Women in Advanced Reproductive Age: Are the Follicular Output Rate, the Follicle-Oocyte Index and the Ovarian Sensitivity Index Predictors of Live Birth in an IVF Cycle?

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Feb 15

PMID 35160310

Authors

Andrea Roberto Carosso

Rik van Eekelen

Alberto Revelli

Stefano Canosa

Noemi Mercaldo

Chiara Benedetto

Gianluca Gennarelli

Affiliations

Soon will be listed here.

Abstract

(1) : Several researchers have investigated alternative markers related to ovarian responsiveness in order to better predict IVF outcomes, particularly in advanced reproductive-aged women. The follicular output rate (FORT), the follicle-oocyte index (FOI) and the ovarian sensitivity index (OSI) are among the most promising. However, these three metrics have not been investigated as independent predictors of live birth in women of advanced reproductive age; neither have they been compared to the two 'component' characteristics that are used to calculate them. (2) : A logistic regression model containing all relevant predictors of ovarian reserve or response was used to evaluate the potential of FORT, FOI and OSI as predictors of live birth. After, the non-linear associations between FORT, FOI and OSI and the probability of live birth were evaluated. Finally, we fitted multiple logistic regression models to compare whether FORT, FOI and OSI were more informative predictors than their components. (3) : 590 couples received a total of 740 IVF cycles, after which, 127 (17.5%) obtained a live birth. None of FORT, FOI and OSI showed a strength of association or a p-value even close to female age (odds ratio for live birth (95% confidence interval) 1.00 (0.99-1.01), 1.00 (0.99-1.01), 0.98 (0.88-1.11) and 0.58 (0.48-0.72), respectively). The three models comparing FORT, FOI and OSI with the number of oocytes retrieved, the AFC, the number of preovulatory follicles and the FSH total dose were not more informative. (4) : In a population of women of advanced age with unexplained infertility, none of FORT, FOI and OSI were predictive of live birth or more predictive than the two 'component' characteristics that were used to calculate them. We suggest clinicians and researchers still use female age as the most reliable predictor of an IVF treatment.

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References

Sunkara S, Khalaf Y, Maheshwari A, Seed P, Coomarasamy A . Association between response to ovarian stimulation and miscarriage following IVF: an analysis of 124 351 IVF pregnancies. Hum Reprod. 2014; 29(6):1218-24. DOI: 10.1093/humrep/deu053. View

Ferraretti A, La Marca A, Fauser B, Tarlatzis B, Nargund G, Gianaroli L . ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011; 26(7):1616-24. DOI: 10.1093/humrep/der092. View

Peres Fagundes P, Chapon R, Olsen P, Schuster A, Mattia M, Cunha-Filho J . Evaluation of three-dimensional SonoAVC ultrasound for antral follicle count in infertile women: its agreement with conventional two-dimensional ultrasound and serum levels of anti-Müllerian hormone. Reprod Biol Endocrinol. 2017; 15(1):96. PMC: 5732451. DOI: 10.1186/s12958-017-0314-x. View

van Smeden M, Moons K, de Groot J, Collins G, Altman D, Eijkemans M . Sample size for binary logistic prediction models: Beyond events per variable criteria. Stat Methods Med Res. 2018; 28(8):2455-2474. PMC: 6710621. DOI: 10.1177/0962280218784726. View

Revelli A, Gennarelli G, Biasoni V, Chiado A, Carosso A, Evangelista F . The Ovarian Sensitivity Index (OSI) Significantly Correlates with Ovarian Reserve Biomarkers, Is More Predictive of Clinical Pregnancy than the Total Number of Oocytes, and Is Consistent in Consecutive IVF Cycles. J Clin Med. 2020; 9(6). PMC: 7355532. DOI: 10.3390/jcm9061914. View

Papaleo E, Zaffagnini S, Munaretto M, Vanni V, Rebonato G, Grisendi V . Clinical application of a nomogram based on age, serum FSH and AMH to select the FSH starting dose in IVF/ICSI cycles: a retrospective two-centres study. Eur J Obstet Gynecol Reprod Biol. 2016; 207:94-99. DOI: 10.1016/j.ejogrb.2016.10.021. View

