Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 17 , ISSUE 4 ( October-December, 2023 ) > List of Articles


Baseline Scoring System: A Novel Way to Design Safe Ovulation Induction Protocols

Chaitanya Nagori, Sonal Panchal

Keywords : Antral follicle count, Baseline scoring, Gonadotropin dose, Ovarian stromal flow

Citation Information : Nagori C, Panchal S. Baseline Scoring System: A Novel Way to Design Safe Ovulation Induction Protocols. Donald School J Ultrasound Obstet Gynecol 2023; 17 (4):282-289.

DOI: 10.5005/jp-journals-10009-2000

License: CC BY-NC 4.0

Published Online: 28-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Success of any assisted reproductive technology is chiefly dependent on two decisions—selection of correct stimulation protocol, and this needs to be tailor-designed for every patient ideally. Selection of correct stimulation protocol is based on prestimulation assessment of female to assess ovarian response and reserve. This is done by baseline ultrasound scan on 2nd–3rd day of menstrual cycle. Reserve relates to antral follicle count (AFC) or ultimate yield of follicles/ova at the end of stimulation, and this can be decided by AFC and ovarian volume, whereas response relates to sensitivity of ovary to ovulation stimulating agents to produce those follicles and this relates to ovarian stromal blood flow [resistance index (RI) and peak systolic velocity (PSV)]. Adding age and body mass index (BMI) to these parameters, a baseline scoring system has been developed that has been proven to be a safe and efficient way to decide stimulation protocols.

  1. Hull MGR. Polycystic ovarian disease: clinical aspects and prevalence. Res Clin Forums 1989;11:21–34.
  2. ER te Velde. Advances in fertility studies and reproductive medicine IFFS 2007;306
  3. Panchal S, Nagori CB. Comparison of anti-mullerian hormone and antral follicle count for assessment of ovarian reserve. J Hum Reprod Sci 2012;5(3):274–278. DOI: 10.4103/0974-1208.106340
  4. Järvelä IY, Sladkevicius P, Kelly S, et al. Quantification of ovarian power Dopppler signal with three-dimensional ultrasonography to predict response during in vitro fertilization. Obstet Gynecol 2003;102(4):816–822. PMID: 14551013.
  5. Haadsma ML, Bukman A, Groen H, et al. The number of small antral follicles (2–6 mm) determines the outcome of endocrine ovarian reserve tests in a subfertile population. Hum Reprod 2007;22(7):1925–1931. DOI: 10.1093/humrep/dem081
  6. Wahd SA, Alalaf SK, Al-Shawaf T, et al. Ovarian reserve markers and assisted reproductive technique (ART) outcomes in women with advanced endometriosis. Reprod Biol Endocrinol 2014;12:120. DOI: 10.1186/1477-7827-12-120
  7. Zaidi J, Barber J, Kyei-Mensah A, et al. Relationship of ovarian stromal blood flow at baseline ultrasound to subsequent follicular response in an in vitro fertilization program. Obstet Gynecol 1996;88(5):779–784. DOI: 10.1016/0029-7844(96)00316-X
  8. Engmann L, Saldkevicius P, Agrawal R, et al. Value of ovarian stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and outcome of in vitro fertilization treatment. Fertil Steril 1999;71(1):22–29. DOI: 10.1016/s0015-0282(98)00406-3
  9. Kupesic S, Kurjak A. Predictors of IVF outcome by three-dimensional ultrasound. Hum Reprod 2002;17(4):950–955. DOI: 10.1093/humrep/17.4.950
  10. Arora A, Gainder S, Dhaliwal L, et al. Clinical significance of ovarian stromal blood flow in assessment of ovarian response in stimulated cycle for in vitro fertilization. Int J Reprod Contracept Obstet Gynecol 2015;4(5):1380–1383. DOI: 10.18203/2320-1770.ijrcog20150715
  11. Nagori C. Baseline scan and ultrasound diagnosis of PCOS. Donald School J Ultrasound Obstet Gynecol 2012;6(3):290–299. DOI: 10.5005/jp-journals-10009-1252
  12. Freiesleben NL, Lossl K, Bogstad J, et al. Predictors of ovarian response in intrauterine insemination patients and development of a dosage nomogram. Reprod Biomed Online 2008;17(5):632–641. DOI: 10.1016/s1472-6483(10)60310-0
  13. Olivennes F, Howles CM, Borini A, et al. Individualizing FSH dose for assisted reproduction using a novel algorithm: the CONSORT study. Reprod Biomed Online 2009;18(2):195–204. DOI: 10.1016/s1472-6483(10)60256-8
  14. Ng EH, Tang OS, Chan CC, et al. Ovarian stromal blood flow in the prediction of ovarian response during in vitro fertilization treatment. Hum Reprod 2005;20(1):3147–3151. DOI: 10.1093/humrep/dei166
  15. Panchal S, Nagori C. Ultrasound based decision making on stimulation protocol for superovulated IUI cycles. IJIFM 2016;7(1):7–13. DOI: 10.5005/jp-journals-10016-1119
  16. Ravhon A, Lavery S, Michael S, et al. Dynamic assays of inhibin B and oestradiol following Buserelin acetate administration as predictors of ovarian response in IVF. Hum Reprod 2000;15(11):2297–2301. DOI: 10.1093/humrep/15.11.2297
  17. Popovic-Todorovic B, Loft A, Lindhard A, et al. A prospective study of predictive factors of ovarian response in ‘standard’ IVF/ICSI patients treated with recombinant FSH. A suggestion for recombinant FSH dosage normogram. Hum Reprod 2003;18(4):781–787. DOI: 10.1093/humrep/deg181
  18. Merce LT, Barco MJ, Bau S, et al. Prediction of ovarian response and IVF/ICSI outcome by three dimensional ultrasonography and power Doppler angiography. Eur J Obstet Gynecol Reprod Biol 2007;132(1):93–100. DOI: 10.1016/j.ejogrb.2006.07.051
  19. Ng EHY, Yeung WSB, Fong DYT, et al. Effects of age on hormonal and ultrasound markers of ovarian reserve in Chinese women with proven fertility. Hum Reprod 2003;18(10):2169–2174. DOI: 10.1093/humrep/deg404
  20. Scheffer GJ, Broekmans FJ, Dorland M, et al. Antral follicle counts by TVS are related to age in women with proven natural fertility. Fertil Steril 1999;72(5):845–851. DOI: 10.1016/s0015-0282(99)00396-9
  21. Lam PM, Johnson IR, Rainne-Fenning NJ. Three dimensional ultrasound features of the polycystic ovary and the effect of different phenotypic expressions on these parameters. Hum Reprod 2007;22(12):3116–3123. DOI: 10.1093/humrep/dem218
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