Ovarian Response Prediction Index Research Articles

O-255 Ovarian Response Prediction Index (ORPI) as a predictor tool for ovarian response and clinical pregnancy in IVF/ICSI cycle : A Prospective Cohort Study

Abstract Study question Can incorporation of the Ovarian Response Prediction Index (ORPI), integrating AMH, AFC and age, offer a reliable prognostication of ovarian stimulation response in ART cycles? Summary answer The study affirms that ORPI, a three-variable index, emerges as a robust predictor for both ovarian response and clinical pregnancy rates within IVF/ICSI cycles. What is known already In the realm of individualized Controlled Ovarian Stimulation, precision in forecasting ovarian response proves pivotal. Ovarian reserve, influenced by age, AMH, and AFC, exhibits considerable heterogeneity among women of analogous age. While AMH and AFC function as pivotal markers, a holistic approach, exemplified by ORPI, stands out as a more comprehensive tool for predicting ovarian response. Study design, size, duration This prospective cohort study enrolled 302 subjects undergoing IVF cycles at a tertiary infertility center spanning from 1st January 2022 to 31st December 2023. Rigorous inclusion criteria mandated age ≤38 years, a BMI between 20–25 kg/m2, regular menstrual cycles, intact bilateral ovaries, no history of ovarian surgeries, absence of severe endometriosis, and no evidence of endocrine disorders. Participants/materials, setting, methods Subjects adhering to the inclusion criteria underwent venous blood sampling for AMH measurement and transvaginal ultrasound for AFC assessment. The ORPI was meticulously computed as (AMH × AFC) / patient age. Key endpoints encompassed the total oocytes retrieved, mature MII oocytes, and occurrences of clinical pregnancy. Rigorous statistical methodologies were employed for robust analysis. Main results and the role of chance The mean values for age (years), AMH (ng/mL), ORPI, AFC, and fertilized oocytes were 31.75 ± 4, 3.75 ± 3.39, 1.06 ± 1.22, 7.1 ± 2.94, and 6.11 ± 3.26, respectively. A highly significant positive correlation (p-value < 0.0001) was observed between ORPI and the numbers of oocytes and MII oocytes, with correlation coefficients of 0.714 and 0.746, respectively. Interpretation of the area under the ROC curve revealed that ORPI was a significant predictor of obtaining ≥4 oocytes at a cutoff point of > 0.2, with an area under the curve of 0.907. Similarly, for MII oocytes ≥4, ORPI was a significant predictor at a cutoff point of > 0.2, with an area under the curve of 0.937. In the case of positive clinical pregnancy, ORPI emerged as a significant predictor at a cutoff point of > 0.75, with an area under the curve of 0.822. The study underscored a substantial positive correlation between ORPI and both oocyte and MII oocyte counts, affirming ORPI’s pivotal role as a predictor for clinical pregnancy. Limitations, reasons for caution Limitations due to the constraint of sample size temper the generalizability of findings. The study did not account for live birth rates, and a comparative analysis with alternative markers was omitted. A more expansive, meticulously designed study is imperative. Wider implications of the findings ORPI, an innovative ovarian response biomarker, showcases considerable potential for predicting both ovarian response and clinical pregnancy rates. Its integration into individualized Controlled Ovarian Stimulation regimens holds promise for augmenting the counselling and prognostication process for patients embarking on IVF/ICSI cycles. Trial registration number MCDH/2023/28

Evaluation of Ovarian Response Indexes as Predictors to the Outcome of Intracytoplasmic Sperm Injection

