Ovulation prediction in spontaneous and induced cycles: the role ovarian reserve markers

ABSTRACT

To evaluate the role of day 3; serum FSH, inhibin-B, estradiol, [biochemical markers], ultrasound measured antral follicle count AFC and ovarian volume OV. [biophysical markers]; as static screening markers of the ovarian reserve in ovulation prediction in induced cycles in infertile patients with different induction protocols; as dynamic performance tests compared to spontaneous cycles in matched fertile patients. Also, to analyze the correlations between these markers and prediction of ovulation success in induced cycles with different induction protocols. Prospective comparative controlled study. Infertility Clinic, University Hospital, El Minia and private IVF center, Egypt. Eighty infertile patients [study group] classified into four subgroups, twenty patients each according to the method of ovulation induction and twenty matched fertile subjects [control group]. Day 3; serum inhibin-B, FSH, estradiol were measured together with transvaginal ultrasound measurements of the antral follicle count and ovarian volume in the study and the control groups. The study group was subdivided into four subgroups according the method of ovulation induction; whether clomiphene citrate [group I], or human menopausal gonadotropine [group II], or low dose follicle stimulating hormone [group III] or long IVF protocol [group IV]. The predictive values of different screening markers in relation to ovulation. Other outcome measures were ovulation rate as detected by progesterone measurement in day 21 of the cycle together with analysis of the correlations between various biochemical and biophysical markers and prediction of ovulation success in induced cycles with different induction protocols. The predictive values [sensitivity, specificity, positive predictive value, negative predictive value and accuracy] in relation to ovulation prediction of FSH [< 10 IU/L] were [96.66, 60.00, 95.60, 66.66 and 93.00%, respectively], serum inhibin-B [> 45 pg/ml] were [97.77, 70.00, 96.70, 77.77 and 95.00%, respectively], estradiol [< 75 pg/ml] were [96.59, 75.00, 96.59, 75.00 and 94.00%, respectively] AFC [> 6] were [97.77, 70.00, 96.70, 77.77 and 95.00%, respectively], and OV [> 3 cm][3] were [96.66, 60.00, 95.66, 66.66 and 93.00%, respectively]. Multivariate analysis of the variables that predict ovulation in induced cycles demonstrated that; of the biochemical variables FSH was the most significant contributor to ovulation [R2 = 0.93, P, serum FSH, inhibin-B, estradiol, AFC and ovarian volume are good screening markers of the ovarian reserve in the general infertility patients. Of the biochemical factors the main predictor for ovulation in induced cycles is FSH while AFC is the main biophysical one