Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve.
OBJECTIVE
To identify and quantify predictors of poor ovarian response in in vitro fertilization (IVF). DESIGN; Prospective study. SETTING; Tertiary fertility center.


METHODS
One hundred twenty women undergoing their first IVF cycle.


METHODS
Measurement of the number of antral follicles and the total ovarian volume by ultrasound, and of basal levels of FSH, E(2), and inhibin B on cycle day 3.


METHODS
Ovarian response, and clinical and ongoing pregnancy rates. RESULT(S); The antral follicle count was the best single predictor for poor ovarian response: area under the receiver operating characteristic curve = 0.87. Addition of basal FSH and inhibin B levels to a logistic model with the antral follicle count significantly improved the prediction of poor response; the addition of basal E(2) levels and total ovarian volume did not improve the prediction. To express the discriminative performance of this model toward poor response, a maximum area under the receiver operating characteristic curve of 0.92 was calculated. Poor responders had significantly lower clinical and ongoing pregnancy rates than did normal responders.


CONCLUSIONS
Our data demonstrate that the antral follicle count provides better prognostic information on the occurrence of poor response during hormone stimulation for IVF than does the patient's chronological age and the currently used endocrine markers. However, endocrine tests remain informative. Multivariate models can achieve more accurate predictions of outcomes of complex events like ovarian response in IVF.
Bancsi
László F J M M
LF
Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. lbanczi@azu.nl
Broekmans
Frank J M
FJ
Eijkemans
Marinus J C
MJ
de Jong
Frank H
FH
Habbema
J Dik F
JD
te Velde
Egbert R
ER
D000328:Adult; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007124:Immunoenzyme Techniques; D007265:Inhibins / Q000097:blood; D016015:Logistic Models; D008297:Male; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000502:physiology; D010053:Ovary / Q000000981:diagnostic imaging / Q000502:physiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012372:ROC Curve; D018709:Statistics, Nonparametric; D014463:Ultrasonography
C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D005640:Follicle Stimulating Hormone