Multi-marker assessment of ovarian reserve predicts oocyte yield after ovulation induction (original) (raw)
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Archives of Gynecology and Obstetrics, 2013
Introduction The objective of this study was to determine whether ovarian reserve markers can predict ovarian response in women undergoing their first cycle of assisted reproduction. Materials and methods This prospective observational study included 292 infertile patients undergoing their first IVF trial in the Assisted Reproductive Unit in a tertiary care hospital. Day 2 follicle stimulating hormone (FSH), Inhibin B, anti-Mullerian hormone (AMH), antral follicle count (AFC) and ovarian volume was measured before commencement of controlled ovarian hyperstimulation. The main outcome measures were oocytes retrieved and this was correlated with ovarian reserve markers. Results The mean age was 31.8 (±4.4) years and mean duration of infertility 8.2 (±3.9) years. The correlation between oocytes retrieved and age, day 2 FSH, Inhibin B, AMH, AFC and volume of the ovary was calculated. A negative correlation was found with age (r = -0.22, p \ 0.001) and day 2 FSH (r = -0.35, p \ 0.001). A positive correlation was seen with AMH (r = 0.15, p = 0.022), AFC (r = 0.48, p \ 0.05) and volume (r = 0.17, p = 0.009). In the bivariate analysis, 1 year increase in age was found to decrease the oocytes retrieved count by 0.37 with a significant p value. The independent significant factors found in multiple linear regression analysis were day 2 FSH and AFC.
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.
Archives of Gynecology and Obstetrics, 2011
Objective The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro fertilization (IVF) program. Materials and methods A prospective analysis was performed in 180 patients undergoing their first IVF trial, which is being conducted at a department of assisted reproduction in a tertiary medical center. The main outcome measures were determined as age and antral follicle count as well as the serum concentrations of follicle stimulating hormone, luteinizing hormone (LH), estradiol (E2), inhibin B and AMH. The predictive power of the aforementioned measures in specifying ovarian response was determined by means of discriminate analyses. Results As expected, day 3 LH levels were significantly high in the poor responder group. The poor responders had significantly lower antral follicle counts, retrieved oocyte number, and mature oocyte counts as well as day 3 AMH levels (5.8 ± 2.32 vs. 1.8 ± 0.80 ng/ml). There was a positive correlation with antral follicle count, basal AMH, E2 and follicle count on the day of HCG administration and negative correlation with age. The AMH level was addressed as the only significant factor in determination of mature oocyte number. A cut-off point for serum AMH concentration indicating the value of 2.97 ng/ml was found to predict the poor ovarian response with a sensitivity of 100.0% and a specificity of 89.6%. However, the same cut-off point was not as predictive for the non-conception circumstance. Conclusion The present study concludes that AMH is a promising biochemical marker for the prediction of ovarian response and that a cut-off point indicating the value of 2.97 ng/ml can be adopted for this prediction.
Hormonal and functional biomarkers in ovarian response
PURPOSE: Success rates of any artificial reproduction techniques depend on a correct protocol for ovarian stimulation. This can be decided only by proper assessment of ovarian reserve before commencing ovarian stimulation. This study has been conducted to investigate the role of hormonal and functional biomarkers in the prediction of ovarian response. METHODS: A total of 689 women between July 2012 and July 2013 undergoing IVF at Kocaeli University have been enrolled in the study. Patients have been categorized into three groups according to the number of oocytes retrieved: 0-3 oocytes (poor responders), 4-15 oocytes (normoresponders), and >16 oocytes (hyperresponders). Groups have been compared according to follicle-stimulating hormone (FSH), E2, luteinizing hormone (LH) levels, antral follicle counts, and E2 levels on hCG days. Furthermore, regression analysis has been performed with parameters such as age, FSH, LH, E2, anti-mullerian hormone (AMH) and antral follicle counts (AFC) that can affect the total number of oocytes retrieved and pregnancy rates and their interactions with each other have been investigated. RESULTS: FSH, age, hCG day LH level, cycle cancellation rate, total gonadotropin dose were significantly higher in the poor responder group, but in this group, AFC, AMH, hCG day E2 level, and the number of MII oocytes were significantly lower. Cut-off values of normal responders for FSH, AMH, and AFC were 8.43 area under curve [AUC: 0.541 (0.491-0.590)], 0.62 [AUC: 0.704 (0.638-0.764)], and 6 [AUC: 0.715 (0.667-0.760)], respectively. Cut-off values for the absolute poor response group (cycle cancellation) were 12.75 for FSH [AUC: 0.533 (0.49-0.57)], 0.23 for AMH [AUC: 0.678 (0.618-0.733)], and 6 for AFC [AUC: 0.576 (0.531-0.613)]. AMH and AFC were the best markers for the prediction of total oocyte count, independent of age, FSH, and LH levels. CONCLUSIONS: AMH and AFC were found to be the best ovarian reserve tests that can determine the total oocyte count retrieved, without any significant effects on pregnancy rates.