Abstract Background: Knowing predictors of pregnancy in assistant reproductive technology, knowing of predictors of pregnancy is helpful for clinicians to individualize treatment 14 Plans and improve patient counseling, and for patients to decide whether to undergo infertility treatment. Therefore, it is important to evaluate ovarian reserve prediction indexes as an index to predict response to assistant reproductive technology. Objectives: To evaluate the ovarian reserve index (AMH*AFC/Age), taking into account the total number of MII oocytes retrieved and the quality of embryo obtained as well as the pregnancy rate. Materials and Methods: This study is designed as a cohort prospective study and was conducted in Al-Sadder Teaching Medical City, Al Najaf Province. Sixty couples were enrolled. The gynecological examination was performed on day 2 of the cycle (CD2): vaginal ultrasound (U/S) and blood tests for FSH, LH, AMH, estradiol (E2), serum prolactin, and thyroid function test. The ovarian response prediction index (OPRI) values were measured by multiplying the AMH serum level (ng/mL) by the number of antral follicles with a diameter of 2–9 mm and then dividing the result by the age of the subjects (years). Results: The current study showed that the pregnancy rate of the studied group was 33.33%. There was a significant difference between pregnant and nonpregnant women in their AMH level (P value was 0.004). ORPI was significantly higher in pregnant women than nonpregnant women. Binary logistic regression analysis shows that there was a significant positive correlation of ORPI and higher AMH, AFC, lower BMI, MII, oocytes, and embryo number. ROC curve shows that ORPI had an AUC of 1.00 at cutoff point 2, giving a sensitivity and specificity of 97% and 100%, respectively, and an AUC of 1.00 at a cutoff point 1, giving a sensitivity and specificity of 100% and 95%, respectively, which indicate that ORPI is an important predicting factor for ICSI success rate. Conclusion: ORPI was significantly higher in pregnant women than in the nonpregnant group; AMH was significantly higher in pregnant women than in the nonpregnant group. Women with higher AMH, AFC, and lower BMI are more likely to have higher ORPI.

Effects of ovarian response prediction index and follicle-oocyte index on pregnancy outcomes: a retrospective cohort study of 12,218 fresh transfer cycles

Objective: To investigate the potential relationships among the ovarian response prediction index (ORPI), follicle-oocyte index (FOI), and clinical pregnancy rate (CPR) in women undergoing their first in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) fresh cycle transfer. Methods: In this retrospective cohort study, we included 12,218 women who underwent their first IVF/ICSI-ET cycle between December 2014 and January 2021. The primary and secondary outcomes of our study were CPR and cumulative live birth rate (CLBR), respectively. The data were divided into three groups according to the ORPI and FOI tertiles. Multivariate logistic regression analyses, stratification analyses, interaction, restricted cubic splines, and receiver operating characteristic (ROC) curves were constructed to identify the relationships among ORPI, FOI, and CPR. Results: A statistically significant increase in CPR was detected from the lowest to the highest tertile group (ORPI: 48.12%, 54.07%, and 53.47%, P <0.001; FOI:49.99%, 52.95%, and 52.71%, P=0.012). A higher CLBR was observed in the high group (ORPI: 38.63%, 44.62%, and 44.19%, P <0.001; FOI: 41.02%, 43.78%, and 42.59%, P=0.039). Multivariate logistic regression analysis revealed no statistically significant differences between ORPI, FOI, and neither CPR [odds ratio (OR) (95% confidence interval (CI), 0.99 (0.97-1.00) vs. (1.02 (0.84-1.24)] nor CLBR [OR (95% CI), 0.99 (0.97-1.01) vs. 0.99 (0.81-1.20)]. No significant association was found among FOI, ORPI, and CPR, even in the subgroups. Restricted cubic spline analyses indicated the existence of a nonlinear relationship across the entire range of FOI and ORPI. The ORPI and FOI variables had poor predictive ability (AUC< 0.60) for CPR. Conclusions: Both ORPI and FOI are not reliable predictors of clinical pregnancy or live birth outcomes in fresh embryo transfers. Clinicians and researchers should avoid using FOI and ORPI to assess pregnancy outcomes after fresh embryo transfer because of their limited relevance and predictive value.

Evaluative effectiveness of follicular output rate, ovarian sensitivity index, and ovarian response prediction index for the ovarian reserve and response of low-prognosis patients according to the POSEIDON criteria: a retrospective study.

