Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: An individual patient data approach

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, R. A. Anderson, M. Ashrafi, L. Bancsi, E. Caroppo, A. Copperman, T. Ebner, M. Eldar Geva, M. Erdem, E. M. Greenblatt, K. Jayaprakasan, Raine Fenning & 15 others E. R. Klinkert, J. Kwee, C. B. Lambalk, A. La Marca, M. McIlveen, L. T. Merce, S. Muttukrishna, S. M. Nelson, H. Y. Ng, B. Popovic-Todorovic, J. M J Smeenk, C. Tomás, P. J Q Van der Linden, I. A. van Rooij, I. K. Vladimirov

Research output: Contribution to journalArticle

213 Citations (Scopus)

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.

LanguageEnglish
Article numberdms041
Pages26-36
Number of pages11
JournalHuman Reproduction Update
Volume19
Issue number1
DOIs
Publication statusPublished - 1 Jan 2013

Keywords

  • AFC
  • AMH
  • IVF outcome prediction
  • Individual patient data meta-analysis
  • Ovarian reserve tests

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Broer, Simone L. ; van Disseldorp, Jeroen ; Broeze, Kimiko A. ; Dolleman, Madeleine ; Opmeer, Brent C. ; Bossuyt, Patrick ; Eijkemans, Marinus J C ; Mol, Ben Willem J ; Broekmans, Frank J M ; Anderson, R. A. ; Ashrafi, M. ; Bancsi, L. ; Caroppo, E. ; Copperman, A. ; Ebner, T. ; Geva, M. Eldar ; Erdem, M. ; Greenblatt, E. M. ; Jayaprakasan, K. ; Fenning, Raine ; Klinkert, E. R. ; Kwee, J. ; Lambalk, C. B. ; La Marca, A. ; McIlveen, M. ; Merce, L. T. ; Muttukrishna, S. ; Nelson, S. M. ; Ng, H. Y. ; Popovic-Todorovic, B. ; Smeenk, J. M J ; Tomás, C. ; Van der Linden, P. J Q ; van Rooij, I. A. ; Vladimirov, I. K. / Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy : An individual patient data approach. In: Human Reproduction Update. 2013 ; Vol. 19, No. 1. pp. 26-36.
@article{e7de2ed2598e4a3c9c5e6166a755c11b,
title = "Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: An individual patient data approach",
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-M{\"u}llerian 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 = "AFC, AMH, IVF outcome prediction, Individual patient data meta-analysis, Ovarian reserve tests",
author = "Broer, {Simone L.} and {van Disseldorp}, Jeroen and Broeze, {Kimiko A.} and Madeleine Dolleman and Opmeer, {Brent C.} and Patrick Bossuyt and Eijkemans, {Marinus J C} and Mol, {Ben Willem J} and Broekmans, {Frank J M} and Anderson, {R. A.} and M. Ashrafi and L. Bancsi and E. Caroppo and A. Copperman and T. Ebner and Geva, {M. Eldar} and M. Erdem and Greenblatt, {E. M.} and K. Jayaprakasan and Raine Fenning and Klinkert, {E. R.} and J. Kwee and Lambalk, {C. B.} and {La Marca}, A. and M. McIlveen and Merce, {L. T.} and S. Muttukrishna and Nelson, {S. M.} and Ng, {H. Y.} and B. Popovic-Todorovic and Smeenk, {J. M J} and C. Tom{\'a}s and {Van der Linden}, {P. J Q} and {van Rooij}, {I. A.} and Vladimirov, {I. K.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1093/humupd/dms041",
language = "English",
volume = "19",
pages = "26--36",
journal = "Human Reproduction Update",
issn = "1355-4786",
publisher = "Oxford University Press",
number = "1",

}

Broer, SL, van Disseldorp, J, Broeze, KA, Dolleman, M, Opmeer, BC, Bossuyt, P, Eijkemans, MJC, Mol, BWJ, Broekmans, FJM, Anderson, RA, Ashrafi, M, Bancsi, L, Caroppo, E, Copperman, A, Ebner, T, Geva, ME, Erdem, M, Greenblatt, EM, Jayaprakasan, K, Fenning, R, Klinkert, ER, Kwee, J, Lambalk, CB, La Marca, A, McIlveen, M, Merce, LT, Muttukrishna, S, Nelson, SM, Ng, HY, Popovic-Todorovic, B, Smeenk, JMJ, Tomás, C, Van der Linden, PJQ, van Rooij, IA & Vladimirov, IK 2013, 'Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: An individual patient data approach', Human Reproduction Update, vol. 19, no. 1, dms041, pp. 26-36. https://doi.org/10.1093/humupd/dms041

Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy : An individual patient data approach. / Broer, Simone L.; van Disseldorp, Jeroen; Broeze, Kimiko A.; Dolleman, Madeleine; Opmeer, Brent C.; Bossuyt, Patrick; Eijkemans, Marinus J C; Mol, Ben Willem J; Broekmans, Frank J M; Anderson, R. A.; Ashrafi, M.; Bancsi, L.; Caroppo, E.; Copperman, A.; Ebner, T.; Geva, M. Eldar; Erdem, M.; Greenblatt, E. M.; Jayaprakasan, K.; Fenning, Raine; Klinkert, E. R.; Kwee, J.; Lambalk, C. B.; La Marca, A.; McIlveen, M.; Merce, L. T.; Muttukrishna, S.; Nelson, S. M.; Ng, H. Y.; Popovic-Todorovic, B.; Smeenk, J. M J; Tomás, C.; Van der Linden, P. J Q; van Rooij, I. A.; Vladimirov, I. K.

In: Human Reproduction Update, Vol. 19, No. 1, dms041, 01.01.2013, p. 26-36.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy

T2 - Human Reproduction Update

AU - Broer, Simone L.

AU - van Disseldorp, Jeroen

AU - Broeze, Kimiko A.

AU - Dolleman, Madeleine

AU - Opmeer, Brent C.

AU - Bossuyt, Patrick

AU - Eijkemans, Marinus J C

AU - Mol, Ben Willem J

AU - Broekmans, Frank J M

AU - Anderson, R. A.

AU - Ashrafi, M.

AU - Bancsi, L.

AU - Caroppo, E.

AU - Copperman, A.

AU - Ebner, T.

AU - Geva, M. Eldar

AU - Erdem, M.

AU - Greenblatt, E. M.

AU - Jayaprakasan, K.

AU - Fenning, Raine

AU - Klinkert, E. R.

AU - Kwee, J.

AU - Lambalk, C. B.

AU - La Marca, A.

AU - McIlveen, M.

AU - Merce, L. T.

AU - Muttukrishna, S.

AU - Nelson, S. M.

AU - Ng, H. Y.

AU - Popovic-Todorovic, B.

AU - Smeenk, J. M J

AU - Tomás, C.

AU - Van der Linden, P. J Q

AU - van Rooij, I. A.

AU - Vladimirov, I. K.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - 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.

AB - 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.

KW - AFC

KW - AMH

KW - IVF outcome prediction

KW - Individual patient data meta-analysis

KW - Ovarian reserve tests

UR - http://www.scopus.com/inward/record.url?scp=84870309984&partnerID=8YFLogxK

U2 - 10.1093/humupd/dms041

DO - 10.1093/humupd/dms041

M3 - Article

VL - 19

SP - 26

EP - 36

JO - Human Reproduction Update

JF - Human Reproduction Update

SN - 1355-4786

IS - 1

M1 - dms041

ER -