Prognostic value of ovarian stimulation indices in patients of advanced reproductive age

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Abstract
Introduction. Achieving pregnancy and live birth in assisted reproductive technology (ART) programs in the cohort of women of advanced reproductive age represents a complex clinical challenge due to the implementation of irreversible processes of biological and ovarian aging. The development and introduction of additional integrative indicators of ovarian stimulation into clinical practice are of great importance for the objective assessment of reproductive potential and optimization of IVF protocols. Aim . To evaluate the indices FORT, FOI, and OSI as predictors of successful ART outcomes in patients of advanced reproductive age. Materials and methods . The study included 256 married couples with women aged 40–42 years who underwent infertility treatment using standard IVF programs. An analysis of the clinical and anamnestic characteristics of the patients included in the study was performed. To assess the prognostic significance of follicular output rate (FORT), follicle-to-oocyte index (FOI), and ovarian sensitivity index (OSI), ROC analysis was conducted. Results . According to the ROC analysis, none of the ovarian stimulation parameters demonstrated sufficient accuracy for practical application in predicting clinical pregnancy in women of advanced reproductive age. To determine the prognostic significance of the studied ovarian stimulation parameters for live birth, ROC analysis was also performed, which demonstrated high significance for the number of preovulatory follicles (AUC 0.73 (95% CI 0.62–0.85)) and the FORT index (AUC 0.84 (95% CI 0.72–0.96)). The remaining parameters did not show high value in predicting live birth. Conclusions. In the present study, a good prognostic value of the FORT index in predicting live birth was demonstrated, indicating potential applicability in clinical practice in the cohort of women of advanced reproductive age. Further studies on larger samples are required for the wider implementation of this index into clinical practice.

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