Failure of in vitro fertilization: prognosis criteriae

##plugins.themes.academic_pro.article.sidebar##

Published Jan 12, 2016
Download
pdf
Vol. 93 No. 11 (2015): Issue Nov 2015

##plugins.themes.academic_pro.article.main##

Moez Kdous
Marouene Braham
Ghaya Merdassi
Zied Takalli
Amel Zhioua
Fethi Zhioua

Abstract

SUMMARY
Background: age, obesity and increased FSH serum level in women are prognosis criteriae associated with decreased fertility and adverse Assisted Reproductive Technologies (ART) outcomes.
Objective: To assess the effect of age, FSH and BMI on pregnancy rate in ICSI.
Methods: A retrospective and comparative study of 500 women who underwent ICSI cycle during the study period from January 2004 to December 2005. Age, FSH and BMI were compared in two groups of patients: Those achieving a pregnancy: The “pregnancy+” group and those failing to have a pregnancy: The “pregnancy-“group. For each of previous parameters ROC curve and logistic regression study were performed.
Results: age was significantly lower in “pregnancy+” group (32,4±3,9 years vs 33,7±4,8 ans ; p=0,005). Analysis of ROC curve and logistic regression study show that for age, the most discriminative cut-off for predicting pregnancy is 38 years (Se=7,5%, Sp=75,6%) (AUC=0,572; p=0,02) (OR=2,1 ; LR+=6,7 ;IC[1 ;1,4] ; p0,009). FSH was significantly lower in “pregnancy+” group (5,5±1,8UI /L vs 6,2±3UI/L, p=0,003). Analysis of ROC curve and logistic regression study show that for
FSH, the most discriminative cut-off for predicting pregnancy is 9UI/L (Se=3,7%, Sp=85.2%) (AUC=0,539 ; p=0,03) (OR=3,6; IC[1,4 ;9,3]; LR+ =10,1; p=0,003). BMI was also significantly lower in “pregnancy+” group (24,7± 3,6 kgm-2 vs 27,1±4,5 kgm-2 ; p<10-3). The most discriminative cut-off for predicting pregnancy is 25,4 kgm- 2 (Se=31,7%, Sp=33,3%) (AUC=0,663 ; p<10-3) (OR=4; IC[2,1 ;7,7]; LR+ =19,38; p<10-3).
Conclusion: age, FSH and BMI affect markedly the prognosis of ICSI. We found significantly lower Pregnancy rates in older women (> 38 years), in women with elevated FSH (> 9UI/L) or elevated BMI (> 25,4 kgm-2). Our results can be used when counseling and before including patients in an IVF program, to give them probability of success and weight loss required to optimize chances of pregnancy.

Keywords:

