Differentiating clinical profiles: predicting good responders, poor responders, and hyperresponders.

Overview

OBJECTIVE: To describe the different clinical and laboratory diagnostic methods (basal and dynamic tests) available to identify poor-, good-, and high-responder patients undergoing treatment with in vitro fertilization (IVF). DESIGN: Analytical review. SETTING: IVF program. PATIENTS: Women in different age groups undergoing IVF treatment. INTERVENTION(S): Assessment of clinical and laboratory parameters and correlation with outcomes. MAIN OUTCOME MEASURE(S): Response to ovarian stimulation and success of the assisted reproductive technologies (ART). RESULT(S): Age, basal follicle-stimulating hormone (FSH), estradiol and inhibin-B levels, and dynamic testing serve to predict individual response to ovarian stimulation for ART. CONCLUSION(S): Markers of ovarian reserve (day 3 FSH, inhibin B and E(2)) are particularly predictive and useful in guiding the choice of the optimal protocol for ART. However, no tests are absolutely predictive of a successful outcome. For the younger individual, and for the patient at risk of developing ovarian hyperstimulation syndrome (OHSS), assessment and identification of clinical and laboratory parameters predictive of a high response to ovarian stimulation should guide the clinician in choosing an appropriate stimulation protocol, thus attenuating the risk of OHSS.