title: Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: an individual patient data meta-analysis.
abstract: OBJECTIVE
  To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups.
  
  
  METHODS
  Authors of studies reporting on basal FSH, antimüllerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy.
  
  
  METHODS
  In vitro fertilization clinics.
  
  
  METHODS
  A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs.
  
  
  METHODS
  None.
  
  
  METHODS
  Excessive response prediction.
  
  
  RESULTS
  We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same.
  
  
  CONCLUSIONS
  We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Simone L
authors.initials: SL
authors.lastname: Broer
authors.forename: Madeleine
authors.initials: M
authors.lastname: Dólleman
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Disseldorp
authors.forename: Kimiko A
authors.initials: KA
authors.lastname: Broeze
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Martinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: Ben Willem
authors.initials: BW
authors.lastname: Mol
authors.forename: Frank J M
authors.initials: FJ
authors.lastname: Broekmans
mesh_terms: D000328:Adult; D002452:Cell Count / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D007206:Individuality; D007246:Infertility / Q000175:diagnosis / Q000628:therapy; D008423:Maternal Age; D054315:Oocyte Retrieval / Q000706:statistics & numerical data; D016471:Ovarian Hyperstimulation Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D010053:Ovary / Q000166:cytology*; D010062:Ovulation Induction / Q000009:adverse effects / Q000706:statistics & numerical data; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors
keywords: Assisted Reproduction; antimullerian horme; antral folicle count; excessive response; ovarian hyperstimulation syndrome