Document Detail


Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach.
MedLine Citation:
PMID:  23188168     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND Although ovarian reserve tests (ORTs) are frequently used prior to IVF treatment for outcome prediction, their added predictive value is unclear. We assessed the added value of ORTs to patient characteristics in the prediction of IVF outcome. METHODS An individual patient data (IPD) meta-analysis from published studies was performed. Studies on FSH, anti-Müllerian hormone (AMH) or antral follicle count (AFC) in women undergoing IVF were identified and authors were contacted. Using random intercept logistic regression models, we estimated the added predictive value of ORTs for poor response and ongoing pregnancy after IVF, relative to patient characteristics. RESULTS We were able to collect 28 study databases, comprising 5705 women undergoing IVF. The area under the receiver-operating characteristic curve (AUC) for female age in predicting poor response was 0.61. AFC and AMH each significantly improved the model fit (P-value <0.001). Moreover, almost a similar accuracy was reached using AMH or AFC alone (AUC 0.78 and 0.76, respectively). Combining the two tests, however, did not improve prediction (AUC 0.80, P = 0.19) of poor response. In predicting ongoing pregnancy after IVF, age was the best single predictor (AUC 0.57), and none of the ORTs added any value. CONCLUSIONS This IPD meta-analysis demonstrates that AFC and AMH clearly add to age in predicting poor response. As single tests, AFC and AMH both fully cover the prediction of poor ovarian response. In contrast, none of the ORTs add any information to the limited capacity of female age to predict ongoing pregnancy after IVF. The clinical usefulness of ORTs prior to IVF will be limited to the prediction of ovarian response.
Authors:
Simone L Broer; Jeroen van Disseldorp; Kimiko A Broeze; Madeleine Dolleman; Brent C Opmeer; Patrick Bossuyt; Marinus J C Eijkemans; Ben-Willem J Mol; Frank J M Broekmans;
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't     Date:  2012-11-27
Journal Detail:
Title:  Human reproduction update     Volume:  19     ISSN:  1460-2369     ISO Abbreviation:  Hum. Reprod. Update     Publication Date:    2013 Jan-Feb
Date Detail:
Created Date:  2012-11-29     Completed Date:  2013-09-23     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9507614     Medline TA:  Hum Reprod Update     Country:  England    
Other Details:
Languages:  eng     Pagination:  26-36     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Anti-Mullerian Hormone / blood
Cell Count
Female
Fertilization in Vitro*
Follicle Stimulating Hormone / blood
Humans
Ovarian Follicle / physiology
Ovary / physiology*
Ovulation Prediction*
Predictive Value of Tests
Pregnancy
Prognosis
ROC Curve
Grant Support
ID/Acronym/Agency:
G1100357//Medical Research Council
Chemical
Reg. No./Substance:
80497-65-0/Anti-Mullerian Hormone; 9002-68-0/Follicle Stimulating Hormone
Investigator
Investigator/Affiliation:
S L Broer / ; J van Disseldorp / ; K A Broeze / ; M Dolleman / ; B C Opmeer / ; R A Anderson / ; M Ashrafi / ; L Bancsi / ; E Caroppo / ; A Copperman / ; T Ebner / ; M Eldar Geva / ; M Erdem / ; E M Greenblatt / ; K Jayaprakasan / ; Raine Fenning / ; E R Klinkert / ; J Kwee / ; C B Lambalk / ; A La Marca / ; M McIlveen / ; L T Merce / ; S Muttukrishna / ; S M Nelson / ; H Y Ng / ; B Popovic-Todorovic / ; J M J Smeenk / ; C Tomás / ; P J Q Van der Linden / ; I A van Rooij / ; I K Vladimirov / ; P B Bossuyt / ; M J C Eijkemans / ; B W Mol / ; Frank Broekmans /

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