In Vitro Fertilization Clinical Trial
Official title:
Prediction of Ovarian Response After Ovarian Stimulation for in Vitro Fertilization
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.
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.
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