The aim was to explore the implications of follicular output rate (FORT), ovarian sensitivity index (OSI), ovarian response prediction index (ORPI), and follicle-to-oocyte index (FOI) in low-prognosis patients defined by POSEIDON criteria. In total, 4030 fresh in vitro fertilization (IVF) cycles from January 2013 to October 2021 were included in this retrospective cohort analysis and were categorized into four groups based on the POSEIDON criteria. The FORT between Groups 1 and 2 (0.61 ± 0.34 vs. 0.65 ± 0.35, P = 0.081) and Groups 3 and 4 (1.08 ± 0.82 vs. 1.09 ± 0.94, P = 0.899) were similar. The OSI in the order from the highest to the lowest were 3.01 ± 1.46 in Group 1, 2.28 ± 1.09 in Group 2, 1.54 ± 1.04 in Group 3, and 1.34 ± 0.96 in Group 4 (P < 0.001). The trend in the ORPI values was consistent with that in the OSI. FORT, OSI, ORPI, and FOI complemented each other and offered excellent effectiveness in reflecting ovarian reserve and response, but they were not good predictors of clinical pregnancy rate (CPR) from IVF.

Performance of Ovarian Response Prediction Index As Predictor of Ovarian Response

Objective: We aimed to evaluate potential predictors of response to controlled ovarian stimulation (COS), including follicle stimulating hormone (FSH), Estradiol, antral follicle count (AFC), and ovarian response prediction index (ORPI). Methods: In this prospective, single center study, we recruited 55 infertile women underwent the first cycle of in vitro fertilization/ intracytoplasmic injection/intrauterine insemination (IVF/ICSI/IUI). We measured serum FSH and anti-mullerian hormone (AMH) level by ELISA and evaluated AFC. In accordance with formula, AMH x AFC / patient's age, ORPI was calculated. Results: The study participants are aged between 25 to 48 in infertility women. The mean age of the participants are 34.5 ± 5.5. The hormonal predictors, as well as ovarian response, are presented in Table 2. Predict ovarian hypo response by E2 and ORPI. Multivariable models improved the predictive accuracy for hypo-response (AUC &gt; 0.6). With regard to the hyper-response, ORPI, E2 and AFC showed good predictors. In the multivariable model, the ORPI, E2 and AFC presented the best predictive accuracy, with an AUC 0.81, a sensitivity of 87 %, and a specificity of 67 %. Conclusion: ORPIndex is predicting the hyper-response more accurately than the ovarian hypo- response in infertility women. Participant’s ovarian reserve biomarkers (AFC and E level) was significantly increased predictive accuracy.

The Predictive Levels of Serum Anti-Müllerian Hormone and the Combined Index of the Number of Retrieved Oocytes and Good-Quality Embryos in Advanced-Age Infertile Women.

The primary objective of the study was to assess the values of serum anti-Müllerian hormone (AMH) levels and the combined index for the prediction of number of oocytes retrieved (NOR) and number of good-quality embryos (GQE) in infertile women undergoing IVF/ICSI treatment. A group of 521 infertile women aged 21–46 years were recruited as subject in this study. Serum AMH, hormones, and antral follicle count (AFC) were measured. The infertile women were categorized into three groups: 21–34 years (reproductive age), 35–39 years (reproductive age), and 40–46 years (advanced-age infertile). The predictive accuracy of variables was analyzed by the receiver operating characteristic (ROC) curve. AFC, AFC/age ratio, AMH/age ratio, and ovarian response prediction index (ORPI) decreased gradually, while AMH decreased significantly with increase in age. Moreover, NOR and GQE were positively correlated with AFC, AMH, AFC/age ratio, AMH/age ratio, and ORPI (P < 0.001). A statistical significance was observed in predicted oocyte retrieval including AMH, AMH/age ratio, and ORPI between 21–34 years and 35–46 years; especially in the 35–46 years group, these variables reached a “high” grade in the diagnostic accuracy because area under curve (AUC) ranged from 0.982 to 0.988 significantly. No statistical significance was observed for FSH, AMH, AFC, and related combined index predicting GQE. The predictive value of AFC and AFC/age ratio was limited regarding oocyte retrieval; however, AMH, AMH/age ratio, and ORPI concurrently had an excellent value for predicting NOR in reproductive-age women, especially in advanced-age infertile women.

