests for Pregnancy Likelihood. The Huge Difference Between Quantity and Quality

American Journal of Biomedical Science & Research, 2019

The study had two objectives. First, to identify factors capable of predicting the quantitative ovarian response of patients by applying a multiple linear regression analysis. Evaluated variables included age, BMI, antral follicle count (AFC), anti-Müllerian hormone (AMH), basal FSH, LH and Estradiol determination, the amount of administered rFSH during ovarian stimulation and Estradiol and Progesterone levels on day of ovulation triggering. Second, to assess, by applying a multivariate logistic analysis, whether the same parameters, plus the number of achieved oocytes, were useful for identifying chances of pregnancy.