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Can’t the computer just take care of all of this?
Published in Thomas A. Gerds, Michael W. Kattan, Medical Risk Prediction, 2021
Thomas A. Gerds, Michael W. Kattan
The left panel of Figure 8.12 illustrates the model with its input layer (age, antral follicle count), a hidden layer with 5 neurons, and an outcome layer (ovarian hyperstimulation syndrome). The right panel of Figure 8.12 shows the predicted risk of ovarian hyperstimulation syndrome that individual patients would receive from this model. From a biological perspective, it makes sense to assume that increasing antral follicle count increases the risk of OHSS. However, for any given age, the change of risk shown in the right panel of Figure 8.12 is dropping to almost zero in between moderate/high-risk areas (indicated by the narrow white stripe). It seems that this reflects overfitting. The problem is not simply that an artificial neural network is prone to overfitting, but rather that this overfitting can be difficult to detect, i.e., when the predictor variable space is high dimensional and not 2-dimensional as in our example. Also, it may very well happen that an overfitting neural network (or other machine learning method) scores the best prediction performance on average (IPA, AUC) with a model that is biologically implausible.
Ultrasound Features of Ovarian Hyperstimulation Syndrome
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Arianna D'Angelo, Rudaina Hassan, Nazar N. Amso
A high antral follicle count (AFC) has been reported to be associated with an increased risk of developing OHSS. The cut-off for AFC used to predict OHSS varies within studies depending on the definition of antral follicle and operator technique used in follicle counting the AFC. Various studies have found that if the AFC is found to be greater than 14, there is an increased risk of OHSS.
The Use of Ovarian Markers
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
Neena Malhotra, Siladitya Bhattacharya
Ultrasonographic assessments include antral follicle count (AFC) and ovarian volume. The number of antral follicles reflects the size of the remaining follicular pool and correlates with the number of oocytes retrieved following stimulation. Ovarian volume declines with advancing age and is a potential indicator of ovarian reserve.
Diagnostic value of anti-Müllerian hormone combined with androgen-levels in Chinese patients with polycystic ovary syndrome
Published in Gynecological Endocrinology, 2023
Lingling Jiang, Xiangyan Ruan, Yanqiu Li, Muqing Gu, Jiaojiao Cheng, Yuejiao Wang, Yu Yang, Che Xu, Zhikun Wang, Lili Liu, Alfred O. Mueck
Age, height, body mass, body mass index (BMI), waist circumference, hip circumference, systolic blood pressure, and diastolic blood pressure were collected. Blood samples were collected on the second to third day of the menstrual cycle, and in amenorrheic cases, blood was drawn when no follicles ≥10 mm in diameter were seen on ultrasound, and blood was collected from the brachial vein between 8:00 to 10:00 am after 12 h of fasting. The antral follicle count was determined using transvaginal ultrasound. In amenorrheic cases, we measure progesterone and human chorionic gonadotropin to exclude possible ovulation or pregnancy. Serum anti-müllerian hormone was determined by the Elecsys AMH Plus immunoassay (Roche Diagnostics International Ltd, Rotkreuz, Switzerland). The levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), progesterone (P), thyroid stimulating hormone (TSH), cortisol (F) were determined by ADVIA Centaur XP automatic chemiluminescence immunoassay produced by Siemens Company in Germany. Total testosterone (T), free testosterone (FT) (calculated), sex hormone binding globulin (SHBG) (calculated on website http://www.issam.ch/freetesto.htm), bioavailable testosterone (BIOT) (calculated),17-hydroxyprogesterone (17-OHP), and dehydroepiandrosterone sulfate (DHEAS), androstenedione (A2), were determined by liquid chromatography-mass spectrometry tandem method (LC-MS/MS), which were performed using an AB Sciex 5500 mass spectrometer coupled with a Shimadzu Nexera X2 high-performance liquid chromatography (HPLC) system[22].
Which is more predictive ovarian sensitivity marker if there is discordance between serum anti-Müllerian hormone levels and antral follicle count? A retrospective analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Kiper Aslan, Isil Kasapoglu, Cihan Cakir, Meltem Koc, Murat Deniz Celenk, Baris Ata, Berrin Avci, Gurkan Uncu
Female age, serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) are commonly used to assess ovarian reserve and predict response to ovarian stimulation (Ferraretti et al. 2011). Antral follicle count is the total count of 2–9 mm follicles in both ovaries measured by transvaginal ultrasound and reflects ovarian reserve (Chang et al. 1998; Broekmans et al. 2010). It is widely known that AFC has a good predictive value for IVF cycle outcomes like; ovarian response, number of retrieved oocytes (Chang et al. 1998; Hsu et al. 2011; Tsakos et al. 2014). Similar to AFC, AMH also has a good predictive value for ovarian response. AMH is produced by granulosa cells from pre-antral and antral follicles and inhibits follicular burn-out (Weenen et al. 2004). As it reflects the ovarian follicular pool, a decreasing number of follicles reduces serum AMH. Anti-Müllerian hormone and AFC are both positively correlated with ovarian reserve, and they are expected to be concordant with each other. Nevertheless, some women present with discordant AMH and AFC results, e.g. low AMH with a normal AFC or vice versa. Such discordance presents a challenge in predicting ovarian response and chances of success with an ART cycle. Limited evidence is available with regard to individual accuracy of AMH and AFC in predicting ovarian response in the presence of discordant results.
Dual trigger with the combination of gonadotropin-releasing hormone agonist and standard dose of human chorionic gonadotropin improves in vitro fertilisation outcomes in poor ovarian responders
Published in Journal of Obstetrics and Gynaecology, 2022
Ilknur Mutlu, Erhan Demirdag, Funda Cevher, Ahmet Erdem, Mehmet Erdem
Antral follicle count (AFC) measurements were carried out on the 3rd day of the cycle. GnRH antagonist protocol was used for all poor-responder patients. The stimulation protocol in both groups included exogenous gonadotropins to a maximum of 375 units in the form of recombinant FSH (Gonal-F, Merck Serono, Turkey) in combination with hMG (Menogon, Ferring, Turkey). Follicular growth monitorization and gonadotropin dose adjustments were performed with serial transvaginal ultrasound and serum E2 measurements to determine the ovarian response to the gonadotropin stimulation. All the sonographic exams were conducted by the Voluson 730 Pro machine (GE Healthcare Austria GmbH & Co OG). 0.25 mg/day subcutaneous cetrorelix (Cetrotide; Asta Medica, Frankfurt, Germany) was started when the leading follicle ≥13 mm or E2 > 300 pg/mL and was continued until the day of ovulation trigger. When at least two follicles were 17 mm or more in mean diameter, final oocyte maturation was triggered by 250 mcg of recombinant hCG (choriogonadotropin alfa) (Ovitrelle, Merck Serono, Turkey) alone in the control (hCG trigger) group or by 250 mcg of recombinant hCG (choriogonadotropin alfa) (Ovitrelle, Merck Serono, Turkey) plus 0.2 mg of triptorelin (Decapepty, Ferring, Turkey) in the study (dual trigger) group. None of the patients were given adjuvant treatments.