Comparative study between ovarian response prediction index versus anti-Müllerian hormone, antral follicular count as predictors of ovarian response in women undergoing IVF/ICSI cycles

Aim:This study aimed to compare individual predictors as AMH, AFC versus the ovarian response prediction index in determining the ovarian response to controlled ovarian stimulationMaterials and Methods: A prospective cohort study conducted on 84 infertile couples candidate for Intracytoplasmic sperm injection (ICSI) for the first time using either long agonist or antagonist protocol according to clinical evaluation. Participants were classified according to the number of MII oocytes into poor response with 3 or less oocytes and normal responders with 4 or more oocytes.Results: The study showed that women with poor response were statistically older than those with normal ovarian response (33.1±5.9 vs. 29.8±5.4, respectively). The number of cumulus (12.1±5.2 vs. 2.5±1.5), MII oocytes (7.8±3.6 vs. 2±0.8), grade A embryos (3±0.8 vs. 1.4±0.9) and total number of embryos (3.8±2.2 vs. 1.7±0.7) were significantly higher in normal responders. ORPI has the highest accuracy in predicting ovarian response (88%) when compared to AMH (83%) and AFC (86%).Conclusion: AMH, AFC and ORPI are good predictive of the ovarian response and help in choosing the protocol and gonadotropin dose of induction and prediction of OHSS

Prediction of Ovarian Response with Ovarian Response Prediction Index (Orpi) during Controlled Ovarian Stimulation in IVF

(Background): To evaluate ORPI as an index to predict the response to ovarian stimulation. (Methods): It is an observational prospective study of 734 patients who underwent controlled ovarian stimulation during period of 1.5 years (July 2017 to December 2018) .Inclusion and exclusion criteria were taken into consideration when patients were recruited. ORPI is calculated by multiplying AMH level (ng/ml) and AFC (n) and the result is divided by age (years) of the patient. The primary outcome measured was number of MII oocytes and secondary outcome was total number of oocytes retrieved. (Results): Positive correlation of ORPI with MII oocytes and total number of oocytes is seen. Regarding the probability of collecting ≥4 oocytes under the ROC curve, the AUC for ORPI is 0.68 (95%CI 0.65-0.72) with sensitivity of 78.4 and specificity of 51.4 for a cut off of &gt;0.44. For collecting ≥ 15 oocytes ROC curve had an AUC of 0.72 with sensitivity of 66.7 and specificity of 73.4 for a cut off of &gt;1.28. ROC curve for the probability of collecting ≥4 MII oocytes depicted an AUC of 0.67 with cut off of &gt;0.77. (Conclusion): The results of our study concluded that in a patient undergoing IVF treatment, ORPI has a poor ability to predict retrieval of ≥4 oocytes or ≥ 4 MII and fair ability for hyper response with ≥15 oocytes. ORPI can serve as a counselling tool for predicting ovarian response.

Performance of ovarian response prediction index (ORPI) in predicting ovarian response and livebirth in the in-vitro fertilisation cycle using a standard stimulation with corifollitropin alpha in a GnRH antagonist protocol

The objective of this study was to evaluate the performance of ovarian response prediction index (ORPI) in predicting ovarian response and livebirth of women undergoing their first in-vitro fertilisation (IVF) cycle. This is a retrospective analysis of 285 women from 2013 to 2016. The outcome measures were area (AUC) under the receiver-operator characteristic (ROC) curves for prediction of excessive and poor response, livebirth in the fresh cycle and cumulative livebirth. The ORPI was significantly correlated with the oocyte number. For prediction of excessive response, AUC for ORPI was comparable to AMH and significantly higher than AFC and female age. At a cut-off of 0.42, ORPI has a sensitivity and specificity of 84% and 77% respectively for prediction of excessive response. For prediction of poor response, AUC for ORPI was significantly higher than AFC, AMH and female age. At a cut-off of 0.12, ORPI has a sensitivity of 69% and specificity of 89% respectively for prediction of poor response. For prediction of livebirth, AUCs of ORPI were not significantly different from AFC and female age. Therefore, ORPI is not a good predictor of livebirth. Its prediction of excessive and poor ovarian response is comparable to that of serum AMH.

