Using the ovarian sensitivity index to define poor, normal, and high response after controlled ovarian hyperstimulation in the long gonadotropin-releasing hormone-agonist protocol: suggestions for a new principle to solve an old problem.
OBJECTIVE
To explore the utility of using the ratio between oocyte yield and total dose of FSH, i.e., the ovarian sensitivity index (OSI), to define ovarian response patterns.


METHODS
Retrospective cross-sectional study.


METHODS
University-affiliated private center.


METHODS
The entire unselected cohort of 7,520 IVF/intracytoplasmic sperm injection treatments (oocyte pick-ups [OPUs]) during an 8-year period (long GnRH agonist-recombinant FSH protocol).


METHODS
None.


METHODS
The distribution of the OSI (oocytes recovered × 1,000/total dose of FSH), the cutoff levels for poor and high response, set at ±1 SD, and the relationship between OSI and treatment outcome.


RESULTS
OSI showed a log-normal distribution with cutoff levels for poor and high response at 1.697/IU and 10.07/IU, respectively. A nomogram is presented. Live-birth rates per OPU were 10.5 ± 0.1%, 26.9 ± 0.6%, and 36.0 ± 1.4% for poor, normal, and high response treatments, respectively. The predictive power (C-statistic) for OSI to predict live birth was superior to that of oocyte yield.


CONCLUSIONS
The OSI improves the definition of ovarian response patterns because it takes into account the degree of stimulation. The nomogram presents evidence-based cutoff levels for poor, normal, and high response and could be used for unifying study designs involving ovarian response patterns.
Department of Obstetrics and Gynecology, Östersunds Sjukhus, Östersund, Sweden.
Malin
M
Huber
Nermin
N
Hadziosmanovic
Lars
L
Berglund
Jan
J
Holte
D000328:Adult; D002064:Buserelin / Q000008:administration & dosage; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D005307:Fertilization in Vitro; D043373:Follicle Stimulating Hormone, Human / Q000008:administration & dosage* / Q000009:adverse effects; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000378:metabolism; D006801:Humans; D050498:Live Birth; D016015:Logistic Models; D017274:Nafarelin / Q000008:administration & dosage; D049451:Nomograms; D054315:Oocyte Retrieval; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced / Q000503:physiopathology; D010053:Ovary / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D043373:Follicle Stimulating Hormone, Human; D011994:Recombinant Proteins; D017274:Nafarelin; D007987:Gonadotropin-Releasing Hormone; D002064:Buserelin
Controlled ovarian hyperstimulation; cutoff levels; excessive ovarian response; ovarian sensitivity index; poor ovarian response