The accuracy of multivariate models predicting ovarian reserve and pregnancy after in vitro fertilization: a meta-analysis |
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| Authors: | Verhagen T E M Hendriks D J Bancsi L F J M M Mol B W J Broekmans F J M |
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| Affiliation: | 1 Department of Obstetrics and Gynecology, Máxima Medical Center Veldhoven, De Run 4600, PO Box 7777, 5500 MB Veldhoven NL, The Netherlands 2 Division of Perinatology and Gynecology, Department of Reproductive Medicine, University Medical Center Utrecht, The Netherlands 3 Department of Obstetrics and Gynecology, Rijnstate Hopsital, Arnhem, The Netherlands 4 Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands |
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| Abstract: | BACKGROUND: To review the accuracy of multivariate models for the predictionof ovarian reserve and pregnancy in women undergoing IVF comparedwith the antral follicle count (AFC) as single test. METHODS: We performed a computerized MEDLINE and EMBASE search to identifyarticles published on multivariate models for ovarian reservetesting in patients undergoing IVF. In order to be selected,articles had to contain data on the outcome of IVF in termsof either pregnancy and/or poor response and on the predictionof these events based on a multivariate model. For the selectedstudies, sensitivity and specificity of the test in the predictionof poor ovarian response and non-pregnancy were calculated.Overall performance was assessed by estimating a summary receiveroperating characteristic (ROC) curve, which was compared withthe ROC curve for the AFC as the current best single test. RESULTS: We identified 11 studies reporting on the predictive capacityof multivariate models in ovarian reserve testing. All studiesreported on the prediction of poor ovarian response, whereasnone reported on the occurrence of pregnancy. The sensitivityfor prediction of poor ovarian response varied between 39% and97% and the specificity between 50% and 96%. Logistic regressionanalysis indicated that cohort studies provided a significantlybetter discriminative performance than case–control studies.As cohort studies are superior to case–control studies,further analysis was limited to the cohort studies. For thecohort studies, a summary ROC curve could be estimated, whichhad a shape similar to that previously made for the AFC. CONCLUSIONS: The accuracy of multivariate models for the prediction of ovarianresponse in women undergoing IVF is similar to the accuracyof AFC. No data are available on the capacity of these modelsto predict pregnancy, let alone live birth. On the basis ofthese findings, the use of more than one single test for theassessment of ovarian reserve cannot currently be supported. |
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| Keywords: | meta-analysis / IVF / ovarian reserve / multivariate models / AFC |
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