Ovarian reserve test with human menopausal gonadotropin as a predictor of in vitro fertilization outcome

Purpose: Our purpose was to determine prospectively, using receiver-operati ng characteristic (ROC) analysis, whether the ovarian reserve test with hMG could improve the predictive value of a woman's age and basal levels of fo llicle stimulating hormone (FSH), E-2, and inhibin or arty combination of t hem regarding ovarian response and pregnancy rate in IVF treatment followin g pituitary desensitization. Methods: The hMG test was performed within 3 months of IVF treatment in 80 women undergoing the first cycle of IVF and consisted of 2 ampoules of hMG daily for 5 days starting on cycle days 2 to 3. Hormone and ultrasound eval uation was performed on cycle days 2 to 3 and 7 to 8. Results: The mean age and basal FSH levels were significantly higher in the canceled (n = 28) than in the control (n = 52) group, whereas the basal in hibin level was significantly higher in the latter Regarding ovarian respon se, the combination FSH plus inhibin had the better diagnostic accuracy (pr edictive value of 70%) among basal variables. When post-hMG parameters (alo ne or in combination) were analyzed, E-2 alone,with a 77% diagnostic accura cy, emerged as the best predictive variable of cancellation in IVF cycles. When ROC analysis was used, the area under the ROC curve for E-2 post-hMG ( diagnostic accuracy of 84.5%) was significantly higher than that for the es timates based on the combination of basal FSH and inhibin (diagnostic accur acy of 71.3%). However woman's age was the only variable independently asso ciated with pregnancy rate. Conclusions: The predictive power of the hMG test of ovarian reserve is bet ter than that of age and basal hormone values (FSH and inhibin) and it is b ased mainly on the E-2 response to hMG treatment. However given that age is the only predictor of pregnancy and considering the cost and discomfort of the hMG test, the usefulness, if any, of the test in predicting IVF perfor mance in the daily clinical setting remains to be established.