Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve

Bancsi, L.F.J.M.M.; Broekmans, Frank J.; Eijkemans, Marinus J.C.; Jong, Frank H. de; Habbema, J. Dik F.; Velde, Egbert R. te

doi:10.1016/s0015-0282(01)02983-1

Cited by 400 publications

(275 citation statements)

References 25 publications

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“…According to data collected previously in our center and partly published (14,15) patients aged Ն41 years or with FSH levels Ն15 IU/L had a significantly higher poor response rate than patients aged Ͻ41 with normal FSH levels (56% of 93 patients vs. 20% of 136 patients, PϽ.001). We therefore defined the first group of patients as expected poor responders and the second group as unexpected poor responders.…”

Section: Patientsmentioning

confidence: 89%

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A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

Klinkert

Broekmans

Looman

et al. 2004

Fertility and Sterility

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102

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Objective: To calculate the cumulative ongoing pregnancy rate in patients with a poor response in their first IVF cycle. Design: Retrospective cohort study. Setting: In vitro fertilization unit of a university hospital. Patient(s): Two hundred twenty-five women who experienced a poor response in their first IVF or intracytoplasmic sperm injection cycle. These patients were divided into 64 expected (aged Ն41 years and/or elevated FSH level) and 161 unexpected poor responders (aged Ͻ41 years and FSH level not elevated). Intervention(s):In vitro fertilization treatment with a long-suppression protocol with FSH-urofollitropin or recombinant FSH. Main Outcome Measure(s): Cumulative ongoing pregnancy rate. This rate was calculated in two ways to correct for dropouts: pessimistic (zero chance of pregnancy for the dropouts) and optimistic (the same chance for the dropouts as for patients who continued). Result(s):The cumulative ongoing pregnancy rate of women with an unexpected poor response in the first cycle was 37% (pessimistic) to 47% (optimistic) after three cycles. Women with an expected poor response had a cumulative ongoing pregnancy rate of 16% (pessimistic) to 19% (optimistic) after 3 cycles. Sixty-four percent of the unexpected poor responders and 31% of the expected poor responders had a normal response in the second cycle, most of them after receiving a higher dose of gonadotropins. Conclusion(s):Most patients with an unexpected poor response in the first cycle had a normal response in the second cycle, leading to an acceptable cumulative ongoing pregnancy rate after three cycles. Patients with an expected poor response in the first cycle should be advised to withdraw from treatment after the first cycle because of a poor prognosis. (Fertil Steril 2004;81:1247Ϫ53.

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Section: Patientsmentioning

confidence: 89%

“…This definition is based on the assumption that a minimum of four oocytes is needed to have an average of two embryos available for transfer, given a mean fertilization rate of 50%-60% in IVF (14). The same definition was used in many other studies (10, 18 -24) and seems to be the most widely used definition of poor response.…”

Section: Definitionsmentioning

confidence: 99%

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

Klinkert

Broekmans

Looman

et al. 2004

Fertility and Sterility

Self Cite

102

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“…Many investigators have used a single test to predict ovarian response to stimulation and resulting pregnancy rates (4,5,(15)(16)(17)(18)(19) influenced by the number of retrieved oocytes, delivery rate is the true outcome of interest, and therefore the important outcome to measure.…”

Section: Screening For Ovarian Insufficiencymentioning

confidence: 99%

A new approach to ovarian reserve testing

Sun

Stegmann

Henne

et al. 2008

Fertility and Sterility

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Objective-To critically examine ovarian reserve testing prior to assisted reproduction. Design-A PUBMED computer search to identify relevant literature. Setting-Multiple sites Interventions-Testing for ovarian reserve Main Outcome Measures-IVF and pregnancy outcomesResult(s)-The prevalence of ovarian insufficiency varies significantly for women aged 30-45 years. Generalization or averaging of threshold values across different aged women leads to very poor sensitivity, specificity, and positive predictive value for all tests of ovarian reserve. Because of the changing prevalence of ovarian insufficiency, there is no single, suitable threshold value for any screening test of ovarian reserve. Our analysis supports dividing impaired ovarian reserve into two groups: age-dependent ovarian aging (physiologic) and premature (non-physiologic) reductions in the oocyte pool. Interpretation of any screening test used requires that age is considered as a variable. To guide clinical interpretation of test results, we suggest using a nomogram of FSH values versus expected delivery rate-per-cycle-start with ART for a given age. Conclusions(s)-Proper interpretation of screening tests for ovarian insufficiency in couplesconsidering ART is important since the presence of impaired ovarian reserve is associated with a low likelihood of pregnancy. The condition of premature (non-physiologic) ovarian insufficiency warrants additional research. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. More than 100 years ago, population studies clearly documented a decrease in fertility with increasing age (1). In today's culture of widely available birth control and workforce equality, women often delay child-bearing to pursue a career. As a result, the childbearing age for women has been delayed from the 20's to the 30's and even into the early 40s (2). This societal shift has resulted in an increase in the number of women who are interested in fertility and have regular cycles, but who are subfertile due to a reduction in their oocyte (egg) supply. Recognition of the profound adverse effect of a reduction in oocyte supply on fertility led to the concept of ovarian reserve and the moniker of 'Diminished Ovarian Reserve' (DOR (5,13,14). NIH Public AccessThe pathophysiology associated with the age-related reduction in fertility (1) is a reduction in the oocyte pool accompanied by an increase in FSH due to reduced feedback from estrogen and inhibins (15). There are also reduced levels of hormones such as anti-Mullerian hormone (AMH) (16). Theoretically, in some women the reduction in the oocyte po...

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“…In addition to the low quality of oocytes, ovarian reserve also declines with age in humans [12] and the reduced antral follicle counts reflect the sub fertility in reproductive aging women as well as cows [13,14]. Thus, it is important to leverage early developmental-stage follicles as an oocyte source in aged females.…”

Section: Introductionmentioning

confidence: 99%

Age-associated changes in bovine oocytes and granulosa cell complexes collected from early antral follicles

Itami

Kawahara-Miki

Kawana

et al. 2014

J Assist Reprod Genet

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Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve

Cited by 400 publications

References 25 publications

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

A new approach to ovarian reserve testing

Age-associated changes in bovine oocytes and granulosa cell complexes collected from early antral follicles

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