Women in Advanced Reproductive Age: Are the Follicular Output Rate, the Follicle-Oocyte Index and the Ovarian Sensitivity Index Predictors of Live Birth in an IVF Cycle?

Abstract

(1) Background: Several researchers have investigated alternative markers related to ovarian responsiveness in order to better predict IVF outcomes, particularly in advanced reproductive-aged women. The follicular output rate (FORT), the follicle-oocyte index (FOI) and the ovarian sensitivity index (OSI) are among the most promising. However, these three metrics have not been investigated as independent predictors of live birth in women of advanced reproductive age; neither have they been compared to the two ‘component’ characteristics that are used to calculate them. (2) Methods: A logistic regression model containing all relevant predictors of ovarian reserve or response was used to evaluate the potential of FORT, FOI and OSI as predictors of live birth. After, the non-linear associations between FORT, FOI and OSI and the probability of live birth were evaluated. Finally, we fitted multiple logistic regression models to compare whether FORT, FOI and OSI were more informative predictors than their components. (3) Results: 590 couples received a total of 740 IVF cycles, after which, 127 (17.5%) obtained a live birth. None of FORT, FOI and OSI showed a strength of association or a p-value even close to female age (odds ratio for live birth (95% confidence interval) 1.00 (0.99–1.01), 1.00 (0.99–1.01), 0.98 (0.88–1.11) and 0.58 (0.48–0.72), respectively). The three models comparing FORT, FOI and OSI with the number of oocytes retrieved, the AFC, the number of preovulatory follicles and the FSH total dose were not more informative. (4) Conclusions: In a population of women of advanced age with unexplained infertility, none of FORT, FOI and OSI were predictive of live birth or more predictive than the two ‘component’ characteristics that were used to calculate them. We suggest clinicians and researchers still use female age as the most reliable predictor of an IVF treatment.

Association of follicle-to-oocyte index and clinical pregnancy in IVF treatment: A retrospective study of 4,323 fresh embryo transfer cycles

“…Higher FOI was associated with higher implantation rate and live birth rate after first fresh embryo transfer ( 19 ). However, similar results were not found in another cohort of women of advanced age with unexplained infertility ( 20 ). To date, evidence on the relationship between FOI index and successful pregnancy in IVF is sparse and lacks systematization.…”

“…To our knowledge, only a few studies in the literature regarded the predictive value of FOI in IVF treatment, and the results were inconsistent ( 19 , 20 , 29 ). A retrospective analysis included 264 IVF cycles and found that higher FOI was associated with the higher implantation rate and live birth rate after first fresh embryo transfer ( 19 ).…”

“…These trends remained significant after adjusted for female age. Another literature reported that, in 740 IVF cycles, women with advanced age (≥39 years) and unexplained infertility, none of FOI, FORT, and OSI were not predictor of live birth, and the non-linear association existed between live birth and FOI ( 20 ). For FOI, their result seemed to be reasonably linear within the range of FOI from 0 to 1.…”

“…For FOI, their result seemed to be reasonably linear within the range of FOI from 0 to 1. However, a recent study retrospectively analyzed 298 IVF cycles with a cohort of women ≥39 years, and their findings suggested that FOI cannot predict live birth ( 20 ). In fact, the predictive value of the AFC was limited in older women, as they had mitochondrial dysfunction, increased apoptosis in granulosa cells, and increased oxidative stress in the follicular fluid ( 30 , 31 ).…”

“…FOI higher than 50% was assumed to represent normal ovarian responsiveness ( 17 ). So far, the association between FOI and IVF pregnancy outcomes, reported by two research teams, remains controversial ( 19 , 20 ). Higher FOI was associated with higher implantation rate and live birth rate after first fresh embryo transfer ( 19 ).…”