Are ovarian reserve tests reliable in predicting ovarian response? Results from a prospective, cross-sectional, single-center analysis

Objetive Several biomarkers of ovarian reserve have been proposed as possible predictors of the response to controlled ovarian stimulation (COS). We aimed to evaluate age, FSH, AMH, antral follicle count (AFC), and ovarian response prediction index (ORPI), as potential predictors of response to COS. Methods Cross-sectional study enrolling of 188 infertile women who underwent the first cycle of IVF/ICSI. AFC was evaluated; serum FSH and AMH levels were measured by ELISA. ORPI was calculated as AMH x AFC/patient´s age. Results As expected, hypo-responder group had less retrieved oocytes, MII, and embryos compared to the good responders. The hyper-response patients were younger, with lower FSH, increased AMH, AFC, and ORPI values. Regarding the assessment of the predictive capacity of ovarian reserve tests, none of them individually or combined showed a good predictive capacity for hypo-response. With respect to the hyper-responder group, individually AMH was the best predictor, while in the multivariable model, ORPI demonstrated the best predictive capacity. Furthermore, patients with serum AMH < 2.09 ng/mL (p25) had fewer AFC than patients with higher AMH values. Conclusions Our findings suggest that none of the ovarian reserve tests showed a good predictive capacity for hypo-response, while the ORPI was the strongest predictor of hyper-response in normovulatory infertile women.

Ovarian response prediction index (ORPI): A novel biomarker for ovarian response prediction in IVF cycle: An implication for individualized controlled ovarian stimulation programme

Background: The success of IVF depends to a large extent on the number and quality of mature oocytes obtained at the time of oocyte retrieval after controlled ovarian stimulation. This can be done by correctly predicting the ovarian response, which largely depends on ovarian reserve. The objective of present study was to assess accuracy of novel biomarker Ovarian Response Prediction Index (ORPI) based on three parameters patient age, AFC, AMH for prediction of ovarian response, so, we would be able to formulate individualized controlled ovarian stimulation approach to optimize cycle outcome. Methodology: This retrospective analysis was performed at our centre involving 100 patients undergoing IVF cycle between August 2019 and February 2020. We calculated ORPI by the following equation: ORPI = (AMH × AFC)/patient age, which was derived by Oliveira et al. Results: There was significant (p = 0.0001) positive correlation of ORPI with AFC, AMH, oocyte, MII oocyte and Embryo (gr1+2). ROC curve analysis showed that at ORPI cut off >0.18 (AUC 0.94) has sensitivity and specificity of 95.7% and 85.7%, respectively, for prediction of ≥4 oocyte recovery, and at cut off >2 (AUC 0.91) has sensitivity and specificity 75% and 85.2%, respectively, for prediction of ≥15 oocyte recovery. This study has demonstrated that for collection of ≥4 MII oocytes, ORPI at cut off >0.50 (AUC 0.86) has sensitivity and specificity of 74.1% and 78.9%, respectively. For probability of collection of >6 good quality embryos, we found ORPI cut off >0.75 with sensitivity and specificity of 72.7% and 64.2%, respectively. Conclusion: This study demonstrated that ORPI, which is simple 3 variable index, has shown excellent ability to predict low and excessive ovarian response and can be useful to tailor individualized controlled ovarian stimulation programme and will be beneficial for counselling and prognostication of infertile couple.

