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Hum. Reprod. Advance Access originally published online on June 21, 2008
Human Reproduction 2008 23(8):1800-1807; doi:10.1093/humrep/den234
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The predictive value of ovarian reserve tests for spontaneous pregnancy in subfertile ovulatory women

M.L. Haadsma1,6, H. Groen2, V. Fidler2, A. Bukman3, E.M.A. Roeloffzen1, E.R. Groenewoud1, F.J.M. Broekmans4, M.J. Heineman1,5 and A. Hoek1

1 Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands 2 Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands 3 Department of Obstetrics and Gynaecology, Meander Medical Center, PO Box 1502, 3800 BM Amersfoort, The Netherlands 4 Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands 5 Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands

6 Correspondence address. E-mail: m.l.haadsma{at}og.umcg.nl

BACKGROUND: The predictive value of ovarian reserve tests (ORTs) for spontaneous pregnancy is unclear. Our study aimed to determine whether ORTs have added value to previously identified prognostic factors for spontaneous pregnancy in subfertile ovulatory couples.

METHODS: A prospective cohort study was performed on 474 subfertile ovulatory couples in two hospitals in Groningen, The Netherlands. The ORTs performed were: antral follicle count (AFC), follicle-stimulating hormone (FSH), inhibin B (basal levels and after stimulation with clomiphene citrate) and the clomiphene citrate challenge test. For each couple, the probability of spontaneous pregnancy was retrospectively calculated using the validated Hunault prediction model which includes the main known prognostic factors for spontaneous pregnancy. Outcome measure was time to spontaneous pregnancy resulting in a live birth.

RESULTS: When added to the Hunault model, only basal FSH and AFC significantly improved the prediction of spontaneous pregnancy (P-values of 0.05 and 0.04). Absolute changes in predicted probabilities after adding basal FSH or AFC were small: the predicted probability of spontaneous pregnancy shifted ≥10% in only 3.8% and 7.9% of the couples, respectively.

CONCLUSIONS: Although basal FSH and AFC significantly improved the validated prediction model for spontaneous pregnancy, the clinical relevance of this finding is limited. We recommend that none of the ORTs studied should be used routinely in the subfertility evaluation of ovulatory couples to predict spontaneous pregnancy chances.

Key words: ovarian reserve test/spontaneous pregnancy/predictive value/prediction model/reproductive ageing

Submitted on December 21, 2007; resubmitted on May 16, 2008; accepted on May 23, 2008.


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