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

Abstract

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.

Correlation between Ovarian Reserve and Incidence of Ectopic Pregnancy afterIn VitroFertilization and Embryo Transfer

“…Thus, the present study utilized both AMH and basal FSH as markers of ovarian reserve. Consistent with our data, previous studies used basal FSH as the supporting factor for evaluating ovarian reserve 2324…”

Age-specific anti-Mullerian hormone (AMH) levels poorly affects cumulative live birth rate after intra-uterine insemination

“…The ability of AMH to predict the ovarian response to stimulation has been widely reported and numerous studies have shown good correlations between AMH and the ovarian stimulation index [26] or the number of collected oocytes in IVF [28] and thus has a good ability to diagnose high and poor responders [29,30]. In IUI, Freiesleben et al, using the same FSH dose (75UI) for all patients, have shown that the number of recruited mature follicles (18 mm) was dependent on the AMH levels [19].…”

“…Ovarian stimulation used a combination of recombinant FSH (Gonal F, Merck, Lyon, France or Puregon, MSD, Paris, France) and GnRH antagonist (Cetrotide 0.25 mg, Merck, Lyon, France or Orgalutran, MSD, Paris, France). The initial dose of FSH was chosen according the female age and the score described by Chalumeau et al [26]. Ovulation was triggered with recombinant hCG (Ovitrelle, Merck, Lyon, France) when at least one follicle ≥ 18 mm was obtained.…”

Making IVF more effective through the evolution of prediction models: is prognosis the missing piece of the puzzle?

“…The predictive factors employed for the construction of the proposed algorithm were FSH, LH/FSH ratio, AMH, BMI, AFC and female age as well. Furthermore, the fact that this retrospective cohortbased model has been subsequently validated on a prospective fashion is an additional strength rendering this mathematical equation a powerful tool in the clinical practice (Chalumeau et al 2018).…”

“…Following another direction in comparison to the models presented in Table 1, the La Marca and Broekmans studies attempted to predict ovarian response to different stimulation protocols (La Marca et al 2012;Broekmans et al 2014). Further to that, Moon and Chalumeau moved one step further by establishing distinct models which could predict the number of retrieved oocytes with a fair accuracy (Moon et al 2016;Chalumeau et al 2018). Apart from the above studies, Lewis assessed the fertilization rate according to male-related variables whereas Ashrafi calculated the OHSS risk chances among NPCOS women (Lewis et al 2004;Ashrafi et al 2015) Despite the predictive capacity of the abovementioned models, the weaknesses identified include the limitation of trial to other countries and clinics alongside those where they were developed and evaluated originally.…”