title: Multi-marker assessment of ovarian reserve predicts oocyte yield after ovulation induction.
abstract: BACKGROUND
  Many hormone and ultrasound measurements have been assessed as possible markers of ovarian reserve and to identify potential poor responders to ovulation induction. The objective of this study is to determine whether multiple biomarkers measured in blood samples collected immediately before commencement of ovulation induction for IVF can predict the outcome of ovarian stimulation.
  
  
  METHODS
  We conducted a prospective observational study, including 356 unselected women undergoing ovulation induction/IVF at two centers. Anti-Müllerian hormone (AMH), inhibin B and FSH were measured before commencement of ovulation induction. The main outcome measures were the number of oocytes retrieved and pregnancy outcome.
  
  
  RESULTS
  Univariate analyses showed that age, FSH, inhibin B and AMH were significant predictors for poor oocyte yield. AMH presented the highest receiver operating characteristic area under the curve (ROC(AUC)) of 0.827 indicating a good discriminating potential for predicting poor ovarian response, followed by FSH with an ROC(AUC) of 0.721. In the multivariate analysis, the variables age, FSH and AMH remained significant and the resulting model provided a high ROC(AUC) of 0.819. Women with an ovarian reserve test of <0.3 have more than a 75% chance of having their treatment cycle canceled, but a value over 0.73 indicates a 38% chance of pregnancy. Number of oocytes and oocyte yield per unit FSH administered were correlated with log model for no pregnancy (r = -0.217, P < 0.001 and r = -0.367, P < 0.001, respectively) but had limited predictive value.
  
  
  CONCLUSIONS
  A derived estimate of ovarian reserve demonstrated superior ability for predicting oocyte yield after ovulation induction when compared with any single endocrine marker (AMH, inhibin B, FSH).
authors.affiliation: Academic Unit of Reproductive and Developmental Medicine, Level 4, The Jessop Wing, Royal Hallamshire Hospital, Sheffield S10 2SF, UK. alazemimajda@hsc.edu.kw
authors.forename: Majedah
authors.initials: M
authors.lastname: Al-Azemi
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Killick
authors.forename: Sheila
authors.initials: S
authors.lastname: Duffy
authors.forename: Clare
authors.initials: C
authors.lastname: Pye
authors.forename: Bassem
authors.initials: B
authors.lastname: Refaat
authors.forename: Natalie
authors.initials: N
authors.lastname: Hill
authors.forename: William
authors.initials: W
authors.lastname: Ledger
mesh_terms: D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007265:Inhibins / Q000097:blood*; D054315:Oocyte Retrieval / Q000379:methods*; D009865:Oocytes; D010053:Ovary / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D015415:Biomarkers; C422364:inhibin B; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone