Abstract
Purpose: To compare basal and clomiphene citrate (CC) induced follicle-stimulating hormone (FSH), estradiol (E2), and inhibin B levels with ultrasound indices of ovarian reserve in infertile women and to test the prognostic value of these tests on response to ovarian stimulation in in vitro fertilization (IVF).
Methods: Fifty-six patients had basal and CC induced serum hormone levels and ultrasound measured mean ovarian volume (MOV) and mean antral follicle counts (MFC). Thirty-two patients were then appropriately selected to have a total of 41 cycles of IVF/ICSI treatment.
Results: Women with diminished ovarian reserve had lower MOV, MFC, day 3 and day 10 inhibin B levels (p< 0.001). Only basal and CC induced FSH and inhibin B correlated with MOV and MFC. Poor responders in IVF/ICSI had higher basal FSH (p< 0.05), lower basal and induced inhibin B levels (p< 0.05), and lower MOV and MFC (p< 0.01) than normal responders. Ovarian volume alone was better than age and basal hormones in predicting poor ovarian response, while abnormal CC test was the only independent significant factor in predicting ovarian response. However, age was the only independent predictor of pregnancy in IVF as compared to hormonal and ultrasound indices of ovarian reserve.
Conclusion: CC test and ovarian volume are better than other hormonal and sonographic tests in predicting the response to ovarian stimulation in IVF cycles.
Keywords: Antral follicle counts, assisted reproduction treatment, ovarian reserve, ovarian volume, poor responder
Full Text
The Full Text of this article is available as a PDF (79.1 KB).
References
- Toner JP, Philput CB, Jones GS, Muasher SJ. Basal follicle-stimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril. 1991;55:784–791. doi: 10.1016/s0015-0282(16)54249-6. [DOI] [PubMed] [Google Scholar]
- Scott RT, Hofmann GE. Prognostic assessment of ovarian reserve. Fertil Steril. 1995;63:1–11. [PubMed] [Google Scholar]
- Licciardi FL, Liu H-C, Rosenwaks Z. Day 3 estradiol serum concentrations as prognosticators of ovarian stimulation response and pregnancy outcome in patients undergoing in vitro fertilization. Fertil Steril. 1995;64:991–994. doi: 10.1016/s0015-0282(16)57916-3. [DOI] [PubMed] [Google Scholar]
- Scott RT, Hofmann GE, Oehninger S, Muasher SJ. Intercycle variability of day 3 follicle stimulating hormone (FSH) levels and its effect on stimulation quality in in vitro fertilization and embryo transfer (IVF/ET) Fertil Steril. 1990;54:297–302. doi: 10.1016/s0015-0282(16)53707-8. [DOI] [PubMed] [Google Scholar]
- Bancsi LF, Huijs AM, Ouden CT, Broekmans FJ, Looman CW, Blankestein MA, te Velde ER. Basal follicle-stimulating hormone levels are of limited value in predicting ongoing pregnancy rates after in vitro fertilization. Fertil Steril. 2000;73:552–557. doi: 10.1016/s0015-0282(99)00552-x. [DOI] [PubMed] [Google Scholar]
- Bukman A, Heineman MJ. Ovarian reserve testing and the use of prognostic models in patients with subfertility. Hum Reprod. Upd. 2001;7:581–590. doi: 10.1093/humupd/7.6.581. [DOI] [PubMed] [Google Scholar]
- Lass A, Gerrard A, Abushheikha N, Akagbosu F, Brinsden P. IVF performance of women who have fluctuating early follicular FSH levels. J Assist Reprod Genet. 2000;17:566–573. doi: 10.1023/A:1026485830540. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Klein NA, Illingworth PJ, Groome NP, McNeilly AS, Battaglìa DE, Soules MR. Decreased inhibin B secretion is associated with the monotropic FSH rise in older, ovulatory women: A study of serum and follicular levels of dimeric inhibin A and B in spontaneous menstrual cycles. J Clin Endocrinol Metab. 1996;81:2742–2745. doi: 10.1210/jcem.81.7.8675606. [DOI] [PubMed] [Google Scholar]
