Pretreatment transvaginal ultrasound examination predicts ovarian responsiveness to gonadotrophins in in-vitro fertilization

Purpose : To compare basal and clomiphene citrate (CC) induced follicle-stimulating hormone (FSH), estradiol (E 2 ), and inhibin B levels with ultrasound indices of ovarian reserve in infertile women and to test the prognostic value of these tests on response to ovarian stimulation in in vitro fertilization (IVF). Methods : Fifty-six patients had basal and CC induced serum hormone levels and ultrasound measured mean ovarian volume (MOV) and mean antral follicle counts (MFC). Thirty-two patients were then appropriately selected to have a total of 41 cycles of IVF/ICSI treatment. Results : Women with diminished ovarian reserve had lower MOV, MFC, day 3 and day 10 inhibin B levels ( p < 0.001). Only basal and CC induced FSH and inhibin B correlated with MOV and MFC. Poor responders in IVF/ICSI had higher basal FSH ( p < 0.05), lower basal and induced inhibin B levels ( p < 0.05), and lower MOV and MFC ( p < 0.01) than normal responders. Ovarian volume alone was better than age and basal hormones in predicting poor ovarian response, while abnormal CC test was the only independent significant factor in predicting ovarian response. However, age was the only independent predictor of pregnancy in IVF as compared to hormonal and ultrasound indices of ovarian reserve. Conclusion : CC test and ovarian volume are better than other hormonal and sonographic tests in predicting the response to ovarian stimulation in IVF cycles.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Erdem

Gursoy

et al. 2004

“…Tomas et al examined the predictive value of early-follicular-phase antral follicle count (AFC) detected by ultrasound (20). They found that the number of baseline follicles strongly correlated with the number of recovered oocytes.…”

Section: Discussionmentioning

confidence: 99%

Use of Stimulated Serum Estradiol Measurements for the Prediction of Hyperresponse to Ovarian Stimulation in in Vitro Fertilization (IVF)

Hendriks

Klinkert

Bancsi

et al. 2004

Purpose : In ovarian stimulation an exaggerated ovarian response is often seen and is related to medical complications, such as ovarian hyperstimulation syndrome (OHSS), and increased patient discomfort. If it were possible to identify hyperresponders at an early stage of the stimulation phase, adaptation of the stimulation protocol would become feasible to minimize potential complications. Therefore, we studied the usefulness of measuring stimulated serum estradiol (E 2 ) levels in predicting ovarian hyperresponse. Methods : A total of 109 patients undergoing their first IVF treatment cycle using a long protocol with GnRH agonist was prospectively included. The E 2 level was evaluated on day 3 and 5 of the stimulation phase. Two outcome measures were defined. The first was ovarian hyperresponse (collection of ≥15 oocytes at retrieval and/or peak E 2 > 10000 pmol/L, or cancellation due to ≥30 follicles growing and/or peak E 2 > 15000 pmol/L, or OHSS developed). The second outcome measure comprised a subgroup representing the more severe hyperresponders, named extreme-response (cancellation or OHSS developed). Results : The data of 108 patients were analyzed. The predictive accuracy of E 2 measured on stimulation day 3 towards ovarian hyperresponse was clearly lower than that of E 2 measured on stimulation day 5 (area under the receiver operating characteristic curve (ROC AUC ) 0.75 and 0.81, respectively). For extreme-response the predictive accuracy of E 2 measured on stimulation day 3 or 5 was comparable (ROC AUC 0.81 and 0.82, respectively). For both outcome measures the stimulated E 2 tests yielded only acceptable specificity with moderate sensitivity at higher cutoff levels. Prediction of extreme-response seemed slightly more effective due to a lower error rate. Conclusions : There is a significant predictive association between E 2 levels measured on stimulation day 3 and 5 and both ovarian hyperresponse and extreme-response in IVF. However, the clinical value of stimulated E 2 levels for the prediction of hyperresponse is low because of the modest sensitivity and the high false positive rate. For the prediction of extreme-response the clinical value of stimulated E 2 levels is moderate.

“…Many factors have been examined as prognostic markers related to the ovarian response to gonadotropin administration, including age [37], hormones such as follicle-stimulating hormone (FSH) [29], estradiol (E2) [18], inhibin B [24] and anti-Müllerian hormone [24,25], smoking [9], and sonographic indices of ovarian reserve such as ovarian volume, antral follicle count and ovarian blood flow [16,32,33]. Furthermore, certain predictive models of ovarian response have been developed, but they have modest accuracy and limited clinical use, because of high intra-and inter-individual variability [8] .…”

Section: Introductionmentioning

confidence: 99%

Do estrogen receptor alpha polymorphisms have any impact on the outcome in an ART program?

Anagnostou

Malamas

Mavrogianni

et al. 2013

Purpose To investigate two of the most studied estrogen receptor alpha polymorphisms (PvuII and XbaI) in combination, in order to evaluate their impact on an ART program outcome. Methods 203 normally ovulating women who underwent IVF or ICSI treatment were genotyped for PvuII and XbaI polymorphisms in ESR1 intron 1 using Real-Time PCR. The relationship between the presence of polymorphic alleles and the ovulation induction parameters and outcome was examined. Results Women were grouped according to the number of polymorphic alleles they carried in two groups (0-2 versus 3-4 polymorphic alleles). The presence of 3 or more polymorphic alleles was associated with significantly lower E2 levels on the day of hCG administration and a significantly lower rate of good quality embryos. Conclusion There is an association between ESR1 polymorphisms and some ART parameters such as the level of E2 on the day of hCG administration and the quality of the embryos. These results underline the importance of ESR1 as a candidate gene for the prediction of ovarian response to IVF/ICSI protocols. Future research work concerning several more genes is necessary for a better evaluation of patients before entering an IVF/ICSI program.