Predictive values of anti-müllerian hormone, antral follicle count and ovarian response prediction index (ORPI) for assisted reproductive technology outcomes

This prospective study was performed from June 2012 to June 2014 at Royan Institute to compare the predictive values of serum anti-müllerian hormone (AMH), antral follicle count (AFC) and ovarian response prediction index (ORPI) ([AFC × AMH]/age) for in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycle outcomes. Five hundred and fifty women included in the study with male factor and unexplained infertility were the first candidates for IVF/ICSI cycles. Serum AMH level was measured by a commercial ELISA kit and AFC was calculated by a transvaginal ultrasonography on day 2–3 of the menstrual cycle before starting ovarian stimulation. All women underwent IVF/ICSI cycles using a long standard protocol with gonadotropin-releasing hormone agonist. The receiver operating characteristic curves (ROC) analysis showed that both AMH and AFC were good predictors of ovarian response with an area under the curves (AUC) > 0.75; even it seems that AFC was being a better predictor. Combining these variables is necessary as ORPI will not improve the prediction value. All the variables had poor predictive ability (AUC <0.60) for clinical pregnancy and live birth rates. Logistic regression analysis showed the AMH less than 0.4 ng/ml and quality of transferred embryos were significant predictors for clinical pregnancy rate.

Comparison of ovarian responsiveness tests with outcome of assisted reproductive technology - a retrospective analysis.

IntroductionThis study aims to compare the association between the most commonly used ovarian responsiveness markers – age, anti-Müllerian hormone levels (AMH), antral follicle count (AFC), ovarian sensitivity index (OSI), and ovarian response prediction index (ORPI) – and ovarian responsiveness to gonadotropin stimulation in assisted reproductive technology (ART) cycles.Material and methodsPatients who underwent intracytoplasmic sperm injection treatment using either a gonadotropin releasing hormone (GnRH) antagonist or agonist protocol were enrolled in the study. Data of the patients were abstracted from the hospital’s database. Tests were compared for total number of retrieved oocytes, metaphase II (MII) oocytes, embryos, good quality embryos on day 1 and day 3, and ongoing pregnancies per cycle.ResultsThe OSI was the ovarian response test that had the strongest relationship with the ART outcomes. The level of association between the ovarian response tests and poor ovarian response data was (in descending order): OSI, ORPI, AFC, AMH, and age (AUCOSI = 0.976, AUCORPI = 0.905, AUCAFC = 0.899, AUCAMH = 0.864, AUCage = 0.617). The overall association between OSI and poor ovarian response was significantly higher than the other parameters (p 1 = 0.0023, p 2 = 0.0014, p 3 = 0.0001, p 4 ≤ 0.0001). In patients with high ovarian response data, OSI had the highest association, followed by AFC and ORPI age (AUCOSI = 0.984, AUCAFC = 0.907, AUCORPI = 0.887). There was no statistically significant difference among the tests for the data of patients with ongoing pregnancies.ConclusionsIn this study, which is the first study comparing the five most frequently used ovarian responsiveness markers and the second study signifying the role of OSI in an antagonist protocol, OSI was found to be more convenient to calculate, and it could be superior to other ovarian responsiveness markers for poor and high ovarian responses on cycles with agonist or antagonist protocols.

The TP73 gene polymorphism (rs4648551, A>G) is associated with diminished ovarian reserve.

It’s known that the members of the TP53 family are involved in the regulation of female reproduction. Studies in mice showed that the TP73 gene (member of this family) plays a role in the size of follicular pool, ovulation rate and maintenance of genomic stability. In the present study we analyzed data from 605 patients with ≤ 37 years attending their first intracytoplasmic sperm injection (ICSI). The association between the TP73 polymorphism (rs4648551, A>G) and the following parameters related to ovarian reserve, like age, antral follicular count (AFC), anti-Mullerian hormone levels (AMH) and ovarian response prediction index (ORPI) was evaluated. Our results showed an association of the AA genotype with diminished ovarian reserve (AMH <1, AFC ≤9). Women presenting the AA genotype had a 2.0-fold increased risk for having AMH <1 and AFC ≤9 (OR 2.0, 95% CI 1.23-3.31, P = 0.005). Patients presenting AA genotype had the lowest levels of AMH (P = 0.02), the lowest number of antral follicles (P = 0.01) and the lowest ORPI (P = 0.007). Analyzing the alleles, we can see an enrichment of the A allele in the group of diminished ovarian reserve (OR 1.4, 95%CI 1.02-1.83, P = 0.04). To the best of our knowledge, the present study is the first to analyze this polymorphism in humans for assessing the numbers of ovarian follicles and AMH levels and, therefore, the ovarian reserve. Our findings can contribute to the use of this polymorphism as a potential marker of diminished ovarian reserve.

