Yonsei Med J.  2015 Mar;56(2):482-489. 10.3349/ymj.2015.56.2.482.

What Number of Oocytes Is Appropriate for Defining Poor Ovarian Response?

• Kim SK
• Lee JR
• Jee BC
• Suh CS
• Kim SH

• KMID: 2070028
• DOI: http://doi.org/10.3349/ymj.2015.56.2.482

Abstract

PURPOSE
This study attempted to derive an objective and sophisticated definition of poor ovarian response (POR).
MATERIALS AND METHODS
A total of 176 consecutive in vitro fertilization (IVF) cycles (137 patients) with conventional ovarian stimulation during 2009 to 2012 were studied by retrospective analysis. Optimal oocyte number (total or mature) was determined by statistics-based (distribution of oocyte number) and prognosis-based approaches (prediction for IVF outcome). Receiver operating characteristics curve analysis was used to show what number of oocytes could predict IVF pregnancy and whether clinical and laboratory variables could predict newly defined POR.
RESULTS
The 25th percentile of the distribution corresponded to total oocytes < or =2 and mature oocyte < or =1. The cut-off values for the prediction of IVF outcomes were total oocytes >5 and mature oocyte >1. Considering the incidence of POR (34.1%), a reasonable definition of POR was decided as total oocytes < or =2 or mature oocyte < or =1. For the prediction of this new definition, the extreme cut-off value (by setting a false positive rate of 5%) of serum anti-Mullerian hormone (AMH) was < or =0.76 ng/mL, which was better than serum follicle stimulating hormone or age. A new simple definition of POR was derived as total oocytes < or =2 or mature oocyte < or =1 in a previous cycle or a serum AMH level of < or =0.76 ng/mL. When this simple criterion was re-applied to our data, the predictive performance was similar to the Bologna criteria.
CONCLUSION
We here propose a new definition of POR, which is simple and supported by statistical and prognostic analyses.

Keyword

Ovarian stimulation; poor ovarian response; decreased ovarian response; oocyte number

MeSH Terms

Adult
Anti-Mullerian Hormone/blood
Female
Fertilization in Vitro
Follicle Stimulating Hormone/blood
Humans
Infertility, Female/blood/*therapy
*Oocytes
*Ovulation Induction
Pregnancy
Prognosis
ROC Curve
Retrospective Studies
*Sperm Injections, Intracytoplasmic
Treatment Outcome
Anti-Mullerian Hormone
Follicle Stimulating Hormone

Figure

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  Fig. 1 Distribution of number of retrieved oocytes. (A) Total oocyte. (B) Mature oocyte. Each percentile value is shown with lines.

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  Fig. 2 Pairwise comparison of three ROC curves. Each ROC curve was constructed to predict POR defined as total oocytes ≤2 or mature oocyte ≤1. Area under the curve of serum AMH was highest (AMH 0.787, FSH 0.712, age 0.730). ROC, receiver operating characteristic; FSH, follicle stimulating hormone; POR, poor overian response; AMH, anti-Mullerian hormone.

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