Ultrasonography as a tool for the prediction of outcome in IVF patients: a comparative meta-analysis of ovarian volume and antral follicle count.
OBJECTIVE
To investigate by meta-analysis the predictive capacity of ovarian volume as an ovarian reserve test in comparison to the antral follicle count (AFC).


METHODS
Meta-analysis.


METHODS
Tertiary fertility center.


METHODS
Patients undergoing IVF.


METHODS
None.


METHODS
Poor ovarian response, nonpregnancy.


RESULTS
A total of 10 studies were detected reporting on ovarian volume and 17 studies on AFC. Because of heterogeneity among studies, calculation of one summary point estimate for sensitivity and specificity was not meaningful. However, for both tests, summary receiver operating characteristic curves for the outcome measures poor response and nonpregnancy could be estimated and compared. The AFC performed statistically significantly better than ovarian volume in the prediction of poor response. The overall accuracy for predicting nonpregnancy was poor for both tests. The clinical value in poor response prediction was only evident for the AFC as a considerable number of cases can be identified who will have a high chance of producing a poor response to stimulation. The clinical value for nonpregnancy was virtually absent for both tests.


CONCLUSIONS
In conclusion, the predictive performance of ovarian volume toward poor response is clearly inferior compared with that of AFC. Therefore, the AFC may be considered the test of first choice when estimating quantitative ovarian reserve before IVF. For the prediction of cases with a very low chance for pregnancy, ovarian reserve testing with the use of ultrasound appears inadequate.
Hendriks
Dave J
DJ
Department of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. hendriks.kuipers@casema.nl <hendriks.kuipers@casema.nl>
Kwee
Janet
J
Mol
Ben W J
BW
te Velde
Egbert R
ER
Broekmans
Frank J M
FJ
D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D016015:Logistic Models; D006080:Ovarian Follicle / Q000000981:diagnostic imaging*; D010053:Ovary / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D011247:Pregnancy; D012372:ROC Curve; D014463:Ultrasonography