Predictors of ovarian sensitivity to gonadotropins: a multicentric retrospective investigation of 1,942 women candidates to ART
Age and AMH levels appear to be important predictors of ovarian sensitivity to gonadotropins in women undergoing IVF/ICSI cycles.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This study investigated predictors of ovarian sensitivity to gonadotropins in 1,942 women undergoing IVF/ICSI cycles. It measured ovarian sensitivity using Follicle Output Rate (FORT) and Follicle to Oocytes Index (FOI) with a daily gonadotropin dosage between 225-300 IU. The findings indicated correlations between age, AMH levels, and ovarian sensitivity metrics.
Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Ovarian sensitivity to exogenous gonadotropin represents a matter of interest in the reproductive field. Follicle to Oocytes Index and Follicle output rate were proposed to better assess this phenomenon better reflecting the dynamic nature of ovarian sensitivity. So far, few are known regarding the pattern of ovarian sensitivity and its relationship with anthropometric, chronological, and biological age. The aim of the present paper is to assess relevant predictors of ovarian sensitivity measured by FORT and FOI in women undergoing IVF/ICSI cycles <bold>Methods:</bold> This retrospective study was carried out through 81,547 IVF/ICSI cycles conducted from January 2023 to July 2024 at a tertiary IVF center. The following inclusion criteria were adopted: age between 21- 40 years old; daily gonadotropin dosage between 225-300 IU; antral follicle count based between 5 and 25; Body Mass Index (BMI) between 18.5 and 30 kg/m <sup>2</sup> ; antagonist protocol. Exclusion criteria were: oocyte donor cycle; dual trigger or GnRH agonist triggering. Ovarian stimulation used recombinant and urinary gonadotropins with a flexible antagonist protocol; hCG trigger was given when ≥3 follicles reached 16–17 mm. <bold>Results:</bold> Chronological age is negatively correlated with both FOI (ρ= -0.145, p value= <0.001, 95% CI from-0.189 to -0.100) and FORT (ρ= -0.084, p value <0.001, 95% CI from -0.129 to -0.038). Conversely, AMH positively correlated with FOI (ρ= 0.141, p value <0.001, 95% CI from 0.096, 0.186) and FORT (ρ= 0.136, p value <0.001, 95% CI from 0.091 to 0.181). A significant negative association between FOI and BMI (ρ= -0.045, p value = 0.048, 95 CI from -0.090 to 0.001) was also observed. A multivariable regression analysis considering FOI as a dependent variable confirmed that Age and AMH are respectively negative and positive predictors of FOI. <bold>Conclusion</bold> : This study suggests that age and AMH may be the most important predictors of FOI and FORT which could be the best way to assess the ovarian sensitivity to exogenous gonadotropin. To confirm our findings, larger analyses involving different ethnicities and multiple predictors will be required in the future. </p>
Background
This paper addresses the predictors of ovarian sensitivity to gonadotropins, a critical factor in reproductive health. Previous studies have suggested that various factors, including age and hormonal levels, may influence ovarian response. Understanding these predictors is essential for optimizing fertility treatments, particularly in assisted reproductive technology (ART) settings.
Methods
This multicentric retrospective study analyzed data from 81,547 IVF/ICSI cycles conducted from January 2023 to July 2024. Inclusion criteria included women aged 21-40 years, daily gonadotropin dosages between 225-300 IU, antral follicle counts between 5 and 25, and a BMI between 18.5 and 30 kg/m². The primary outcomes were FOI and FORT, measured after ovarian stimulation with recombinant and urinary gonadotropins.
Results
The primary endpoint indicated that chronological age negatively correlated with FOI (ρ= -0.145, p value= <0.001, 95% CI from -0.189 to -0.100). Additionally, AMH levels positively correlated with FOI (ρ= 0.141, p value <0.001, 95% CI from 0.096 to 0.186). A multivariable regression confirmed age and AMH as significant predictors of FOI.
Interpretation
These findings align with existing literature suggesting that age negatively impacts ovarian sensitivity while AMH serves as a positive predictor. However, the effect sizes, while statistically significant, may not translate to clinically meaningful differences in all populations. Limitations include the retrospective nature of the study and potential confounding factors not accounted for.
Key findings
- Chronological age negatively correlated with FOI (ρ= -0.145, p value= <0.001, 95% CI from -0.189 to -0.100)
- Chronological age negatively correlated with FORT (ρ= -0.084, p value <0.001, 95% CI from -0.129 to -0.038)
- AMH positively correlated with FOI (ρ= 0.141, p value <0.001, 95% CI from 0.096 to 0.186)
- AMH positively correlated with FORT (ρ= 0.136, p value <0.001, 95% CI from 0.091 to 0.181)
- Significant negative association between FOI and BMI (ρ= -0.045, p value = 0.048, 95 CI from -0.090 to 0.001)
Limitations
- retrospective study design
- potential confounding variables not controlled
- limited to a specific age range
- results may not generalize to other populations
- no long-term follow-up data