A randomized controlled trial investigating the use of a predictive nomogram for the selection of the FSH starting dose in IVF/ICSI cycles

Allegra, Adolfo; Marino, Angelo; Volpes, Aldo; Coffaro, Francesco; Scaglione, Piero; Gullo, Salvatore; Marca, Antonio La

doi:10.1016/j.rbmo.2017.01.012

Cited by 69 publications

(65 citation statements)

References 42 publications

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“…Previously, a nomogram based on age, AMH and day 3 FSH was proposed to predict the FSH starting dose before an agonist protocol (La Marca et al, 2012), but this only explained 30% of the variability in ovarian sensitivity (r = 0.31). Nevertheless, a randomized trial of the use of this nomogram for agonist protocols allowed an optimal response of 63% to be obtained versus 42% in the control group (Allegra et al, 2017). In our study, even if the combination of parameters allowed a significant increase in the correlation coefficient, it remained relatively low (r = 0.6), suggesting that other parameters were involved.…”

Section: Discussioncontrasting

confidence: 49%

Establishment and validation of a score to predict ovarian response to stimulation in IVF

Chalumeau

Moreau

Gatimel

et al. 2018

Reproductive BioMedicine Online

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This study aimed to integrate clinical and biological parameters in a score able to predict ovarian response to stimulation for IVF in gonadotrophin-releasing hormone (GnRH) antagonist protocols. A progressive discriminant analysis to establish a score including the main clinical and biological parameters predicting ovarian response was performed by retrospectively analysing data from the first ovarian stimulation cycle of 494 patients. The score was validated in a prospectively enrolled, independent set of 257 patients undergoing their first ovarian stimulation cycle. All ovarian stimulations were performed using a combination of GnRH antagonist and recombinant FSH. Ovarian response was assessed through ovarian sensitivity index (OSI). Parameters from the patients' database were classified according to correlation with OSI: the progressive discriminant analysis resulted in the following calculation: score = 0.192 - (0.004 × FSH (IU/l)) + (0.012 × LH:FSH ratio) + (0.002 × AMH (ng/ml)) - (0.002 × BMI (kg/m)) + (0.001 × AFC) - (0.002 × age (years)). This score was significantly correlated with OSI in the retrospective (r = 0.599; P < 0.0001) and prospective (r = 0.584; P < 0.0001) studies. In conclusion, the score including clinical and biological parameters could explain 60% of the variance in ovarian response to stimulation.

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Section: Discussioncontrasting

confidence: 49%

Establishment and validation of a score to predict ovarian response to stimulation in IVF

Chalumeau

Moreau

Gatimel

et al. 2018

Reproductive BioMedicine Online

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“…The absence of an international AMH standard and the lack of awareness among some clinicians regarding differences in assay performance have also contributed to these concerns . For example, the algorithm developed by La Marca and colleagues for the individualization of follitropin alpha doses was initially derived using the Beckman Coulter AMH assay, but was subsequently externally validated and assessed in a randomized controlled trial using the modified AMH Generation II assay from Beckman. In contrast, follitropin delta dosing has been linked with the Roche Elecsys ® AMH immunoassay as the companion diagnostic that was validated in the phase 3 ESTHER‐1 registration study .…”

Section: Discussionmentioning

confidence: 99%

“…Several algorithms incorporating biomarkers of ovarian reserve have been developed to individualize dosing of different gonadotropin preparations . Two of these, which incorporate anti‐Müllerian hormone (AMH) concentrations as a biomarker of ovarian reserve, have been externally validated in randomized controlled clinical trials …”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Two of these, which incorporate anti-Müllerian hormone (AMH) concentrations as a biomarker of ovarian reserve, have been externally validated in randomized controlled clinical trials. 6,7 AMH is produced primarily by granulosa cells of developing pre-antral and small antral follicles, and the circulating hormone is believed to originate mainly from follicles up to 8 mm in diameter.…”

Section: Introductionmentioning

confidence: 99%

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Anti‐Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta

