Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: An individual patient data meta-analysis

Simone L. Broer, Madeleine Dólleman, Jeroen Van Disseldorp, Kimiko A. Broeze, Brent C. Opmeer, Patrick M M Bossuyt, Martinus J C Eijkemans, Ben Willem Mol, Frank J M Broekmans, A. Aflatoonian, R. A. Anderson, M. Ashrafi, L. Bancsi, E. Caroppo, A. B. Copperman, T. Ebner, T. Eldar-Geva, M. Erdem, T. Freour, C. Gnoth & 21 others E. M. Greenblatt, K. Jayaprakasan, N. Raine-Fenning, E. Klinkert, J. Kwee, A. La Marca, C. B. Lambalk, M. McIlveen, L. Mohiyiddeen, L. T. Merce, S. Muttukrishna, L. G. Nardo, 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, IPD-EXPORT Study Group

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Objective: To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups. Design: Authors of studies reporting on basal FSH, antimüllerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy. Setting: In vitro fertilization clinics. Patient(s): A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs. Intervention(s): None. Main Outcome Measure(s): Excessive response prediction. Result(s): We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same. Conclusion(s): We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.

LanguageEnglish
JournalFertility and Sterility
Volume100
Issue number2
DOIs
Publication statusPublished - 1 Aug 2013

Keywords

  • Assisted Reproduction
  • antimullerian horme
  • antral folicle count
  • excessive response
  • ovarian hyperstimulation syndrome

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Broer, Simone L. ; Dólleman, Madeleine ; Van Disseldorp, Jeroen ; Broeze, Kimiko A. ; Opmeer, Brent C. ; Bossuyt, Patrick M M ; Eijkemans, Martinus J C ; Mol, Ben Willem ; Broekmans, Frank J M ; Aflatoonian, A. ; Anderson, R. A. ; Ashrafi, M. ; Bancsi, L. ; Caroppo, E. ; Copperman, A. B. ; Ebner, T. ; Eldar-Geva, T. ; Erdem, M. ; Freour, T. ; Gnoth, C. ; Greenblatt, E. M. ; Jayaprakasan, K. ; Raine-Fenning, N. ; Klinkert, E. ; Kwee, J. ; La Marca, A. ; Lambalk, C. B. ; McIlveen, M. ; Mohiyiddeen, L. ; Merce, L. T. ; Muttukrishna, S. ; Nardo, L. G. ; 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. ; IPD-EXPORT Study Group. / Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups : An individual patient data meta-analysis. In: Fertility and Sterility. 2013 ; Vol. 100, No. 2.
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title = "Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: An individual patient data meta-analysis",
abstract = "Objective: To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups. Design: Authors of studies reporting on basal FSH, antim{\"u}llerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy. Setting: In vitro fertilization clinics. Patient(s): A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs. Intervention(s): None. Main Outcome Measure(s): Excessive response prediction. Result(s): We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same. Conclusion(s): We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.",
keywords = "Assisted Reproduction, antimullerian horme, antral folicle count, excessive response, ovarian hyperstimulation syndrome",
author = "Broer, {Simone L.} and Madeleine D{\'o}lleman and {Van Disseldorp}, Jeroen and Broeze, {Kimiko A.} and Opmeer, {Brent C.} and Bossuyt, {Patrick M M} and Eijkemans, {Martinus J C} and Mol, {Ben Willem} and Broekmans, {Frank J M} and A. Aflatoonian and Anderson, {R. A.} and M. Ashrafi and L. Bancsi and E. Caroppo and Copperman, {A. B.} and T. Ebner and T. Eldar-Geva and M. Erdem and T. Freour and C. Gnoth and Greenblatt, {E. M.} and K. Jayaprakasan and N. Raine-Fenning and E. Klinkert and J. Kwee and {La Marca}, A. and Lambalk, {C. B.} and M. McIlveen and L. Mohiyiddeen and Merce, {L. T.} and S. Muttukrishna and Nardo, {L. G.} 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.} and {IPD-EXPORT Study Group}",
year = "2013",
month = "8",
day = "1",
doi = "10.1016/j.fertnstert.2013.04.024",
language = "English",
volume = "100",
journal = "Fertility and Sterility",
issn = "0015-0282",
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Broer, SL, Dólleman, M, Van Disseldorp, J, Broeze, KA, Opmeer, BC, Bossuyt, PMM, Eijkemans, MJC, Mol, BW, Broekmans, FJM, Aflatoonian, A, Anderson, RA, Ashrafi, M, Bancsi, L, Caroppo, E, Copperman, AB, Ebner, T, Eldar-Geva, T, Erdem, M, Freour, T, Gnoth, C, Greenblatt, EM, Jayaprakasan, K, Raine-Fenning, N, Klinkert, E, Kwee, J, La Marca, A, Lambalk, CB, McIlveen, M, Mohiyiddeen, L, Merce, LT, Muttukrishna, S, Nardo, LG, Nelson, SM, Ng, HY, Popovic-Todorovic, B, Smeenk, JMJ, Tomás, C, Van Der Linden, PJQ, Van Rooij, IA, Vladimirov, IK & IPD-EXPORT Study Group 2013, 'Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: An individual patient data meta-analysis', Fertility and Sterility, vol. 100, no. 2. https://doi.org/10.1016/j.fertnstert.2013.04.024

Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups : An individual patient data meta-analysis. / Broer, Simone L.; Dólleman, Madeleine; Van Disseldorp, Jeroen; Broeze, Kimiko A.; Opmeer, Brent C.; Bossuyt, Patrick M M; Eijkemans, Martinus J C; Mol, Ben Willem; Broekmans, Frank J M; Aflatoonian, A.; Anderson, R. A.; Ashrafi, M.; Bancsi, L.; Caroppo, E.; Copperman, A. B.; Ebner, T.; Eldar-Geva, T.; Erdem, M.; Freour, T.; Gnoth, C.; Greenblatt, E. M.; Jayaprakasan, K.; Raine-Fenning, N.; Klinkert, E.; Kwee, J.; La Marca, A.; Lambalk, C. B.; McIlveen, M.; Mohiyiddeen, L.; Merce, L. T.; Muttukrishna, S.; Nardo, L. G.; 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.; IPD-EXPORT Study Group.

In: Fertility and Sterility, Vol. 100, No. 2, 01.08.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups

T2 - Fertility and Sterility

AU - Broer, Simone L.

AU - Dólleman, Madeleine

AU - Van Disseldorp, Jeroen

AU - Broeze, Kimiko A.

AU - Opmeer, Brent C.

AU - Bossuyt, Patrick M M

AU - Eijkemans, Martinus J C

AU - Mol, Ben Willem

AU - Broekmans, Frank J M

AU - Aflatoonian, A.

AU - Anderson, R. A.

AU - Ashrafi, M.

AU - Bancsi, L.

AU - Caroppo, E.

AU - Copperman, A. B.

AU - Ebner, T.

AU - Eldar-Geva, T.

AU - Erdem, M.

AU - Freour, T.

AU - Gnoth, C.

AU - Greenblatt, E. M.

AU - Jayaprakasan, K.

AU - Raine-Fenning, N.

AU - Klinkert, E.

AU - Kwee, J.

AU - La Marca, A.

AU - Lambalk, C. B.

AU - McIlveen, M.

AU - Mohiyiddeen, L.

AU - Merce, L. T.

AU - Muttukrishna, S.

AU - Nardo, L. G.

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.

AU - IPD-EXPORT Study Group

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Objective: To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups. Design: Authors of studies reporting on basal FSH, antimüllerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy. Setting: In vitro fertilization clinics. Patient(s): A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs. Intervention(s): None. Main Outcome Measure(s): Excessive response prediction. Result(s): We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same. Conclusion(s): We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.

AB - Objective: To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups. Design: Authors of studies reporting on basal FSH, antimüllerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy. Setting: In vitro fertilization clinics. Patient(s): A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs. Intervention(s): None. Main Outcome Measure(s): Excessive response prediction. Result(s): We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same. Conclusion(s): We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.

KW - Assisted Reproduction

KW - antimullerian horme

KW - antral folicle count

KW - excessive response

KW - ovarian hyperstimulation syndrome

UR - http://www.scopus.com/inward/record.url?scp=84930786061&partnerID=8YFLogxK

U2 - 10.1016/j.fertnstert.2013.04.024

DO - 10.1016/j.fertnstert.2013.04.024

M3 - Article

VL - 100

JO - Fertility and Sterility

JF - Fertility and Sterility

SN - 0015-0282

IS - 2

ER -