An application of Lacker's mathematical model for the prediction of ovarian response to superstimulation

Introduction. A mathematical model of ovarian follicular growth is applied to the problem of predicting ovarian response in a superstimulation protocol. Methods. Fifty-four women enrolled in an ovarian superstimulation program of therapy for the amelioration of idiopathic infertility had their ovarian cycles synchronized by taking Demulen 30 for two weeks prior to the study. Daily ultrasonographic imaging, measurements of serum estradiol and doses of hMG began on day 5 after the patients stopped taking Demulen. The diameters of individual follicles were measured and followed daily. When the largest follicle attained a diameter of 19 mm, hCG was given to induce ovulation. Individual follicle growth data were fit to a mathematical model of ovarian follicle maturation and the resulting parameters were used to classify patients into low and high ovarian response groups. Results. The parameters computed from the mathematical model fit were found to be predictive of ovarian response with a sensitivity of 71% and a specificity of 70%. The parameters were also meaningful within the context of the original mathematical model and have value for determining how doses of hMG may be adjusted during the course therapy to increase the ovarian response in individuals. Conclusion. Mathematical modeling of ultrasonographically derived follicular growth data has significant potential for clinical application in ovarian superstimulation protocols. The method of fitting follicular growth data to a mathematical follicle maturation surface furthermore provides a straightforward approach for the characterization of ovarian follicular dynamics in general.