- Seifer DB, Gardner AC, Lambert-Messerlian G, Schneyer AL. Differential secretion of dimeric inhibin in cultured luteinized granulosa cells as a function of ovarian reserve. J Clin Endocrinol Metab. 1996;81:736–739. doi: 10.1210/jcem.81.2.8636296. [DOI] [PubMed] [Google Scholar]
- Danforth DR, Arbogast LK, Mroueh J, Kim MH, Kennard EA, Seifer DB, Friedman CI. Dimeric inhibin: A direct marker of ovarian aging. Fertil Steril. 1998;70:119–123. doi: 10.1016/s0015-0282(98)00127-7. [DOI] [PubMed] [Google Scholar]
- Seifer DB, Lambert-Messerlian G, Hogan JW, Gardiner AC, Blazar AS, Berk CA. Day 3 serum inhibin-B is predictive of assisted reproductive technologies outcome. Fertil Steril. 1997;67:110–114. doi: 10.1016/s0015-0282(97)81865-1. [DOI] [PubMed] [Google Scholar]
- Seifer DB, Scott RT, Bergh PA, Abrogast LK, Friedman CI, Mack CK, Danforth DR. Women with declining ovarian reserve may demonstrate a decrease in day 3 serum inhibin B before a rise in follicle-stimulating hormone. Fertil Steril. 1999;72:63–65. doi: 10.1016/s0015-0282(99)00193-4. [DOI] [PubMed] [Google Scholar]
- Corson SL, Gutman J, Batzer FR, Wallace H, Klein N, Soules MR. Inhibin-B as a test of ovarian reserve for infertile women. Hum Reprod. 1999;14:2818–2821. doi: 10.1093/humrep/14.11.2818. [DOI] [PubMed] [Google Scholar]
- Tomas C, Nuojua-Huttunen S, Martikainen H. Pretreatment transvaginal ultrasound examination predicts ovarian responsiveness to gonadotrophins in in-vitro fertilization. Hum Reprod. 1997;12:220–223. doi: 10.1093/humrep/12.2.220. [DOI] [PubMed] [Google Scholar]
- Chang MY, Chiang CH, Hsieh TT, Soong YK, Hsu KH. Use of the antral follicle count to predict the outcome of assisted reproductive technologies. Fertil Steril. 1998;69:505–510. doi: 10.1016/s0015-0282(97)00557-8. [DOI] [PubMed] [Google Scholar]
- Hsieh YY, Chang CC, Tsai HD. Antral follicle counting in predicting the retrieved oocyte number after ovarian hyperstimulation. J Assist Reprod Genet. 2001;18:320–324. doi: 10.1023/A:1016688806431. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Reuss ML, Kline J, Santos R, Levin B, Timor-Tritsch I. Age and ovarian follicle pool assessed with transvaginal ultrasonography. Am J Obstet Gynecol. 1996;174:624–627. doi: 10.1016/s0002-9378(96)70439-8. [DOI] [PubMed] [Google Scholar]
- Sharara FI, McClamrock HD. The effect of aging on ovarian volume measurements in infertile women. Obstet Gynecol. 1999;94:57–60. doi: 10.1016/s0029-7844(99)00242-2. [DOI] [PubMed] [Google Scholar]
- Lass A, Skull J, McVeigh E, Margara R, Winston RM. Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotropin for in-vitro fertilization can predict poor response. Hum Reprod. 1997;12:294–297. doi: 10.1093/humrep/12.2.294. [DOI] [PubMed] [Google Scholar]
- Syrop CH, Dawson JD, Husman KJ, Sparks AE, Van Voorhis BJ. Ovarian volume may predict assisted reproductive outcomes better than follicle stimulating hormone concentration on day 3. Hum Reprod. 1999;14:1752–1756. doi: 10.1093/humrep/14.7.1752. [DOI] [PubMed] [Google Scholar]
- Hall JE, Welt CK, Cramer DW. Inhibin A and Inhibin B reflect ovarian function in assisted reproduction but are less useful at predicting outcome. Hum Reprod. 1999;14:409–415. doi: 10.1093/humrep/14.2.409. [DOI] [PubMed] [Google Scholar]
