Main characteristics of IVF / ICSI protocols in patients with suboptimal response to controlled ovarian stimulation

2021 ◽  
Vol 70 (1) ◽  
pp. 109-118
Author(s):  
Nguyen Cong Tuan ◽  
Lyailya Kh. Dzhemlikhanova ◽  
Manizha R. Makhmadaliyeva ◽  
Igor Yu. Kogan ◽  
Dariko A. Niauri ◽  
...  
Keyword(s):  
Ovarian Stimulation ◽  
Hormone Level ◽  
Negative Impact ◽  
Uterine Fibroids ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Controlled Ovarian Stimulation ◽  
Pelvic Surgery ◽  
Normal Response ◽  
Response Predictors

Hypothesis/Aims of study: According to the number of oocytes retrieved in IVF/ICSI protocols, the ovarian response to controlled ovarian stimulation is divided into: poor (03 oocytes), suboptimal (49 oocytes), normal (1015 oocytes) and excessive (15 oocytes) response. However, the effectiveness of IVF / ICSI programs in women with a suboptimal response is poorly understood, since this cohort of patients is often fallen into the category of women with a normal response. The aim of this study was to determine the main characteristics of IVF / ICSI programs in patients with suboptimal response to be further compared to those in women with normal response to controlled ovarian stimulation. Study design, materials and methods: This retrospective study included 568 patients: 470 women with suboptimal response and 98 women with normal response to controlled ovarian stimulation. The comparative analysis comprised clinical and anamnestic data, as well as the main characteristics of assisted reproductive technology programs in the selected clinical groups. Results: It was found that patients with suboptimal response to controlled ovarian stimulation had significantly more frequent history of pelvic surgery (71.3 % vs. 55.1 %; p 0.01) and pelvic inflammatory diseases (70.9% vs. 60.2%; p 0.05). Parameters of ovarian reserve (serum anti-Mllerian hormone level and antral follicle count) in women with suboptimal response were significantly lower (p 0.001). In addition, the number of mature oocytes, 2PN zygotes, good quality embryos (p 0.001), as well as the clinical pregnancy rate in women with suboptimal response were found to be significantly lower than in patients with normal response to controlled ovarian stimulation (27.2% vs. 41.7%; p 0.01). It was noted that concomitant uterine fibroids enhanced the negative impact on the effectiveness of IVF / ICSI programs in women with suboptimal response to controlled ovarian stimulation (OR = 0.5; 95% CI: 0.30.9; p = 0.03). ROC analysis identified predictors of suboptimal response to controlled ovarian stimulation, such as serum anti-Mllerian hormone level (AUC = 0.80) with the cut-off value of 2.57 ng / ml (sensitivity 74%, specificity 75%) and antral follicle count (AUC = 0.90) with the cut-off value of 10 follicles (sensitivity 80%, specificity 94%). Conclusion: In women with suboptimal response to controlled ovarian stimulation, IVF / ICSI success rates are significantly reduced when compared to those in women with normal response. Concomitant uterine fibroids may further decrease the effectiveness of IVF / ICSI protocols in patients with suboptimal response. Predictors of suboptimal response include the serum anti-Mllerian hormone level and antral follicle count.

scholarly journals Antral follicle count and anti-Müllerian hormone level as predictors of ovarian hyperstimulation syndrome in women with polycystic ovarian syndrome undergoing controlled ovarian stimulation

2021 ◽  
Vol 21 (86) ◽  
pp. e200-e205
Author(s):  
Rubina Izhar ◽  
◽  
Samia Husain ◽  
Muhammad Ahmad Tahir ◽  
Mauzma Kausar ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Ovarian Stimulation ◽  
Ovarian Hyperstimulation Syndrome ◽  
Polycystic Ovarian Syndrome ◽  
Hormone Level ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Controlled Ovarian Stimulation ◽  
Ovarian Hyperstimulation ◽  
Ovarian Syndrome

