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Hum. Reprod. Advance Access originally published online on March 3, 2006
Human Reproduction 2006 21(7):1816-1823; doi:10.1093/humrep/del042
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© The Author 2006. 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

Value of ovarian reserve testing before IVF: a clinical decision analysis

Ben W. Mol 1 , 2 , 3 , 4 , 9 , Tamara E.M. Verhagen 5 , Dave J. Hendriks 6 , John A. Collins 7 , 8 , Arri Coomarasamy 3 , Brent C. Opmeer 4 and Frank J. Broekmans 6

1 Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Academic Medical Center, Amsterdam 2 Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands 3 Department of Obstetrics and Gynaecology, Birmingham Women’s Hospital, Birmingham, UK 4 Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam 5 Department of Obstetrics and Gynecology, Academic Hospital Maastricht, Maastricht 6 Department of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands 7 Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario 8 Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada

9 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Academic Medical Center, P.O.Box 22660, 1100 DD Amsterdam, The Netherlands. E-mail: b.mol1{at}chello.nl

BACKGROUND: To assess the value of testing for ovarian reserve prior to a first cycle IVF incorporating patient and doctor valuation of mismatches between test results and treatment outcome. METHODS: A decision model was developed for couples who were considering participation in an IVF programme. Three strategies were evaluated: (I) withholding IVF without prior testing, (II) testing for ovarian reserve, and then deciding on IVF treatment if ovarian reserve was estimated to be sufficient, and (III) treatment with IVF without prior ovarian reserve testing. The outcome considered was the birth of a child. The valuation of the combination of the strategy conducted and the outcome accomplished was expressed on a distress scale in units of ‘IVF cycles that were performed in vain’. Correct treatment with IVF and correct withholding of IVF were considered to bring no distress. The distress of withholding IVF in case pregnancy occurred is consequently specified by the ratio of the expected distress after incorrect withholding IVF to the expected distress after incorrect performing IVF (distress ratio). We interviewed both patients and doctors to determine realistic estimates for this distress ratio. RESULTS: The value of testing for ovarian reserve depends strongly on the expected pregnancy rate after IVF as well as on the valuation of the incorrect decisions from testing. For realistic ranges of the success rate after IVF and for distress ranges as were measured, treatment of all couples without testing was found to generate less distress than testing for ovarian reserve. The sensitivity and specificity of testing for ovarian reserve has to improve to 50 and 96% respectively, to make testing a valuable strategy. CONCLUSION: Based on the decision analysis, where current test accuracy and preference inventory among patients and physicians were used, testing for ovarian reserve seems not useful for current IVF programmes.

Key words: artificial reproductive treatment/decision analysis/ovarian reserve testing


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