Abstract
AimsThis study aimed to explore the value of ovarian reserve tests (ORTs) for predicting poor ovary response (POR) and whether an age cutoff could improve this forecasting, so as to facilitate clinical decision-making for women undergoing in vitro fertilization (IVF).MethodsA retrospective cohort study was conducted on poor ovary response (POR) patients using real-world data from five reproductive centers of university-affiliated hospitals or large academic hospitals in China. A total of 89,002 women with infertility undergoing their first traditional ovarian stimulation cycle for in vitro fertilization from January 2013 to December 2019 were included. The receiver operating characteristic (ROC) curve was performed to estimate the prediction value of POR by the following ORTs: anti-Mullerian hormone (AMH), antral follicle count (AFC), basal FSH (bFSH), as well as patient age.ResultsIn this retrospective cohort, the frequency of POR in the first IVF cycle was 14.8%. Age, AFC, AMH, and bFSH were used as predicting factors for POR, of which AMH and AFC were the best indicators when using a single factor for prediction (AUC 0.862 and 0.842, respectively). The predictive values of the multivariate model included age and AMH (AUC 0.865), age and AFC (AUC 0.850), age and all three ORTs (AUC 0.873). Compared with using a single factor alone, the combinations of ORTs and female age can increase the predictive value of POR. Adding age to single AMH model improved the prediction accuracy compared with AMH alone (AUC 0.865 vs. 0.862), but the improvement was not significant. The AFC with age model significantly improved the prediction accuracy of the single AFC model (AUC 0.846 vs. 0.837). To reach 90% specificity for POR prediction, the cutoff point for age was 38 years old with a sensitivity of 40.7%, 5 for AFC with a sensitivity of 55.9%, and 1.18 ng/ml for AMH with a sensitivity of 63.3%.ConclusionAFC and AMH demonstrated a high accuracy when using ROC regression to predict POR. When testing is reliable, AMH can be used alone to forecast POR. When AFC is used as a prediction parameter, age is suggested to be considered as well. Based on the results of the cutoff threshold analysis, AFC ≤ 5 and AMH ≤ 1.18 ng/ml should be recommended to predict POR more accurately in IVF/ICSI patients.
Highlights
Predicting a patient’s ovarian response prior to the start of the first in vitro fertilization (IVF) cycle is important in clinical practice for providing important diagnostic and prognostic value.Poor ovary response (POR) is characterized by a low number of growing follicles and low serum estradiol levels after exogenous gonadotropin stimulation, resulting in a poor oocyte retrieval
According to the consensus elaborated by the European Society of Human Reproduction and Embryology (ESHRE) in 2011, to define POR, at least two of the following three features must be present: (i) Advanced maternal age (≥40 years) or any other risk factor for POR, (ii) a previous POR (≤3 oocytes with a conventional stimulation protocol), (iii) an abnormal ovarian reserve test (i.e., antral follicle count (AFC) of 5–7 follicles or AMH of 0.5–1.1 ng/ml)
During the process of Gn usage, recombined FSH accounted for 54.01%, and HMG was added to the latter stage of control ovarian stimulation (COS) in 97.6% of the cycles
Summary
Predicting a patient’s ovarian response prior to the start of the first IVF cycle is important in clinical practice for providing important diagnostic and prognostic value.Poor ovary response (POR) is characterized by a low number of growing follicles and low serum estradiol levels after exogenous gonadotropin stimulation, resulting in a poor oocyte retrieval. According to the consensus elaborated by the European Society of Human Reproduction and Embryology (ESHRE) in 2011, to define POR, at least two of the following three features must be present: (i) Advanced maternal age (≥40 years) or any other risk factor for POR, (ii) a previous POR (≤3 oocytes with a conventional stimulation protocol), (iii) an abnormal ovarian reserve test (i.e., AFC of 5–7 follicles or AMH of 0.5–1.1 ng/ml). Two episodes of POR after maximal stimulation are sufficient to define a patient as a poor responder in the absence of advanced maternal age or abnormal ORT. From that time, according to the literatures, the prevalence of POR after ovarian stimulation ranged from 5.6 to 35.1% worldwide [3], and it relates to poor IVF outcomes and low pregnancy rate for these patients [4]
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