Diminished ovarian reserve in the United States assisted reproductive technology population Diagnostic trends among 181536 cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System

Capsule:
Diminished ovarian reserve (DOR) assignment increased 7% among all Society for Assisted Reproductive Technology Clinic Outcomes Reporting System cycles from 2004 to 2011, despite minimal increase in patient age at cycle start. The ability of DOR assignment to predict poor ovarian response worsened.

Authors:
Kate Devine, M.D., Sunni L. Mumford, Ph.D., Mae Wu, D.O., Alan H. DeCherney, M.D., Micah J. Hill, D.O., Anthony Propst, M.D.

Volume 104, Issue 3, Pages 612-619

Abstract:

Objective:
To evaluate trends in diminished ovarian reserve (DOR) assignment in the Society for Assisted Reproductive Technology (SART) Clinic Outcomes Reporting System database and to evaluate its accuracy in predicting poor ovarian response (POR) as defined in European Society of Human Reproduction and Embryology’s Bologna criteria (2011).

Design:
Retrospective cohort study.

Setting:
Not applicable.

Patient(s):
A total of 181,536 fresh, autologous ART cycles reported to SART by U.S. clinics in 2004 and 2011 (earliest and most recent available reporting years).

Intervention(s):
None.

Main Outcome Measure(s):
DOR assignment was the primary exposure. POR, defined as cycle cancellation for poor response or less than 4 oocytes retrieved after conventional gonadotropin stimulation (>149 IU FSH daily), was the primary outcome. Secondary outcomes were live birth and number of oocytes retrieved. DOR prevalence, power of DOR and FSH (Result(s):
DOR prevalence increased from 19% to 26% from 2004 to 2011. Among cycles clinically assigned as DOR, incidence of POR decreased from 32% to 30%, and live birth improved from 15% to 17%. Comparing basal FSH ≥12 versus clinical assignment of DOR, basal FSH had a higher specificity (92.2% vs. 81.6%) and positive predictive value (38.3% vs. 30.9%) for predicting POR. Live birth among POR cycles was 4%.

Conclusion(s):
DOR diagnosis is increasing, and accuracy remains poor, despite the availability of additional diagnostic parameters such as antral follicle count and antimüllerian hormone. POR entailed poor outcomes, but the majority of patients clinically assigned as DOR did not experience POR. Development and use of more accurate predictors of POR are needed to minimize patient distress resulting from overdiagnosis.

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