IVF. Age. FSH. Body mass index

##plugins.themes.academic_pro.article.details##

References

  1. Gunby J, Daya S. Assisted Reproductive Technologies (Art) In Canada: 2002 Results From The Canadian Art Register. Fertil Steril 2005;86:1356-64.
  2. Schwartz D, Mayaux Mj. Female Fecundity As A Function Of Age. New Engl J Med 1982;305:404-5.
  3. Menken J, Trussel J, Larsen U. Age And Infertility. Science 1986;233:1389-94.
  4. Navot D, Bergh Pa, Williams Ma Et Al. Poor Oocyte Quality Rather Than Implantation Failure As A Cause Of Age-Related Decline In Female Fertility. Lancet 2006;337:1375-7.
  5. Romeu A, Muasher Sj, Acosta A Et Al. Results Of In Vitro Fertilization Attempts In Women 40 Years Of Age And Older: The Norfolk Experience. Fertil Steril 2004;47:130-6.
  6. Chetkowski Rj, Rode Ra, Burruel V, Nass Te. The Effect Of Pituitary Suppression And The Women's Age On Embryo Viability And Uterine Receptivity. Fertil Steril 1991;56:1095-103.
  7. Kerin Jf, Warnes Gm, Quinn P Et Al. In Vitro Fertilization And Embryo Transfer Program. J In Vitro Fertil Embryo Transfer 2011;1:63-71
  8. Meldrun D. Female Reproductive Aging - Ovarian And Uterine Factors. Fertil Steril 1993;59:1-5.
  9. Lervan D, Ben-Shlomo I, Dor J Et Al. Aging Of Endometrium And Oocytes: Observation On Conception And Abortion Rates In An Egg Donation Model. Fertil Steril 2009;56:1091-4.
  10. Richardson Sj, Nelson Jf. Follicular Depletion During The Menopausal Transition. Ann Ny Acad Sci 2008;592:13-20.
  11. Nikolettos N, Kupker W, Al-Hasani S Et Al. Icsi Outcome In Patients Of 40 Years Age And Over: A Retrospective Analysis. Eur J Obstet Gynecol Reprod Biol 2008;91:177-182.
  12. Belaisch-Allart J, Devaux A, Ayel Jp, De Mouzon J. La Femme De 40 Ans Et Plus En Fiv Et En Icsi : Données Fivnat. Gyn Obstet Fertil 2004;32(9): 730-36.
  13. Huijis Am, Den Ouden Ct Et Al. Basal Follicle-Stimulating Hormone Levels Are Of Limited Value In Predicting Ongoing Pregnancy Rates After In Vitro Fertilization. Fertil Steril 2009;73(3):552-57
  14. Jenkins Jm, Davies Dw, Devonport H Et Al. Comparison Of “Poor” Responders With “Good” Responders Using A Standard Buserelin/Human Menopausal Gonadotrophin Regime For In-Vitro Fertilization.Hum Reprod 1991;6:918-21.
  15. Pellicer A, Lightman A, Diamond Mp, Russell Jb, Decherney Ah. Outcome Of In Vitro Fertilization In Women With Low Response To Ovarian Stimulation. Fertil Steril 1987;47:812-15.
  16. Bancsi Lfj, Broekmans Fjm, Mol Bwj, Habbema Jdf, Te Velde Er. Performance Of Basal Follicle-Stimulating Hormone In The Prediction Of Poor Ovarian Response And Failure To Become Pregnant After In Vitro Fertilization: A Meta-Analysis. Fertil Steril 2008;79(5):1091-1100.
  17. Frazier Lm, Grainger Da, Schieve La,Toner Jp. Follicle-Stimulating Hormone And Estradiol Levels Independently Predict The Success Of Assisted Reproductive Technology Treatment. Fertil Steril 2011;82(4):834-40.
  18. Van Montfrans Jm, Hoek A, Van Hooff Mh, De Koning Ch, Tonch N, Lambalk Cb. Predictive Value Of Basal Follicle-Stimulating Hormone Concentrations In A General Subfertility Population. Fertil Steril 2000;74:97-103.
  19. Van Rooij Iaj, De Jong E, Broekmans Fjm, Te Velde Er. Pregnancies In A General Infertility Population With Elevated Fsh Levels .Reprod Biomed Online 2009, 11:180-1.
  20. Levi Aj, Raynault Mf, Bergh Pa, Drews Mr, Miller Bt, Scott Rt. Reproductive Outcome In Patients With Diminished Ovarian Reserve. Fertil Steril 2011;76:666-9.
  21. Pellicer A, Lightman A, Diamond Mp, Russell Jb, Decherney Ah. Outcome Of In Vitro Fertilization In Women With Low Response To Ovarian Stimulation. Fertil Steril 2007;47:812-15.
  22. Seifer Db, Lambert-Messerlian G, Hogan Jw, Gardiner Ac, Blazar As, Berk Ca. Day 3 Serum Inhibin-B Is Predictive Of Assisted Reproductive Technologies Outcome. Fertil Steril 1997;67:110-14.
  23. Chang My, Chiang Ch, Hsieh Tt, Soong Yk, Hsu Kh. Use Of The Antral Follicle Count To Predict The Outcome Of Assisted Reproductive Technologies. Fertil Steril 2006;69:505-10.
  24. Syrop Ch, Willhoite A, Van Voorhis Bj. Ovarian Volume: A Novel Outcome Predictor For Assisted Reproduction. Fertil Steril 1995;64:1167-71.
  25. Chang My, Chiang Ch, Hsieh Tt, Soong Yk, Hsu Kh. Use Of The Antral Follicle Count To Predict The Outcome Of Assisted Reproductive Technologies. Fertil Steril 2011;69:505-10.
  26. Bongain A, Isnard V, Gillet Jy. Obesity In Obstetrics And Gynaecology. Eur J Obstet Gynecol Reprod Biol 1998;77:217-28.
  27. Rich-Edwards Jw, Spiegelman D, Garland M, Et Al. Physical Activity Body Mass Index, And Ovulatory Disorder Infertility. Epidemiology 2002;13:184-90.
  28. Lenoble C, Guibert G, Lefebvre G, Dommergues M. Influence Du Poids Sur Les Taux De Succès En Fécondation In Vitro.Gyn Obstét Fertil ; 36: 940-944
  29. Dechaud H, Anahory T, Reyftmann L, Loup V, Hamamah S, Hedon B. Obesity Does Not Adversely Affect Results In Patients Who Are Undergoing In Vitro Fertilization And Embryo Transfer. Eur J Obstet Gynecol Reprod Biol 2006;127:88-93.
  30. Steinkampf Kr, Hammond Je, Nichols S. Effect Of Body Mass On Pharmacokinetics Of Recombinant Fsh: Sub-Cutaneous Vs Intramuscular Administration. Fertil Steril 2009;70:54-57
  31. Mc Clamrock Jb, Loveland Am, Malinow Fi, Sharara Fi. Effect Of Body Mass Index (Bmi) On Outcome Of In Vitro Fertilization (Ivf). Fertil Steril 2003;72 :38-41