Nelson

Mannaerts

Andersen

et al. 2019

Clinical Endocrinology

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Summary Objective The stability of anti‐Müllerian hormone (AMH) across and between menstrual cycles has been the subject of debate. The objective of this analysis was to study the inter‐ and intracycle variability in repeated measurements and assess the impact on an individualized gonadotropin dosing algorithm and predicted oocyte yield. Design Retrospective analysis of repeat AMH measures from a randomized controlled trial. Patients A total of 1326 women aged 18‐40 years. Measurements Serum AMH levels at screening and at cycle day 2‐3 in up to three ovarian stimulation cycles. AMH variability and its impact on gonadotropin dose and the predicted number of oocytes. Results Repeat serum AMH measurements were strongly correlated within individual women (correlation coefficient 0.92). AMH exhibited limited within‐subject variation (coefficient of variation 23%), a small time‐related decline (mean 6% decrease/y), but no systematic variation across the menstrual cycle. Irrespective of whether the AMH screening value or the AMH at the initiation of ovarian stimulation was used, for women with an AMH level <15 pmol/L, 93% would receive the same gonadotropin dose and attain an identical number of oocytes in 97% of cases. For women with an AMH level ≥15 pmol/L, 80% would receive an individualized dose within ±1.5 μg and 90% would attain ±1 oocyte. Conclusion AMH variability had limited impact on individualized gonadotropin dosing, with 95% of women predicted to obtain an oocyte yield that does not vary beyond 1 oocyte count, irrespective of whether a random or early follicular AMH measurement was used to determine the individualized gonadotropin dose.

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“…15 Nevertheless, a randomized trial of the use of this nomogram for agonist protocols allowed an optimal response of 63% to be obtained versus 42% in the control group. 16 For collection of ≥ 4 oocytes, we found a cut-off of 0.25 (AUC-0.921) for ORPI and 35 (AUC-0.952) for MORPI. Similarly, Oliveira et al, found a cut-off value of 0.2 (AUC-0.91) for ORPI.…”

mentioning

confidence: 70%

Modified ovarian response prediction index: a novel index for ovarian response prediction in GnRH agonist cycles

Kalpana

Panda

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Evaluation of the ovarian reserve is necessary to achieve an appropriate controlled ovarian stimulation (COS). This can be done by correctly predicting the ovarian response. The objective of this study was to derive a simple index by combining the above parameters which will be helpful determining ovarian response.Methods: This retrospective analysis was performed at Guru hospital, Madurai, involving 162 patients between July 2016 and July 2018. Inclusion criteria was all patients attending for their first ICSI (intracytoplasmic sperm injection) cycle between the above period, GnRH agonist protocol as the method of ovarian stimulation, no history of any previous ovarian surgery, presence of both ovaries and no evidence of any obvious endocrine disorders. We calculated MORPI values by multiplying the AMH (ng/ml) level by the number of antral follicles (2-9 mm), and the result was divided by the age (years) of the patient and the day- 3 serum FSH level.Results: At a cut-off value of 35 (AUC-0.952) for collection of ≥ 4 oocytes and 140 (AUC-0.952) for collection of ≥ 15 oocytes, MORPI was found to have optimum sensitivity and specificity under ROC curve analysis.Conclusions: MORPI is a simple, precise and cost effective index to predict a low ovarian response, the collection of >4 MII oocytes and an excessive ovarian response in infertile women. This index also has a good ability to predict the clinical pregnancy rate. This might be used to improve the cost-benefit ratio of ovarian stimulation regimens.

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A randomized controlled trial investigating the use of a predictive nomogram for the selection of the FSH starting dose in IVF/ICSI cycles

Cited by 69 publications

References 42 publications

Establishment and validation of a score to predict ovarian response to stimulation in IVF

Establishment and validation of a score to predict ovarian response to stimulation in IVF

Anti‐Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta

Modified ovarian response prediction index: a novel index for ovarian response prediction in GnRH agonist cycles

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