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Predictors of low response to mild ovarian stimulation initiated on cycle day 5 for IVF.

Predictors of low response to mild ovarian stimulation initiated on cycle day 5 for IVF.
Predictors of low response to mild ovarian stimulation initiated on cycle day 5 for IVF.
Background: Milder stimulation protocols are being developed to minimize adverse effects of ovarian stimulation in in vitro fertilization (IVF) programs. A drawback is the possibility of an increased rate of insufficient ovarian response. This study aimed to develop a prognostic model for the prediction of cycle cancellation due to insufficient response to mild stimulation.

Methods: A total of 174 IVF patients aged <38 years and with a body mass index (BMI) <28 Kg/m2 were treated with mild ovarian stimulation using a fixed daily dose (150 IU) of recombinant follicle-stimulating hormone (rFSH) from cycle day 5 and GnRH antagonist from the late follicular phase. In women with mono- or bifollicular growth (17%), the cycle was cancelled and the treatment was adjusted in a second treatment cycle by starting rFSH on cycle day 2.

Results: In a multivariable logistic regression analysis, duration of infertility, menstrual cycle length, secondary infertility and BMI were included in the prediction model. The area under the receiver-operating characteristics curve of the model was 0.69. A probability cut-off for cancellation of 0.3 yielded an expected sensitivity of 33% and specificity of 92%. Analysis of ovarian response in the subsequent treatment cycle showed an improved ovarian response and a significant reduction in the cancellation rate.

Conclusions: With the presented model, it is possible to identify patients at risk for cycle cancellation, during mild ovarian stimulation, due to insufficient response. The contributing factors of the model suggest that ovarian aging and BMI are related to insufficient response to mild stimulation.
mild ovarian stimulation, ovarian response, prediction models, ivf cycle cancellation
1919-1924
Verberg, M.F.G.
6cfc6f04-fe1f-45ac-9016-fb846dbc4a2c
Eijkemans, M.J.C.
49ac87bc-76a5-493a-8d2b-37abfb606e62
Macklon, N.S.
7db1f4fc-a9f6-431f-a1f2-297bb8c9fb7e
Heijnen, E.M.E.W.
a3f775d4-d175-4e1b-a0c5-dc395d3fef0a
Fauser, B.C.J.M.
c265d1e7-d207-4400-a669-7502343e3b7e
Broekmans, F.J.
17ce14de-42f9-43cb-98be-194dc9430888
Verberg, M.F.G.
6cfc6f04-fe1f-45ac-9016-fb846dbc4a2c
Eijkemans, M.J.C.
49ac87bc-76a5-493a-8d2b-37abfb606e62
Macklon, N.S.
7db1f4fc-a9f6-431f-a1f2-297bb8c9fb7e
Heijnen, E.M.E.W.
a3f775d4-d175-4e1b-a0c5-dc395d3fef0a
Fauser, B.C.J.M.
c265d1e7-d207-4400-a669-7502343e3b7e
Broekmans, F.J.
17ce14de-42f9-43cb-98be-194dc9430888

Verberg, M.F.G., Eijkemans, M.J.C., Macklon, N.S., Heijnen, E.M.E.W., Fauser, B.C.J.M. and Broekmans, F.J. (2007) Predictors of low response to mild ovarian stimulation initiated on cycle day 5 for IVF. Human Reproduction, 22 (7), 1919-1924. (doi:10.1093/humrep/dem089). (PMID:17485438)

Record type: Article

Abstract

Background: Milder stimulation protocols are being developed to minimize adverse effects of ovarian stimulation in in vitro fertilization (IVF) programs. A drawback is the possibility of an increased rate of insufficient ovarian response. This study aimed to develop a prognostic model for the prediction of cycle cancellation due to insufficient response to mild stimulation.

Methods: A total of 174 IVF patients aged <38 years and with a body mass index (BMI) <28 Kg/m2 were treated with mild ovarian stimulation using a fixed daily dose (150 IU) of recombinant follicle-stimulating hormone (rFSH) from cycle day 5 and GnRH antagonist from the late follicular phase. In women with mono- or bifollicular growth (17%), the cycle was cancelled and the treatment was adjusted in a second treatment cycle by starting rFSH on cycle day 2.

Results: In a multivariable logistic regression analysis, duration of infertility, menstrual cycle length, secondary infertility and BMI were included in the prediction model. The area under the receiver-operating characteristics curve of the model was 0.69. A probability cut-off for cancellation of 0.3 yielded an expected sensitivity of 33% and specificity of 92%. Analysis of ovarian response in the subsequent treatment cycle showed an improved ovarian response and a significant reduction in the cancellation rate.

Conclusions: With the presented model, it is possible to identify patients at risk for cycle cancellation, during mild ovarian stimulation, due to insufficient response. The contributing factors of the model suggest that ovarian aging and BMI are related to insufficient response to mild stimulation.

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More information

Published date: July 2007
Keywords: mild ovarian stimulation, ovarian response, prediction models, ivf cycle cancellation

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Local EPrints ID: 185423
URI: http://eprints.soton.ac.uk/id/eprint/185423
PURE UUID: 955c6432-1729-4792-926d-99181d91157d

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Date deposited: 10 May 2011 14:02
Last modified: 14 Mar 2024 03:13

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Contributors

Author: M.F.G. Verberg
Author: M.J.C. Eijkemans
Author: N.S. Macklon
Author: E.M.E.W. Heijnen
Author: B.C.J.M. Fauser
Author: F.J. Broekmans

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