Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/90018
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Type: Journal article
Title: Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach
Author: Broer, S.
van Disseldorp, J.
Broeze, K.
Dolleman, M.
Opmeer, B.
Bossuyt, P.
Eijkemans, M.
Mol, B.
Broekmans, F.
Citation: Human Reproduction Update, 2013; 19(1):26-36
Publisher: Oxford University Press (OUP)
Issue Date: 2013
ISSN: 1355-4786
1460-2369
Statement of
Responsibility: 
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, on behalf of the IMPORT study group
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.
Keywords: ovarian reserve tests
AMH
AFC
individual patient data meta-analysis
IVF outcome prediction
Rights: © The Author 2012
DOI: 10.1093/humupd/dms041
Appears in Collections:Aurora harvest 7
Obstetrics and Gynaecology publications

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