Prestimulation parameters predicting live birth in anovulatory WHO Group II patients undergoing ovulation induction with gonadotrophins

BACKGROUND The objective of this study was to identify baseline predictors of live birth in anovulatory patients undergoing ovulation induction, and based on these predictors, develop nomograms for estimation of the probability of live birth in a single cycle. METHODS Univariate and multivariate log...

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Bibliographic Details
Published in:Human reproduction (Oxford) 2010-08, Vol.25 (8), p.1988-1995
Main Authors: Nyboe Andersen, A., Balen, A.H., Platteau, P., Pettersson, G., Arce, J.-C.
Format: Article
Language:English
Subjects:
Adult
anovulation
Anovulation - drug therapy
Biological and medical sciences
Birth Rate
Cohort Studies
Female
Follicle Stimulating Hormone - blood
gonadotrophin
Gonadotropins - therapeutic use
Gynecology. Andrology. Obstetrics
Humans
live birth
Medical sciences
nomogram
Original
Ovulation Induction
prediction model
Pregnancy
Pregnancy Rate
Regression Analysis
Retrospective Studies
Time Factors
World Health Organization
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Summary:BACKGROUND The objective of this study was to identify baseline predictors of live birth in anovulatory patients undergoing ovulation induction, and based on these predictors, develop nomograms for estimation of the probability of live birth in a single cycle. METHODS Univariate and multivariate logistic regression were used for retrospective analysis of clinical, sonographic and endocrinological parameters collected prior to the start of ovarian stimulation in a cohort of anovulatory World Health Organization (WHO) Group II patients (n = 335), who were resistant to clomiphene citrate (CC) and therefore stimulated with gonadotrophins using a low-dose step-up protocol. RESULTS The univariate analysis identified age [OR = 0.91 (95% CI: 0.84–0.98), P = 0.015], duration of infertility [OR = 0.71 (95% CI: 0.56–0.91), P = 0.007], serum follicle stimulating hormone (FSH) concentration at the start of stimulation [OR = 0.83 (95% CI: 0.69–0.99), P = 0.034] and menstrual cycle pattern (P = 0.022) as significant predictors of live birth. Baseline concentrations of luteinizing hormone, androgens, glucose and insulin, as well as body mass index, were not predictors of live birth. In the multivariate analysis, duration of infertility, FSH and menstrual cycle pattern were independent predictors, and nomograms were designed with these three parameters for individual prediction of the probability of live birth. CONCLUSIONS The chances of live birth in women with WHO Group II anovulatory infertility resistant to CC undergoing ovulation induction with gonadotrophins is highly influenced by the menstrual cycle pattern. Increases in duration of infertility and concentration of FSH (within the normal range) before the start of stimulation have negative influences on the likelihood of achieving a live birth.
ISSN:0268-1161
1460-2350
DOI:10.1093/humrep/deq142