Bessow C, Donato R, de Souza T, Chapon R, Genro V, Cunha-Filho J . Antral follicle responsiveness assessed by follicular output RaTe(FORT) correlates with follicles diameter. J Ovarian Res. 2019; 12(1):48. PMC: 6535188. DOI: 10.1186/s13048-019-0522-4. View

Huber M, Hadziosmanovic N, Berglund L, Holte J . 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. Fertil Steril. 2013; 100(5):1270-6. DOI: 10.1016/j.fertnstert.2013.06.049. View

Baerwald A, Adams G, Pierson R . Characterization of ovarian follicular wave dynamics in women. Biol Reprod. 2003; 69(3):1023-31. DOI: 10.1095/biolreprod.103.017772. View

10.

Alviggi C, Andersen C, Buehler K, Conforti A, De Placido G, Esteves S . A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Fertil Steril. 2016; 105(6):1452-3. DOI: 10.1016/j.fertnstert.2016.02.005. View

11.

Allegra A, Marino A, Volpes A, Coffaro F, Scaglione P, Gullo S . A randomized controlled trial investigating the use of a predictive nomogram for the selection of the FSH starting dose in IVF/ICSI cycles. Reprod Biomed Online. 2017; 34(4):429-438. DOI: 10.1016/j.rbmo.2017.01.012. View

12.

van Tilborg T, Oudshoorn S, Eijkemans M, Mochtar M, van Golde R, Hoek A . Individualized FSH dosing based on ovarian reserve testing in women starting IVF/ICSI: a multicentre trial and cost-effectiveness analysis. Hum Reprod. 2017; 32(12):2485-2495. DOI: 10.1093/humrep/dex321. View

13.

Tal R, Seifer D . Ovarian reserve testing: a user's guide. Am J Obstet Gynecol. 2017; 217(2):129-140. DOI: 10.1016/j.ajog.2017.02.027. View

14.

Li H, Lee V, Lau E, Yeung W, Ho P, Ng E . Role of baseline antral follicle count and anti-Mullerian hormone in prediction of cumulative live birth in the first in vitro fertilisation cycle: a retrospective cohort analysis. PLoS One. 2013; 8(4):e61095. PMC: 3634063. DOI: 10.1371/journal.pone.0061095. View

15.

Huang Y, Li J, Zhang F, Liu Y, Xu G, Guo J . Factors affecting the live-birth rate in women with diminished ovarian reserve undergoing IVF-ET. Arch Gynecol Obstet. 2018; 298(5):1017-1027. PMC: 6182694. DOI: 10.1007/s00404-018-4884-4. View

16.

Genro V, Grynberg M, Scheffer J, Roux I, Frydman R, Fanchin R . Serum anti-Müllerian hormone levels are negatively related to Follicular Output RaTe (FORT) in normo-cycling women undergoing controlled ovarian hyperstimulation. Hum Reprod. 2010; 26(3):671-7. DOI: 10.1093/humrep/deq361. View

17.

Holte J, Berglund L, Milton K, Garello C, Gennarelli G, Revelli A . Construction of an evidence-based integrated morphology cleavage embryo score for implantation potential of embryos scored and transferred on day 2 after oocyte retrieval. Hum Reprod. 2006; 22(2):548-57. DOI: 10.1093/humrep/del403. View

18.

Fatemi H, Doody K, Griesinger G, Witjes H, Mannaerts B . High ovarian response does not jeopardize ongoing pregnancy rates and increases cumulative pregnancy rates in a GnRH-antagonist protocol. Hum Reprod. 2012; 28(2):442-52. DOI: 10.1093/humrep/des389. View

19.

Conforti A, Vaiarelli A, Cimadomo D, Bagnulo F, Peluso S, Carbone L . Pharmacogenetics of FSH Action in the Female. Front Endocrinol (Lausanne). 2019; 10:398. PMC: 6606727. DOI: 10.3389/fendo.2019.00398. View

20.

Weghofer A, Barad D, Darmon S, Kushnir V, Albertini D, Gleicher N . The ovarian sensitivity index is predictive of live birth chances after IVF in infertile patients. Hum Reprod Open. 2020; 2020(4):hoaa049. PMC: 7753003. DOI: 10.1093/hropen/hoaa049. View