Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotrophin for in-vitro fertilization can predict poor response

The study tests the hypothesis that small ovaries measured on transvaginalsonography (TVS) are associated with a poor response to ovulation inductionby human menopausal gonadotrophin (HMG) for in- vitro fertilization (IVF).A total of 140 infertile patients with morphologically normal ovariesundergoing IVF was studied. The mean ovarian volume of each patient wasmeasured on TVS before starting HMG. Subsequent routine IVF management wasconducted without knowledge of the results of TVS. The mean ovarian volumewas 6.3 cm3 (range 0.5- 18.9, SD= 3.1). Patients (n = 17; group A) withsmall ovaries of < 3 cm3 (i.e. overall mean volume - 1 SD) were comparedto patients (n = 123; group B) with ovaries > or = 3 cm3. Both groupswere of similar age (mean 35.8 versus 34.4 years). Early basal FSHconcentrations were increased in group A (9.5 versus 7.0 mIU/ml, P =0.025). The cycle was abandoned before planned oocyte recovery in ninepatients (52.8%) from group A and in 11 patients (8.9%) from group Bbecause of poor response to ovulation induction (P < 0.001). Increasedage and ovarian volume were associated independently with cancellation ofthe cycles. The remaining eight patients from group A who had oocytesretrieved required higher doses of HMG (87.5 versus 53.8 ampoules, P <0.01), yielded fewer follicles (10.3 versus 14.5, P < 0.05) and feweroocytes were recovered from them (6.8 versus 11.0, P < 0.05) comparedwith group B. There was no difference in the fertilization or pregnancyrates or the number of embryos available for transfer in either group. Ourresults indicate a strong association between ovarian volume and ovarianreserve. Small ovaries are associated with poor response to HMG and a veryhigh cancellation rate during IVF. Assessment of ovarian size should be anintegral part of infertility evaluation.