Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups An individual patient data meta analysis

Capsule:
This IPD meta-analysis demonstrates that AFC and AMH add value to age in predicting excessive response to ovarian hyperstimulation and that the accuracy of some ovarian reserve tests is affected by age.

Authors:
Simone L. Broer, M.D., Ph.D., Madeleine Dólleman, M.D., Jeroen van Disseldorp, M.D., Ph.D., Kimiko A. Broeze, M.D., Brent C. Opmeer, Ph.D., Patrick M.M. Bossuyt, Ph.D., Martinus J.C. Eijkemans, Ph.D., Ben Willem Mol, M.D., Ph.D., Frank J.M. Broekmans, M.D., Ph.D. on behalf of the IPD-EXPORT study group

Volume 100, Issue 2, Pages 420-429.e7, August 2013

Abstract:

Objective:
To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups.

Design:
Authors of studies reporting on basal FSH, antimüllerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy.

Setting:
In vitro fertilization clinics.

Patient(s):
A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs.

Intervention(s):
None.

Main Outcome Measure(s):
Excessive response prediction.

Result(s):
We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same.

Conclusion(s):
We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.

  • Micah Hill

    Thank you for the very robust IDP meta-analysis. My question regards the definition of excessive response at >15 oocytes. While the Sunkara et al. paper you reference concluded 15 oocytes as the optimal number for IVF, my interpretation of their data is fairly static success rates between 15-25 oocytes. If a more liberal definition of excessive response ( >20 or >25 oocytes ) is used, are the general findings of your model still consistent?

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