Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy

Abstract

Background The presence of a wide range of tests of ovarian reserve suggests that no single test provides a sufficiently accurate result. Many tests are used without reference to an evidence base. So far, individual studies conducted on these tests are too small to give precise estimates of prognostic accuracy. Objectives To systematically assess the accuracy of the available tests of ovarian reserve in terms of prediction of fertility outcomes. Search strategy The search will be conducted using the name of the respective index test being studied (as listed on the MESH database), if more than 2000 citations are listed, ‘ovary’ and or ‘ovarian’, ‘fertility’ and or ‘reserve’ will be combined with the original search term as required. Studies of the accuracy of tests of ovarian reserve will be obtained without language restrictions from 1980 to 2005 using the following electronic databases and Ovid software: MEDLINE, EMBASE, PUBmed, Biological extracts, Pascal, Cochrane Library (CDSR, DARE, CCTR, HTA), Best Evidence databases, SCISEARCH, Conference Proceedings (ISI Proceedings, Healthstar, Current Contents, Science Citation Index, Cancerlit and Econlit and NHS Economic Evaluation database. The National Research Register, the Medical Research Council’s Clinical Trials Register, MEDION, DARE, and the US Clinical Trials register. Selection criteria Studies will be selected if accuracy of tests are compared with a reference standard and include data that can be abstracted into a two‐by‐two table to calculate sensitivity and specificity. The studies to be included in this review will examine one of the following index ‘tests’ within a study population of women undergoing assisted reproductive technology: Clinical variables—age, history of cancelled cycles. Basal blood tests—follicle‐stimulating hormone (FSH), lutenising hormone (LH), FSH:LH ratios, estradiol (E2), inhibin A and B, progesterone (P4), P4:E2 ratios, antimullerian hormone, testosterone, vascular endothelial growth factor, insulin‐like growth factor‐1:insulin‐like growth factor binding protein‐1 ratios. Dynamic tests—clomiphene citrate challenge test, gonadotropin analogue stimulating test, exogenous FSH ovarian reserve test. Ultrasound tests—antral follicle count, ovarian volume, ovarian stromal peak systolic velocity, including waveform and pulsatility index, ovarian follicular vascularity. Histology—ovarian biopsy. Data collection and analysis Two independent reviewers will perform quality assessment and data extraction. Prognostic accuracy will be determined by calculating positive and negative likelihood ratios for the following outcomes or reference standards: live birth, ongoing pregnancy, clinical pregnancy, biochemical pregnancy, embryos available for transfer, eggs obtained at oocyte retrieval, cycles cancelled prior to oocyte retrieval. Main results and conclusions N/A.

What is the best treatment option for infertile women aged 40 and over?

“…Around 1 % of women will experience premature ovarian failure before 40 years of age. It follows that the women who undergo an earlier menopause, will also experience an earlier loss of fertility, leaving approximately 10 % of women who will have decreased ovarian function in their early to mid 30s [15].…”

Individual capacity for DNA repair and maintenance of genomic integrity: a fertile ground for studies in the field of assisted reproduction

“…Advanced hormonal assessments (estradiol, inhibin B, anti-M€ ullerian hormone) and ultrasound assessments (antral follicle count, ovarian volume) to assess ovarian reserve [14] may be additionally recommended for couples with unexplained infertility and/or those that are candidates for AR, as the ovarian reserve may be directly associated with the chances of natural conception (albeit within an extended timeframe) as well as with the chances for response to ovarian stimulation.…”

Prediction of Poor Ovarian response by Biochemical and Biophysical Markers: A Logistic Regression Model

“…By ROC analysis, the cutoff value of inhibin B to identify poor responders was found to be 23.75 pg/ml. Seifer et al reported higher cycle cancelation rates and lower pregnancy rates in women with low (\45 pg/ml) day 3 serum inhibin B concentrations [6]. According to the study of Seifer et al, the value of inhibin B of 45 pg/ml was considered as a cutoff to identify poor responders.…”