Combined evaluation of risk factors predicting poor ovarian responders in Chinese patients undergoing in vitro fertilization

Abstract

This study aimed to explore the parameters associated with poor ovarian response (POR) to develop an early warning score model (EWSM) for detecting POR in Chinese women undergoing in vitro fertilization, in order to improve the outcomes. Between 2005 and 2011, we recruited 736 patients with POR after IVF and 736 individuals with normal ovarian response after IVF as controls. Clinical parameters were determined to evaluate the ovarian reserve. We then compared the clinical parameters between the POR and control groups, and performed a multivariate analysis to determine the independent factors associated with ovarian response. Receiver-operator characteristic (ROC) was used to analyze the predicted values of individual and combined risk factors. The predicted values were further tested in another cohort of 957 patients. Age, basal follicle-stimulating hormone (bFSH), antral follicle count (AFC), and FSH/luteinizing hormone (LH) ratio were identified as independent factors associated with ovarian response. The EWSM was established using a combination of these parameters. The sensitivity and specificity of the EWSM were 74.6% and 93.6%, respectively. In conclusion, combination of individual risk factors could predict POR with high specificity. The EWSM may help in the evaluation of IVF treatment at an early stage.

Chinese abstract

研究的目的为探讨与卵巢低反应(POR)相关参数以建立针对检测中国接受体外受精妇女POR的早期预警评分模型(EWSM)，以改善患者的预后。从2005至2011年，我们招募了736名IVF后发生POR的患者，以及作为对照的736名IVF后卵巢反应正常的个体。检测临床指标用于评估卵巢储备。接下来我们将POR组与对照组的临床指标进行对比，进行多因素分析确定与卵巢低反应相关的独立因素。受试者工作特征曲线（ROC）用于分析独立或合并风险因素的预测值。在另一个957名患者的队列中进一步检测预测值。年龄，基础卵泡刺激素(bFSH)，窦卵泡数目(AFC)和FSH/LH比值被认为是与卵巢反应相关的独立因素。综合上述参数建立EWSM。 EWSM的敏感性与特异性分别为74.6% 和 93.6%。综上，综合独立风险因素可预测POR，且具有很高的特异性。ESWM对早期IVF评估或有所助益。

• Early warning score model
• in vitro fertilization
• poor ovarian response
• receiver operating curve
• sensitivity and specificity

Declaration of interest

The authors report no conflicts of interest. This work was supported by Beijing Municipal Science and Technology Commission (code: Z121107001012165, Z151100004015167), Basic-Clinical Cooperation Research Fund from Capital Medical University (No.15JL77) and Beijing municipal Health technology High-level Talent project (No. 2014-3-076) to Ma Yanmin, Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (code: ZYLX201510) to Yin Chenghong.

Supplementary material available online