Using the ovarian sensitivity index to define poor, normal, and high response after controlled ovarian hyperstimulation in the long gonadotropin-releasing hormone-agonist protocol: suggestions for a new principle to solve an old problem
Malin Huber, Nermin Hadziosmanovic, Lars Berglund, Jan Holte, Malin Huber, Nermin Hadziosmanovic, Lars Berglund, Jan Holte
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.
Keywords: Controlled ovarian hyperstimulation; cutoff levels; excessive ovarian response; ovarian sensitivity index; poor ovarian response.
Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Source: PubMed