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

• 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 x 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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

Nyckelord

Controlled ovarian hyperstimulation

poor ovarian response

excessive ovarian response

cutoff levels

ovarian sensitivity index

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