Are ovarian reserve tests reliable in predicting ovarian response? Results from a prospective, cross-sectional, single-center analysis

Abstract

Objetive

Several biomarkers of ovarian reserve have been proposed as possible predictors of the response to controlled ovarian stimulation (COS). We aimed to evaluate age, FSH, AMH, antral follicle count (AFC), and ovarian response prediction index (ORPI), as potential predictors of response to COS.

Methods

Cross-sectional study enrolling of 188 infertile women who underwent the first cycle of IVF/ICSI. AFC was evaluated; serum FSH and AMH levels were measured by ELISA. ORPI was calculated as AMH x AFC/patient´s age.

Results

As expected, hypo-responder group had less retrieved oocytes, MII, and embryos compared to the good responders. The hyper-response patients were younger, with lower FSH, increased AMH, AFC, and ORPI values. Regarding the assessment of the predictive capacity of ovarian reserve tests, none of them individually or combined showed a good predictive capacity for hypo-response. With respect to the hyper-responder group, individually AMH was the best predictor, while in the multivariable model, ORPI demonstrated the best predictive capacity. Furthermore, patients with serum AMH < 2.09 ng/mL (p25) had fewer AFC than patients with higher AMH values.

Conclusions

Our findings suggest that none of the ovarian reserve tests showed a good predictive capacity for hypo-response, while the ORPI was the strongest predictor of hyper-response in normovulatory infertile women.

摘要

目的：几个卵巢储备的生物标志物被建议用来预测控制性卵巢刺激（COS）的反应。我们的目的是评估年龄、卵泡刺激素（FSH）、AMH、卵巢窦卵泡计数（AFC）和卵巢反应预测指数（ORPI）, 作为反应COS指标的潜在可能性。

方法：采用横断面研究方法, 对188名接受第一个周期IVF/ICSI的不孕女性进行研究。评估AFC, 用ELISA法检测血清FSH、AMH水平。ORPI按照AMH×AFC/患者的年龄来计算。

结果：与反应良好组相比, 低反应组获得的卵母细胞、MII和胚胎较少。高反应组患者比较年轻, FSH较低, AMH、AFC和ORPI值升高。在评估卵巢储备的预测能力方面, 单项和联合试验均未显示出较好的卵巢低反应的预测能力。对于高反应组, 单独的AMH是最好的预测因子, 而在多变量模型中, ORPI表现的预测能力最好。此外, 血清AMH<2.09ng/mL（p25）的AFC低于AMH值较高的患者。

结论：我们的研究结果表明, 卵巢储备功能检查都不能良好的预测卵巢低反应能力。而ORPI是正常排卵的不孕症妇女的卵巢高反应的最强预测因子。

Keywords:

• Ovarian reserve testing
• controlled ovarian stimulation
• ovarian response prediction index
• infertility

Acknowledgments

We would like to thank Instituto Ideia Fértil team, especially Dr. Emerson Barchi Cordts for helping with the study design and clinical interpretation of the data. We also would like to thank Capes for granting Carla Peluso a PhD student scholarship.

Disclosure statement

The authors declare that they have no competing interests.

Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author contributions

CP; CPB and BB conceived study design. CP, RO, FLAF, and BB performed the data collection and analyzed data. CP; GLP, and BB performed statistical analysis. CP, RO, DMC, FLAF, CPB, and BB interpreted the data. ASL reviewed the data analysis and edited the manuscript. All authors approved the final version for submission.

Additional information

Funding

This work was supported by FAPESP (Foundation for Research Support of the State of São Paulo) research grant #2014/06177-2.