The tp73 gene polymorphism (rs4648551- a/a genotype) is related with reduction in the number of antral follicles

It’s known that members of the TP53 family are involved in the regulation of female reproduction. Studies in mice showed that the TP73 gene (member of this family) plays a role in the size of follicle pool, ovulation rate and maintenance of genomic stability. Therefore, we intended to analyze the association between a polymorphism on the TP73 gene and some characters associated with ovarian reserve (age, antral follicles count-AFC, anti-müllerian hormone-AMH levels and the ovarian response prediction index (ORPI) since there is no study in humans.

Clinical decision in ovarian stimulation guided by the ovarian response prediction index (ORPI)

To expand the evaluation of the ovarian response prediction index (ORPI) based on the AMH, AFC and age and to verify its reliability as a predictor of ovarian response to stimulation in assisted reproductive technology (ART) cycles.

Expand evaluation of the ovarian response prediction index (ORPI) for individualised controlled ovarian stimulation

Expand evaluation of the ovarian response prediction index (ORPI) for individualised controlled ovarian stimulation

A new ovarian response prediction index (ORPI): implications for individualised controlled ovarian stimulation

BackgroundThe objective was to present a new ovarian response prediction index (ORPI), which was based on anti-Müllerian hormone (AMH) levels, antral follicle count (AFC) and age, and to verify whether it could be a reliable predictor of the ovarian stimulation response.MethodsA total of 101 patients enrolled in the ICSI programme were included. The ORPI values were calculated by multiplying the AMH level (ng/ml) by the number of antral follicles (2–9 mm), and the result was divided by the age (years) of the patient (ORPI=(AMH x AFC)/Patient age).ResultsThe regression analysis demonstrated significant (P<0.0001) positive correlations between the ORPI and the total number of oocytes and of MII oocytes collected. The logistic regression revealed that the ORPI values were significantly associated with the likelihood of pregnancy (odds ratio (OR): 1.86; P=0.006) and collecting greater than or equal to 4 oocytes (OR: 49.25; P<0.0001), greater than or equal to 4 MII oocytes (OR: 6.26; P<0.0001) and greater than or equal to 15 oocytes (OR: 6.10; P<0.0001). Regarding the probability of collecting greater than or equal to 4 oocytes according to the ORPI value, the ROC curve showed an area under the curve (AUC) of 0.91 and an efficacy of 88% at a cut-off of 0.2. In relation to the probability of collecting greater than or equal to 4 MII oocytes according to the ORPI value, the ROC curve had an AUC of 0.84 and an efficacy of 81% at a cut-off of 0.3. The ROC curve for the probability of collecting greater than or equal to 15 oocytes resulted in an AUC of 0.89 and an efficacy of 82% at a cut-off of 0.9. Finally, regarding the probability of pregnancy occurrence according to the ORPI value, the ROC curve showed an AUC of 0.74 and an efficacy of 62% at a cut-off of 0.3.ConclusionsThe ORPI exhibited an excellent ability to predict a low ovarian response and a good ability to predict a collection of greater than or equal to 4 MII oocytes, an excessive ovarian response and the occurrence of pregnancy in infertile women. The ORPI might be used to improve the cost-benefit ratio of ovarian stimulation regimens by guiding the selection of medications and by modulating the doses and regimens according to the actual needs of the patients.