Abstract
(1) Background: Several researchers have investigated alternative markers related to ovarian responsiveness in order to better predict IVF outcomes, particularly in advanced reproductive-aged women. The follicular output rate (FORT), the follicle-oocyte index (FOI) and the ovarian sensitivity index (OSI) are among the most promising. However, these three metrics have not been investigated as independent predictors of live birth in women of advanced reproductive age; neither have they been compared to the two ‘component’ characteristics that are used to calculate them. (2) Methods: A logistic regression model containing all relevant predictors of ovarian reserve or response was used to evaluate the potential of FORT, FOI and OSI as predictors of live birth. After, the non-linear associations between FORT, FOI and OSI and the probability of live birth were evaluated. Finally, we fitted multiple logistic regression models to compare whether FORT, FOI and OSI were more informative predictors than their components. (3) Results: 590 couples received a total of 740 IVF cycles, after which, 127 (17.5%) obtained a live birth. None of FORT, FOI and OSI showed a strength of association or a p-value even close to female age (odds ratio for live birth (95% confidence interval) 1.00 (0.99–1.01), 1.00 (0.99–1.01), 0.98 (0.88–1.11) and 0.58 (0.48–0.72), respectively). The three models comparing FORT, FOI and OSI with the number of oocytes retrieved, the AFC, the number of preovulatory follicles and the FSH total dose were not more informative. (4) Conclusions: In a population of women of advanced age with unexplained infertility, none of FORT, FOI and OSI were predictive of live birth or more predictive than the two ‘component’ characteristics that were used to calculate them. We suggest clinicians and researchers still use female age as the most reliable predictor of an IVF treatment.
Highlights
Since only age was found to be a strong predictor of live birth, we evaluated the non-linear associations between the three metrics separately
follicle-oocyte index (FOI), follicular output rate (FORT) and ovarian sensitivity index (OSI) do not show a stronger or more informative association with live birth than the components used for their calculation, i.e., the number of oocytes retrieved, the antral follicle count (AFC), the number of preovulatory follicles and the follicle-stimulating hormone (FSH) total dose
Women of advanced reproductive age remain an open dilemma and a challenge for all clinicians working in the field of assisted reproductive technologies (ART)
Summary
Oocyte yield depends on several factors that modulate the ovarian responsiveness to controlled ovarian stimulation (COS) These include the type and dose of exogenous gonadotropins; the intrinsic sensitivity of the ovary to hormonal stimulation, partially correlated to the polymorphic variants of the follicle-stimulating hormone (FSH)-receptor [4]; and the rhythm of follicular maturation waves [5]. The wish to find the true ovarian potential in terms of the maximum number of retrieved oocytes and to link this to aforementioned factors has stimulated the research of more sophisticated markers of ovarian function and response, such as the ovarian sensitivity index (OSI) [7,8], the follicular output rate (FORT) [9,10] and the follicle-oocyte index (FOI) [11]. In this retrospective study among women aged 39 or above, we first evaluated non-linear associations between metrics and live birth in women of advanced reproductive age, compared all three metrics to one another, and compared these three metrics to the two variables that were used to calculate them
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