Ovarian sensitivity index is strongly related to circulating AMH and may be used to predict ovarian response to exogenous gonadotropins in IVF

Abstract

BackgroundSerum anti-Mullerian hormone (AMH) is currently considered the best marker of ovarian reserve and of ovarian responsiveness to gonadotropins in in-vitro fertilization (IVF). AMH assay, however, is not available in all IVF Units and is quite expensive, a reason that limits its use in developing countries. The aim of this study is to assess whether the "ovarian sensitivity index" precisely reflects AMH so that this index may be used as a surrogate for AMH in prediction of ovarian response during an IVF cycle.MethodsAMH serum levels were measured in 61 patients undergoing IVF with a "long" stimulation protocol including the GnRH agonist buserelin and recombinant follicle-stimulating hormone (rFSH). Patients were divided into four subgroups according to the percentile of serum AMH and their ovarian stimulation was prospectively followed. Ovarian sensitivity index (OSI) was calculated dividing the total administered FSH dose by the number of retrieved oocytes.ResultsAMH and OSI show a highly significant negative correlation (r = -0.67; p = 0.0001) that is stronger than the one between AMH and the total number of retrieved oocytes and than the one between AMH and the total FSH dose.ConclusionsOSI reflects quite satisfactory the AMH level and may be proposed as a surrogate of AMH assay in predicting ovarian responsiveness to FSH in IVF. Being very easy to calculate and costless, its use could be proposed where AMH measurement is not available or in developing countries where limiting costs is of primary importance.

Ovarian sensitivity index is a better measure of ovarian responsiveness to gonadotrophin stimulation than the number of oocytes during in-vitro fertilization treatment

“…Our results confirmed the previous findings [5] that OSI was strongly and significantly correlated with AMH and AFC, which were suggested in meta-analyses as the best predictors of ovarian responsiveness as defined on oocyte number [6,7]. There was also significant correlation of OSI with age and body mass index, the latter being not demonstrable in the previous study [5].…”

“…There was also significant correlation of OSI with age and body mass index, the latter being not demonstrable in the previous study [5]. It conforms to the common understanding that advanced age and overweight/obesity are negative factors affecting ovarian responsiveness [10].…”

“…The term OSI was first coined by Biasoni et al [5], where it was expressed as the total administered dose of FSH per retrieved oocyte; thus a lower value represents higher ovarian sensitivity and vice versa. We redefined OSI by reversing the numerator and denominator so that it is literally and conceptually a more direct reflection of "ovarian sensitivity" rather than "ovarian resistance".…”

“…This ratio, which has been termed as "ovarian sensitivity index (OSI)", was first proposed by Biasoni et al [5]. OSI was shown to have good correlation with anti-Mullerian hormone (AMH) and antral follicle count (AFC) [5], ovarian reserve markers which have been suggested as the best currently available predictors of ovarian responsiveness [6,7]. The use of OSI instead of the number of retrieved oocytes as the measure of ovarian responsiveness would be more appropriate where different subjects are subjected to different daily dosages of gonadotrophin.…”

MILD ovarian stimulation with GnRH-antagonist vs. long protocol with low dose FSH for non-PCO high responders undergoing IVF: a prospective, randomized study including thawing cycles

“…Since the study population was composed of women with prognostic variables that suggested a high responsiveness to ovarian stimulation, a very low cancellation rate (1.5 %) was a priori estimated. Secondary outcomes were the following: total gonadotropin dose, follicular phase length, ovarian sensitivity index (OSI0exogenous FSH/retrieved oocyte) [15], fertilization rate (FR), pregnancy rate (PR) per started cycle, per OPU and per embryo transfer (ET), implantation rate (IR) and live birth rate (LBR) with fresh embryos; pregnancy rate per started cycle, per OPU and per ET, implantation rate and live birth rate with thawed oocytes; cumulative fresh-plusthaw pregnancy rate (CPR).…”