Using the ovarian sensitivity index to define poor normal and high response after COH in the long GnRH agonist protocol Suggestions for a new principle to solve an old problem

Capsule:
Poor, normal, and high ovarian responses were defined with the use of the ovarian sensitivity index, the ratio between oocyte yield and total dose of FSH, in a large unselected IVF cohort.

Authors:
Malin Huber, M.D., Nermin Hadziosmanovic, M.Sc., Lars Berglund, Ph.D., Jan Holte, M.D., Ph.D.

Volume 100, Issue 5, Pages 1270-1276.e3, November 2013

Abstract:

Objective:
To explore the utility of using the ratio between oocyte yield and total dose of FSH, i.e., the ovarian sensitivity index (OSI), to define ovarian response patterns.

Design:
Retrospective cross-sectional study.

Setting:
University-affiliated private center.

Patient(s):
The entire unselected cohort of 7,520 IVF/intracytoplasmic sperm injection treatments (oocyte pick-ups [OPUs]) during an 8-year period (long GnRH agonist–recombinant FSH protocol).

Intervention(s):
None.

Main Outcome Measure(s):
The distribution of the OSI (oocytes recovered × 1,000/total dose of FSH), the cutoff levels for poor and high response, set at ±1 SD, and the relationship between OSI and treatment outcome.

Result(s):
OSI showed a log-normal distribution with cutoff levels for poor and high response at 1.697/IU and 10.07/IU, respectively. A nomogram is presented. Live-birth rates per OPU were 10.5 ± 0.1%, 26.9 ± 0.6%, and 36.0 ± 1.4% for poor, normal, and high response treatments, respectively. The predictive power (C-statistic) for OSI to predict live birth was superior to that of oocyte yield.

Conclusion(s):
The OSI improves the definition of ovarian response patterns because it takes into account the degree of stimulation. The nomogram presents evidence-based cutoff levels for poor, normal, and high response and could be used for unifying study designs involving ovarian response patterns.

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