Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotrophin for in-vitro fertilization can predict poor response

Abstract

The study tests the hypothesis that small ovaries measured on transvaginal sonography (TVS) are associated with a poor response to ovulation induction by human menopausal gonadotrophin (HMG) for in-vitro fertilization (IVF). A total of 140 infertile patients with morphologically normal ovaries undergoing IVF was studied. The mean ovarian volume of each patient was measured on TVS before starting HMG. Subsequent routine IVF management was conducted without knowledge of the results of TVS. The mean ovarian volume was 6.3 cm3 (range 0.5-18.9, SD= 3.1). Patients (n = 17; group A) with small ovaries of < 3 cm3 (i.e. overall mean volume - 1 SD) were compared to patients (n = 123; group B) with ovaries > or = 3 cm3. Both groups were of similar age (mean 35.8 versus 34.4 years). Early basal FSH concentrations were increased in group A (9.5 versus 7.0 mIU/ml, P = 0.025). The cycle was abandoned before planned oocyte recovery in nine patients (52.8%) from group A and in 11 patients (8.9%) from group B because of poor response to ovulation induction (P < 0.001). Increased age and ovarian volume were associated independently with cancellation of the cycles. The remaining eight patients from group A who had oocytes retrieved required higher doses of HMG (87.5 versus 53.8 ampoules, P < 0.01), yielded fewer follicles (10.3 versus 14.5, P < 0.05) and fewer oocytes were recovered from them (6.8 versus 11.0, P < 0.05) compared with group B. There was no difference in the fertilization or pregnancy rates or the number of embryos available for transfer in either group. Our results indicate a strong association between ovarian volume and ovarian reserve. Small ovaries are associated with poor response to HMG and a very high cancellation rate during IVF. Assessment of ovarian size should be an integral part of infertility evaluation.

Comparison of Basal and Clomiphene Citrate Induced FSH and Inhibin B, Ovarian Volume and Antral Follicle Counts as Ovarian Reserve Tests and Predictors of Poor Ovarian Response in IVF

“…The results of the current study, as well as those reported by others, do support that ovarian volume, measured by transvaginal ultrasound, has been correlated well with response to ovulation induction in ART cycles (18)(19)(20)32). Small ovaries (<3 cm 3 ) were found to predict poor response to ovarian stimulation and high cancellation rates but not pregnancy achievement (19). It was also reported that a significant decrease in the number of follicles and a higher cancellation rate observed in women with ovarian volume smaller than 3 cm 3 (18).…”

“…Our cut-off point for ovarian volume that discriminated the poor and normal responder was 2.98 cm 3 with a sensitivity of 75% and specificity of 81.2%. The results of the current study, as well as those reported by others, do support that ovarian volume, measured by transvaginal ultrasound, has been correlated well with response to ovulation induction in ART cycles (18)(19)(20)32). Small ovaries (<3 cm 3 ) were found to predict poor response to ovarian stimulation and high cancellation rates but not pregnancy achievement (19).…”

“…There is also evidence that a direct relation exists between decreased ovarian volume, antral follicle counts and diminished ovarian reserve (17,18). Previous studies have assessed the relations of basal FSH with ovarian antral follicle counts and ovarian volume as well as basal FSH with basal inhibin B to predict ovarian reserve (18)(19)(20)(21). Comparison of basal inhibin B with ovarian antral follicle counts and ovarian volume and other basal and CC induced hormonal parameters of ovarian reserve, to our knowledge, has not been previously reported.…”

The protective effects of human umbilical cord mesenchymal stem cells on damaged ovarian function: A comparative study

“…Along with an age-related decrease in estrogen levels, the absence of the beneficial effects of estrogen on oxidative stress finally causes damage to the ovaries. This may explain the significantly increase in the rate of congenital birth defects in women over age 38 (17). The accumulation of oxidative damage and an accompanying diminishing of antioxidant defenses will ultimately lead to ovarian aging.…”

A Randomized, Double-Blind, Multicenter Study Comparing a Starting Dose of 100 IU or 200 IU of Recombinant Follicle Stimulating Hormone (Puregon�) in Women Undergoing Controlled Ovarian Hyperstimulation for IVF Treatment

“…Possible markers include female age, early follicular serum FSH (18), estradiol and inhibin B concentrations (19), and ultrasonographic parameters including ovarian volume (20), antral follicle count (21), and peak ovarian stromal blood flow velocity (7). Further work is required on selecting stimulation protocols and appropriate starting doses of gonadotropins for women identified to be at increased risk of poor ovarian response.…”