Prediction of Ovarian Response
Condition: In Vitro Fertilization
Study type: Observational

Summary: 
      The purpose of this study is to evaluate if there is an association between the endocrine and
      ultrasonographic markers of ovarian reserve and the IVF outcome and to determine which
      markers contribute to the prediction of poor response in IVF.
    

Detailed description: 
      One of the most frustrating problem in IVF today is that of poor ovarian response. There is
      an amount of woman undergoing infertility treatment, who respond poorly to the usual
      gonatotrophin stimulation protocol applied. The ovarian response, which is the number of
      antral follicles and oocytes which are developed in the ovary after stimulation, is
      correlated directly with the ovarian reserve. As ovarian reserve is defined the existent
      quantitative and qualitative supply of follicles which are found in the ovaries and
      potentially can be developed in dominant and therefore it is closely associated with
      reproductive potential.

      There is a plethora of criteria used to characterize the poor response. The number of
      developed follicles or the number of oocytes retrieved after a standard dose ovarian
      stimulation protocol, are two of the most substantial criteria for the definition of poor
      ovarian reserve. Satisfying response after ovulation induction is considered the retrieval of
      5-14 oocytes per patient, whereas poor response is considered the retrieval of 4 or less
      oocytes. Using the standard doses, however, a number of patients will exhibit inappropriate
      ovarian responses. Exaggerated response leads to increased risk of ovarian hyperstimulation
      syndrome, while on the other hand, inadequate ovarian response is associated with increased
      number of IVF cancellations.

      During the past two decades, a substantial amount of research has been carried out in order
      to improve our knowledge on ovarian response predictors. Age has often guided infertility
      treatment choices, since a woman's chronological age is the single most important factor in
      predicting a couple's reproductive potential, as it is generally acknowledged that
      reproductive ageing is related to both quantitative and qualitative reduction of the
      primordial follicle pool. However, age alone is of limited value and so it cannot predict the
      response to infertility treatment.

      A number of ovarian reserve tests have been designed in order to determine ovarian reserve
      and have been evaluated for their ability to predict the outcome of IVF. Many of these tests
      have become part of the routine diagnostic procedure for infertile patients who undergo
      assisted reproductive techniques. These ovarian reserve tests include the measurement of
      specific endocrine markers in combination with the study of some ultra-sonographic
      parameters.

      Basal FSH was the first widely used endocrine marker of ovarian reserve that had better
      potential than age for predicting decreased ovarian function and today it is established that
      patients with elevated basal FSH levels have lowered success rates after IVF. At present,
      several other markers of ovarian reserve are advocated, such as basal estradiol levels, basal
      LH levels, early follicular phase serum inhibin B concentration and anti-mullerian hormone
      concentration.

      Moreover, several ovarian ultrasonographic parameters are studied as markers for ovarian
      resposiveness. The antral follicle count, the ovarian volume and the ovarian stromal blood
      flow appeared to be indicative of poor response in assisted reproduction.

      The purpose of this prospective study is to evaluate if there is an association between the
      endocrine and ultrasonographic markers of ovarian reserve and the IVF outcome and to
      determine which markers contribute to the prediction of poor response in IVF.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Women undergoing ovarian stimulation with gonadotropins and GnRH antagonists for IVF
      
Biospecimen description: 
      Serum
    
Keywords: IVF; ovarian reserve; poor response