Skip to main content
SpringerLink
Log in

Follicular sensitivity index (FSI): a novel tool to predict clinical pregnancy rate in IVF/ICSI cycles

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

This study aims to introduce a new tool (the Follicular Sensitivity Index; FSI) for objective assessment of follicular responsiveness to exogenous gonadotropins and to evaluate its ability to predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI.

Methods

FSI was calculated as preovulatory follicle count (PFC) × 100,000/[antral follicle count (AFC) × total received FSH doses]. One thousand women were included and were divided according to the FSI tertile values into three groups. The primary outcome was clinical pregnancy defined by the presence of an intrauterine gestational sac 5 weeks after embryo transfer.

Results

There was progressive increase in the clinical pregnancy rate from the low to the high FSI groups (0.27 ± 0.4 vs 0.4 ± 0.4 and 0.58 ± 0.4; p < 0.001). Receiver operator curves showed that FSI had a greater area under the curve than those of the AFC, PFC, and the FSH dose (0.638 vs 0.509, 0.538, and 0.589 respectively). Multivariate logistic regression analysis showed that the correlation between FSI and pregnancy was independent of potential confounding factors like age and body mass index (p < 0.001).

Conclusion

FSI can predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI using GnRH agonist protocol. Higher FSI values had significantly higher oocyte yield and fertilization and clinical pregnancy rates. Wider implications of these findings include the potential use of FSI to define absolute criteria of poor/good ovarian response in IVF/ICSI cycles, guide future IVF cycle management for the same couples, and guide cycle cancelation criteria for poor ovarian response.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Decleer W, Osmanagaoglu K, Meganck G, Devroey P. A new approach for ovarian stimulation in IVF using Corifollitropin alfa in combination with GnRH analogues to trigger final oocyte maturation. A pilot study. Facts Views Vis Obgyn. 2014;6:159–65.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Arce JC, Andersen AN, Fernández-sánchez M, Visnova H, Bosch E, García-Velasco JA, et al. Ovarian response to recombinant human follicle-stimulating hormone: a randomized, antimüllerian hormone-stratified, dose-response trial in women undergoing in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril. 2014;102:1633–40.e5.

    Article  CAS  PubMed  Google Scholar 

  3. Broer SL, Van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, et al. IMPORT study group. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update. 2013;19:26–36.

    Article  PubMed  Google Scholar 

  4. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685–718.

    Article  CAS  PubMed  Google Scholar 

  5. Gougeon A. Regulation of ovarian follicular development in primates: facts and hypotheses. Endocr Rev. 1996;17:121–55.

    Article  CAS  PubMed  Google Scholar 

  6. Gallot V, Berwanger da Silva AL, Genro V, Grynberg M, Frydman N, Fanchin R. Antral follicle responsiveness to follicle-stimulating hormone administration assessed by the follicular output rate (FORT) may predict in vitro fertilization-embryo transfer outcome. Hum Reprod. 2012;27:1066–72.

    Article  CAS  PubMed  Google Scholar 

  7. Genro VK, Grynberg M, Scheffer JB, Roux I, Frydman R, Fanchin R. Serum anti-Müllerian hormone levels are negatively related to follicular output rate (FORT) in normo-cycling women undergoing controlled ovarian hyperstimulation. Hum Reprod. 2011;26:671–7.

    Article  CAS  PubMed  Google Scholar 

  8. Biasoni V, Patriarca A, Dalmasso P, et al. Ovarian sensitivity index is strongly related to circulating AMH and may be used to predict ovarian response to exogenous gonadotropins in IVF. Reprod Biol Endocrinol. 2011;9:112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Zhang N, Hao CF, Zhuang LL, Liu XY, Gu HF, Liu S, et al. Prediction of IVF/ICSI outcome based on the follicular output rate. Reprod BioMed Online. 2013;27:147–53.

    Article  CAS  PubMed  Google Scholar 

  10. Hassan A, Kotb M, Awadallah A, Wahba A, Shehata N. Follicular output rate can predict clinical pregnancy in women with unexplained infertility undergoing IVF/ICSI: a prospective cohort study. Reprod BioMed Online. 2017; doi:10.1016/j.rbmo.2017.03.004.