- Andolf E, Jörgensen C, Svalenius E, Sundén B. Ultrasound measurement of the ovarian volume. Acta Obstet Gynecol Scand. 1987;66:387–389. doi: 10.3109/00016348709022039. [DOI] [PubMed] [Google Scholar]
- Scott RT, Opsahl MS, Leonardi MR, Neal GS, Illions EH, Navot D. Life table analysis of pregnancy rates in a general infertility population relative to ovarian reserve and patient age. Hum Reprod. 1995;10:1706–1710. doi: 10.1093/oxfordjournals.humrep.a136159. [DOI] [PubMed] [Google Scholar]
- Hofmann GE, Danforth DR, Seifer DB. Inhibin-B: the physiologic basis of the clomiphene citrate challenge test for ovarian reserve screening. Fertil Steril. 1998;69:474–477. doi: 10.1016/s0015-0282(97)00531-1. [DOI] [PubMed] [Google Scholar]
- Reame NE, Wyman TL, Phillips DJ, de Kretser DM, Padmanabhan V. Net increase in stimulatory increase input resulting from a decrease in inhibin B and an increase in activin A might contribute in part to the rise in follicular phase follicle-stimulating hormone of aging cycling women. J Clin Endocrinol Metab. 1998;83:3302–3307. doi: 10.1210/jcem.83.9.5130. [DOI] [PubMed] [Google Scholar]
- Welt CK, McNicholl DJ, Taylor AE, Hall JE. Female reproductive aging is marked by decreased secretion of dimeric inhibin. J Clin Endocrinol Metab. 1999;84:105–111. doi: 10.1210/jcem.84.1.5381. [DOI] [PubMed] [Google Scholar]
- Creus M, Penarrubia J, Fabregues F, Vidal E, Carmona F, Casamitjana R, Vanrell JA, Balasch J. Day 3 serum inhibin B and FSH and age as predictors of assisted reproduction treatment outcome. Hum Reprod. 2000;15:2341–2346. doi: 10.1093/humrep/15.11.2341. [DOI] [PubMed] [Google Scholar]
- Loumaye E, Billion JM, Mine JM, Psalit I, Pensis M, Thomas K. Prediction of individual response to controlled ovarian hyperstimulation by means of a clomiphene citrate challenge test. Fertil Steril. 1990;53:295–301. doi: 10.1016/s0015-0282(16)53284-1. [DOI] [PubMed] [Google Scholar]
- Tanbo T, Dale PO, Ludne O, Norman N, Abyholm T. Prediction of response to controlled ovarian hyperstimulation: a comparison of basal and citrate-stimulated follicle stimulating hormone levels. Fertil Steril. 1992;57:819–824. doi: 10.1016/s0015-0282(16)54965-6. [DOI] [PubMed] [Google Scholar]
- Kahraman S, Vicdan K, Isik AZ, Ozgun OD, Alaybeyoglu L, Polat G, Biberoglu K. Clomiphene citrate challenge test in the assessment of ovarian reserve before controlled ovarian hyperstimulation for intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol. 1997;73:177–178. doi: 10.1016/s0301-2115(97)02742-5. [DOI] [PubMed] [Google Scholar]
- Gulekli B, Bulbul Y, Onvural A, Yorukoglu K, Posacı C, Demir N, Erten O. Accuracy of ovarian reserve tests. Hum Reprod. 1999;14:2822–2826. doi: 10.1093/humrep/14.11.2822. [DOI] [PubMed] [Google Scholar]
- Syrop CH, Willhoite A, Van Voorhis BJ. Ovarian volume: A novel outcome predictor for assisted reproduction. Fertil Steril. 1995;64:1167–1171. doi: 10.1016/s0015-0282(16)57979-5. [DOI] [PubMed] [Google Scholar]
- Frattarelli JL, Lauria-Costa DF, Miller BT, Bergh PA, Scott RT. Basal antral follicle number and mean ovarian diameter predict cycle cancellation and ovarian responsivenessin assisted reproductive technology cycles. Fertil Steril. 2000;74:512–517. doi: 10.1016/s0015-0282(00)00708-1. [DOI] [PubMed] [Google Scholar]
- Ng EH, Tang O. P. The significance of the number of antral follicles prior to stimulation in predicting ovarian responses in an IVF program. Hum Reprod. 2000;15:1937–1942. doi: 10.1093/humrep/15.9.1937. [DOI] [PubMed] [Google Scholar]
