What will be response of ovaries to gonadotrophin stimulation??

There are many indices to prognosticate the outcome of IVF so far as retrieval oocytes are consented??  Method No 1: What is Bologna criteria??  Assessment of ovarian reserve  and response   has been   tried by several workers   Bologna criteria also   defines poor  responders as those with A)  age  more than 40 years   B) less than   three follicles per   ovary and C)  anti Mullerian   hormone  less than 0.5 -1.1   ng/mL   

. One of the  earliest  studies  by Ravhon et al  has   used  dynamic assessment of  inhibin B   and estradiol after  Buserelin acetate   as predictors   of ovarian   response    and have found  these to be highly  correlating   with the ovarian   response in IVF   patients  . The two    major drawbacks of this study  are that this  required several  blood tesis   at different times and the study sample  was pretty small .

There are many indices to prognosticate the outcome of IVF so far as retrieval oocytes are concerned ??   Method No 2:  Can we use 3D  ultrasound for assessment   of ovarian  response in IVF cycles?? Yes. Very much. For instance      In 2002   Kupesic  et al used 3D  ultrasound for assessment   of ovarian  response in IVF cycles. A) The antral   follicle   count    and  B) ovarian stromal flow   parameters        on the baseline  scan were shown   to be most   predictive of the ovarian  response   after pituitary  downregulation in this study   followed by total  ovarian   volume ovarian   stromal   areas and age. This   study could predict   favorable IVF   outcome   in 50%   of patients and poor   outcome in 85%    of patients   . Using  this nomogram for dose calculation was   evaluated by the same   group in another    study. The results  of this study   were  in absolute   favor of individualizing   dose according to the dosage   nomogram   proving   the reliability  of ultrasound   parameters and  age    and body  mass  index for decision   on stimulation  doses.

There are many indices to prognosticate the outcome of IVF so far as retrieval oocytes are concerned ??   Method No 2:  Can we use 3D  ultrasound for assessment   of ovarian  response in IVF cycles?? Yes. Very much. For instance      In 2002   Kupesic  et al used 3D  ultrasound for assessment   of ovarian  response in IVF cycles. A) The antral   follicle   count    and  B) ovarian stromal flow   parameters        on the baseline  scan were shown   to be most   predictive of the ovarian  response   after pituitary  downregulation in this study   followed by total  ovarian   volume ovarian   stromal   areas and age. This   study could predict   favorable IVF   outcome   in 50%   of patients and poor   outcome in 85%    of patients   . Using  this nomogram for dose calculation was   evaluated by the same   group in another    study. The results  of this study   were  in absolute   favor of individualizing   dose according to the dosage   nomogram   proving   the reliability  of ultrasound   parameters and  age    and body  mass  index for decision   on stimulation  doses.There are many indices to prognosticate the outcome of IVF so far as retrieval oocytes are concerned??   Method No 4 : Yet another predictive model for dose calculation  prognostication of IVF ??   Popovic Todorovic et al in 2003   combined age,   BMI,  cycle length  and smoking  status   and ultrasound   features of the ovaries   also to design    a dosage  nomogram of recombinant   follicle    stimulating hormone   for IVF/ intracytoplasmic   sperm injection   patients. This   was   a prospective study    and also had a larger   sample volume than the    previous   two studies   . According to this  study total number of   antral follicles   and ovarian stromal   blood  flow were the two most significant   predictors of ovarian response  and ovarian   volume   was highly     significant   predictor of number of   follicles   and oocytes   retrieved. La  Marca  et al have shown   that daily    FSH dose may be   calculated  on the basis  of age AFC and serum  FAH  levels  in a patient.

Another    landmark study   by Olivennes  and Howles  et al  - The CONSORT   study used  basal FSH    BMI  age and AFC for individualizing   FSH dose  for ovarian stimulation . A dose   calculator was developed  using these  factors  as predictors and    was evaluated   in a  prospective  clinical   trial .

The only study that worked  on the dose   calculations  for IUI patients  was by    Freiesleben NL et al in 2008   with 159   patients.  They  evaluated    age , spontaneous  cycle length, body     weight,    BMI    smoking   status total   ovarian  volume   AFC   total Doppler   score  of   ovarian stromal  blood flow  baseline FAH and  estradiol  as possible  predictive factors   of ovarian  response. This study   concluded  that body weight   and AFC    may be used      to achieve     appropriate    ovarian response  for IUI   in ovulatory patients  . Study     by the  same investigators for IVF   and ICSI  patients concluded that AFC   and age  could predict   the low  response    better  whereas  to predict  hyper response  AFC and   cycle   length were   better   parameters.