Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: An individual patient data approach

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, R. A. Anderson, M. Ashrafi, L. Bancsi, E. Caroppo, A. Copperman, T. Ebner, M. Eldar Geva, M. Erdem, E. M. Greenblatt, K. Jayaprakasan, Raine FenningE. 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

*Corresponding author for this work

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234 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numberdms041
Pages (from-to)26-36
Number of pages11
JournalHuman Reproduction Update
Volume19
Issue number1
DOIs
Publication statusPublished - Jan 2013

Keywords

  • AFC
  • AMH
  • Individual patient data meta-analysis
  • IVF outcome prediction
  • Ovarian reserve tests

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    Broer, S. L., van Disseldorp, J., Broeze, K. A., Dolleman, M., Opmeer, B. C., Bossuyt, P., Eijkemans, M. J. C., Mol, B. W. J., Broekmans, F. J. M., Anderson, R. A., Ashrafi, M., Bancsi, L., Caroppo, E., Copperman, A., Ebner, T., Geva, M. E., Erdem, M., Greenblatt, E. M., Jayaprakasan, K., ... Vladimirov, I. K. (2013). Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: An individual patient data approach. Human Reproduction Update, 19(1), 26-36. [dms041]. https://doi.org/10.1093/humupd/dms041