Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve.

OBJECTIVE: To identify and quantify predictors of poor ovarian response in in vitro fertilization (IVF). DESIGN; Prospective study. SETTING; Tertiary fertility center. PATIENT(S): One hundred twenty women undergoing their first IVF cycle. INTERVENTION(S): Measurement of the number of antral follicles and the total ovarian volume by ultrasound, and of basal levels of FSH, E(2), and inhibin B on cycle day 3. MAIN OUTCOME MEASURE(S): Ovarian response, and clinical and ongoing pregnancy rates. RESULT(S); The antral follicle count was the best single predictor for poor ovarian response: area under the receiver operating characteristic curve = 0.87. Addition of basal FSH and inhibin B levels to a logistic model with the antral follicle count significantly improved the prediction of poor response; the addition of basal E(2) levels and total ovarian volume did not improve the prediction. To express the discriminative performance of this model toward poor response, a maximum area under the receiver operating characteristic curve of 0.92 was calculated. Poor responders had significantly lower clinical and ongoing pregnancy rates than did normal responders. CONCLUSION(S): Our data demonstrate that the antral follicle count provides better prognostic information on the occurrence of poor response during hormone stimulation for IVF than does the patient's chronological age and the currently used endocrine markers. However, endocrine tests remain informative. Multivariate models can achieve more accurate predictions of outcomes of complex events like ovarian response in IVF.