Open Access Research

A new ovarian response prediction index (ORPI): implications for individualised controlled ovarian stimulation

Joao Batista A Oliveira123*, Ricardo LR Baruffi12, Claudia G Petersen123, Ana L Mauri12, Adriana M Nascimento2, Laura Vagnini2, Juliana Ricci1, Mario Cavagna124 and Jose G Franco123

Author Affiliations

1 Centre for Human Reproduction Prof. Franco Junior, Preto, Ribeirao, Brazil

2 Paulista Centre for Diagnosis, Research and Training, Preto, Ribeirao, Brazil

3 Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, UNESP, Brazil

4 Women’s Health Reference Centre, Perola Byington Hospital, Paulo, Sao, Brazil

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Reproductive Biology and Endocrinology 2012, 10:94  doi:10.1186/1477-7827-10-94

Published: 21 November 2012

Abstract

Background

The objective was to present a new ovarian response prediction index (ORPI), which was based on anti-Müllerian hormone (AMH) levels, antral follicle count (AFC) and age, and to verify whether it could be a reliable predictor of the ovarian stimulation response.

Methods

A total of 101 patients enrolled in the ICSI programme were included. The ORPI values were calculated by multiplying the AMH level (ng/ml) by the number of antral follicles (2–9 mm), and the result was divided by the age (years) of the patient (ORPI=(AMH x AFC)/Patient age).

Results

The regression analysis demonstrated significant (P<0.0001) positive correlations between the ORPI and the total number of oocytes and of MII oocytes collected. The logistic regression revealed that the ORPI values were significantly associated with the likelihood of pregnancy (odds ratio (OR): 1.86; P=0.006) and collecting greater than or equal to 4 oocytes (OR: 49.25; P<0.0001), greater than or equal to 4 MII oocytes (OR: 6.26; P<0.0001) and greater than or equal to 15 oocytes (OR: 6.10; P<0.0001). Regarding the probability of collecting greater than or equal to 4 oocytes according to the ORPI value, the ROC curve showed an area under the curve (AUC) of 0.91 and an efficacy of 88% at a cut-off of 0.2. In relation to the probability of collecting greater than or equal to 4 MII oocytes according to the ORPI value, the ROC curve had an AUC of 0.84 and an efficacy of 81% at a cut-off of 0.3. The ROC curve for the probability of collecting greater than or equal to 15 oocytes resulted in an AUC of 0.89 and an efficacy of 82% at a cut-off of 0.9. Finally, regarding the probability of pregnancy occurrence according to the ORPI value, the ROC curve showed an AUC of 0.74 and an efficacy of 62% at a cut-off of 0.3.

Conclusions

The ORPI exhibited an excellent ability to predict a low ovarian response and a good ability to predict a collection of greater than or equal to 4 MII oocytes, an excessive ovarian response and the occurrence of pregnancy in infertile women. The ORPI might be used to improve the cost-benefit ratio of ovarian stimulation regimens by guiding the selection of medications and by modulating the doses and regimens according to the actual needs of the patients.

Keywords:
Ovarian response prediction index; Individualised controlled ovarian stimulation; Anti-Müllerian hormone; Antral follicles; Age