Aim: To compare the rate of ovarian hyperstimulation syndrome in women with and without polycystic ovarian syndrome, and to determine the cut-off for the antral follicle count and the anti-Müllerian hormone level predictive of ovarian hyperstimulation syndrome in both groups. Methods: This was a prospective cohort study conducted in women aged 20–35 years who were undergoing controlled ovarian stimulation. The women were divided into those with polycystic ovarian syndrome and the controls on the basis of the Rotterdam criteria. The outcome of stimulation was recorded, and the ovarian response markers were compared in both groups. Results: Among 689 women included in the study, 276 (40.1%) had polycystic ovarian syndrome, and 476 (59.9%) were used as the controls. Ovarian hyperstimulation syndrome occurred in 19.6% of the cases, and in 7.7% of the controls (p <0.001). The conception rate was greater in the group of cases (52.5% vs. 16.5%, p = 0.001). Among the cases, the sensitivity and specificity for the prediction of hyper-response were 94.4% and 97.3% for AFC, and 92.6% and 93.7% for the anti-Müllerian hormone, at the cut-off values of ≥18 and ≥6.425 ng/ml, respectively. Among the controls, the sensitivity and specificity for the prediction of hyper-response were 93.8% and 97.1% for the antral follicle count, and 93.6% and 94.5% for the anti-Müllerian hormone, at the cut-off values of ≥10 and ≥3.95 ng/ml, respectively. Conclusion: Group-specific values should be used to identify and counsel women undergoing controlled ovarian stimulation. In light of available evidence, gynaecologists should be trained to perform ultrasound evaluation, determine the antral follicle count of their patients, and offer them appropriate counselling.

scholarly journals Comparison of Automated Anti-Müllerian Hormone Assays and Antral Follicle Count in Predicting Ovarian Response During Ovarian Stimulation

2019 ◽  
Vol 01 (02) ◽  
pp. 99-105
Author(s):  
Eek Chaw Tan ◽  
Pallavi Chincholkar ◽  
Su Ling Yu ◽  
Serene Liqing Lim ◽  
Rajkumaralal Renuka ◽  
...  
Keyword(s):  
Ovarian Stimulation ◽  
Ovarian Response ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
High Response ◽  
Controlled Ovarian Stimulation ◽  
Poor Ovarian Response ◽  
Vitro Fertilization ◽  
And Performance

Objective: Various parameters had been used to predict ovarian response. Among them, Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) demonstrate the most favourable analytical and performance characteristics. In this pilot study, we aim to determine the cut-off levels of AMH using automated AMH assays and AFC in the prediction of poor and high responders. Study Design: Prospective study of 43 women between 21 to 45 years old scheduled for assisted reproduction. AMH levels on day 3 of menstruation were analysed using two immunoassay kits, namely the Beckman Coulter Access AMH and the Roche Elecsys AMH on the two automated analysers Beckman Coulter DxI 800 and Roche Cobas e602 respectively. AFC was also assessed on day 3 of menstruation prior to in vitro fertilization (IVF). These were compared with the number of oocytes retrieved after controlled ovarian stimulation. Results: AMH (Beckman Coulter Access AMH and Roche Elecsys AMH) highly correlated with AFC and the number of oocytes retrieved after ovarian stimulation. Beckman Coulter Access AMH was the better predictor for poor ovarian response with ROC [Formula: see text] of 0.83. For the prediction of a high response, AFC had a higher ROC [Formula: see text] of 0.95. Through ROC, the AMH cut-off level for poor ovarian response was 2.23 ng/ml with Beckman Coulter Access AMH and 2.02 ng/ml with Roche Elecsys AMH, while the AMH cut-off for a high ovarian response was 5.19 ng/ml with Beckman Coulter Access AMH and 4.60 ng/ml with Roche Elecsys AMH. For AFC, the cut-off for poor ovarian response was 18 and for high response was 34. Conclusion: AMH and AFC are reliable predictors of ovarian response. Establishment of specific levels may improve individualised controlled ovarian stimulation and optimise the oocyte yield. Larger studies are required to establish these findings.

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