  11. Li HW, Lee VC, Ho PC, Ng EH. Ovarian sensitivity index is a better measure of ovarian responsiveness to gonadotrophin stimulation than the number of oocytes during in-vitro fertilization treatment. J Assist Reprod Genet. 2014;31(2):199–203.

    Article  PubMed  Google Scholar 

  12. Huber M, Hadziosmanovic N, Berglund L, Holte J. Using the ovarian sensitivity index to define poor, normal, and high response after controlled ovarian hyperstimulation in the long gonadotropin-releasing hormone agonist protocol: suggestions for a new principle to solve an old problem. Fertil Steril. 2013;100(5):1270–6.

    Article  CAS  PubMed  Google Scholar 

  13. Rouzi AA, Ardawi MS. A randomized controlled trial of the efficacy of rosiglitazone and clomiphene citrate versus metformin and clomiphene citrate in women with clomiphene citrate-resistant polycystic ovary syndrome. Fertil Steril. 2006;85:428–35.

    Article  CAS  PubMed  Google Scholar 

  14. Cooper TG, Noonan E, Von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16:231–45.

    Article  PubMed  Google Scholar 

  15. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26:1616–24.

    Article  CAS  PubMed  Google Scholar 

  16. National Institute for Health and Care Excellence. Fertility: assessment and treatment for people with fertility problems. NICE CG55. London: National Institute for Health and Care Excellence; 2013.

    Google Scholar 

  17. Choe SA, Tae JC, Shin MY, Kim HJ, Kim CH, Lee JY, et al. Application of sperm selection using hyaluronic acid binding in intracytoplasmic sperm injection cycles: a sibling oocyte study. J Korean Med Sci. 2012;27:1569–73.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kotb MM, Hassan AM, Awadallah AM. Does dehydroepiandrosterone improve pregnancy rate in women undergoing IVF/ICSI with expected poor ovarian response according to the Bologna criteria? A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2016;200:11–5.

    Article  CAS  PubMed  Google Scholar 

  19. Kailasam C, Keay SD, Wilson P, Ford WC, Jenkins JM. Defining poor ovarian response during IVF cycles, in women aged <40 years, and its relationship with treatment outcome. Hum Reprod. 2004;19:1544–7.

    Article  CAS  PubMed  Google Scholar 

  20. La Marca A, Giulini S, Tirelli A, Bertucci E, Marsella T, Xella S, et al. Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Hum Reprod. 2007;22:766–71.

    Article  PubMed  Google Scholar 

  21. Nicopoullos JD, Abdalla H. Poor response cycles: when should we cancel? Comparison of outcome between egg collection, intrauterine insemination conversion, and follow-up cycles after abandonment. Fertil Steril. 2011;95:68–71.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Cairo University, 1 Alsaraya street AlKasr AlAiny, Cairo, Egypt

    AbdelGany M. A. Hassan, Mohamed M. M. Kotb & Amr Wahba

  2. Department of Gynecology and Obstetrics, Ain Shams University, Ramsis street, Abassiya, Cairo, Egypt

    Ahmed M. A. AwadAllah

  3. Department of Gynecology and Obstetrics, Beni Suef University, Beni Suef, Egypt

    Nesreen A. A. Shehata

Authors
  1. AbdelGany M. A. Hassan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed M. M. Kotb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed M. A. AwadAllah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nesreen A. A. Shehata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amr Wahba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to AbdelGany M. A. Hassan.

Ethics declarations

The study was approved by the research ethics committee of Cairo University.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hassan, A.M.A., Kotb, M.M.M., AwadAllah, A.M.A. et al. Follicular sensitivity index (FSI): a novel tool to predict clinical pregnancy rate in IVF/ICSI cycles. J Assist Reprod Genet 34, 1317–1324 (2017). https://doi.org/10.1007/s10815-017-0984-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-017-0984-5

Keywords

Search

Navigation