Journal of Assisted Reproduction and Genetics, 2004
Purpose : To compare basal and clomiphene citrate (CC) induced follicle-stimulating hormone (FSH), estradiol (E2), and inhibin B levels with ultrasound indices of ovarian reserve in infertile women and to test the prognostic value of these tests on response to ovarian stimulation in in vitro fertilization (IVF). Methods : Fifty-six patients had basal and CC induced serum hormone levels and ultrasound measured mean ovarian volume (MOV) and mean antral follicle counts (MFC). Thirty-two patients were then appropriately selected to have a total of 41 cycles of IVF/ICSI treatment. Results : Women with diminished ovarian reserve had lower MOV, MFC, day 3 and day 10 inhibin B levels (p< 0.001). Only basal and CC induced FSH and inhibin B correlated with MOV and MFC. Poor responders in IVF/ICSI had higher basal FSH (p< 0.05), lower basal and induced inhibin B levels (p< 0.05), and lower MOV and MFC (p< 0.01) than normal responders. Ovarian volume alone was better than age and basal hormones in predicting poor ovarian response, while abnormal CC test was the only independent significant factor in predicting ovarian response. However, age was the only independent predictor of pregnancy in IVF as compared to hormonal and ultrasound indices of ovarian reserve. Conclusion : CC test and ovarian volume are better than other hormonal and sonographic tests in predicting the response to ovarian stimulation in IVF cycles.
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.
Anti-Mullerian hormone and antral follicle count as predictors of ovarian reserve and successful IVF
Asian Pacific Journal of Reproduction , 2012
bstract Objective To investigate the role of Anti-Mullerian hormone and antral follicle count in predicting the ovarian reserve, and success of IVF. Methods Ninety two infertile couples complaining of infertility due to male or tubal or unexplained factors were included in this comparative prospective study for IVF/ICSI. Day-3 basal hormonal level of FSH, LH, E2, and AMH were measured, followed by Transvaginal ultrasound (TVS) to evaluate the AFC. Controlled ovarian hyperstimulation was done using the long protocol for ovarian hyperstimulation. Methods According to the number of retrieved oocytes women included in this study were classified into two groups; good responders (≥ 4 retrieved oocytes) and poor responders (< 4 retrieved oocytes). Ovarian reserve in this study was assessed by day-3 basal hormonal levels and AFC. The mean Day-3 AMH and mean AFC were significantly high (4.93±1.22) ng/mL, and (12.72±5.70) ng/mL; respectively) in good responders compared with poor responders, also, the number of retrieved oocytes were significantly high in the good responders group compared with poor responders (13.52±9.70) versus (3.91±1.20) (P<0.05). The numbers of chemical and clinical pregnancies were significantly high (6 cases (75%) and 13 cases (72.2%); respectively) in the good responders compared with poor responders (2 cases (25%) and 5 cases (27.8%); respectively). Conclusions Day-3 AMH and AFC are good predictors for ovarian reserve, there were positively correlated with the number of retrieved oocytes and numbers of chemical and clinical pregnancies.
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.