International Journal of Infertility & Fetal Medicine

Register      Login

VOLUME 5 , ISSUE 2 ( May-August, 2014 ) > List of Articles


Fertility Scoring Index: Cimar's Novel System to Predict assisted Reproductive Technology Success

Rochelle Heroina Gracias, Louis Fessy Thalakottoor, Parasuram Gopinath, Gopinathan Kannoly Karunakaran

Citation Information : Gracias RH, Thalakottoor LF, Gopinath P, Karunakaran GK. Fertility Scoring Index: Cimar's Novel System to Predict assisted Reproductive Technology Success. Int J Infertil Fetal Med 2014; 5 (2):44-57.

DOI: 10.5005/jp-journals-10016-1081

License: CC BY-NC 4.0

Published Online: 01-12-2016

Copyright Statement:  Copyright © 2014; The Author(s).



About 15% of all couples are infertile and require fertility treatment. With constantly improving clinical and laboratory procedures, pregnancy rates of about 30% per transfer are routinely reported. In non-donor-oocyte cycles, the percentage of in vitro fertilization/intracytoplasmic sperm injection (IVF/ ICSI) cycles that result in pregnancy ranges from 18 to 45%, depending on several factors (Society for Assisted Reproductive Technology 2009). But a patients concern is about the success rate—‘What is my chance of getting pregnant’? For the success in IVF/ICSI—embryo transfer cycle there are many variables thought to be directly related to the implantation and successful outcome.

Aims and objectives

To identify independent predictors ICSI outcome.

To make a composite predictive scoring system—

For patient selection and counseling for assisted reproductive technology (ART).

That may prove critical in counseling poor prognosis patients, about their prognosis or against IVF treatment (e.g. patients with least benefits in undergoing IVF can opt for donor oocytes/surrogacy, etc. without wasting a cycle in trial and error).

Optimizing treatment by developing more customized individually tailored treatment plan with consideration to predictive factors.

Study design

The research was approved by the institutional review board. A retrospective ongoing study was performed, over a period of 3 years at a well established infertility institution. A sample size of 1020 patients was considered from two hospitals of the same institution. The patients were stimulated by different protocols specific to each patients age, AFC, etc [Polycystic ovarian syndrome (PCOS) patients showing hyperresponse in follicular study-antagonist protocol]; though a majority underwent long agonist protocol. They were evaluated and the outcome was assessed through logistic regression analysis. Several variables were taken into consideration—to name a few; age, previous pregnancy outcome, previous ART treatment if any, E2/LH/P4 [baseline values and on the day of human chorionic gonadotropin (hCG)], etc. A preferential scoring was derived to obtain a predictive scoring for pregnancy outcome.


A pregnancy predicting scoring was arrived at. On considering several variables, the cut off score represented a 50% success rate of IVF/ICSI cycle.


Bearing in mind that fertility is independent of hospital protocols and primarily dependent on the individual woman, the derived predictive scoring can be applied to individual cohort of patients under infertility treatment and has excellent discrimination ability for assessing the likelihood of pregnancy outcome. Application of this scoring will allow individualized treatment decision-making for patients under infertility treatment.

How to cite this article

Gracias RH, Thalakottoor LF, Gopinath P, Karunakaran GK. Fertility Scoring Index: Cimar's Novel System to Predict Assisted Reproductive Technology Success. Int J Infertil Fetal Med 2014;5(2):44-57.

PDF Share
  1. Infertility—epidemiology and referral practice. Hum Reprod 1991;6(10):1391-1394.
  2. IVF monitoring worldwide (ICMART). 22nd Annual Meeting of the ESHRE, Prague, Czech Republic, 18-21 June 2006, Abstract 0-193.
  3. Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE. Hum Reprod 2007;22(6):1513-1525.
  4. Prognostic assessment of ovarian reserve. Fertile Steril 1995 Jan;63(1):1-11.
  5. The role of ovarian volume in reproductive medicine. Hum Reprod Update 1999 May-June;5(3):256-266.
  6. Ovarian volume may predict assisted reproductive outcomes better than follicle stimulating hormone concentration on day Hum Reprod 1999 Jul:14(7):1752-1756.
  7. Antral follicle count and FSH concentration after clomiphene citrate challenge test on the prediction of ovarian response during OVF treatments. Hum Reprod 2005 Jun;20(6):1647-1654.
  8. Predictors of IVF outcome by threedimensional ultrasound. Hum Reprod 2002 Apr;17(4):950-955.
  9. Value of ovarian stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and the outcome of in vitro fertilization treatment. Fertil Steril 1999 Jan;71(1):22-29.
  10. Basal follicle-stimulating hormone levels are of limited value in predicting ongoing pregnancy rates after in vitro fertilization. Fertile Steril 2000 mar;73(3):552-557.
  11. Low day 3 luteinizing hormone values are predictive of reduced response to ovarian stimulation. Hum Reprod 1998 Mar;13(3):531-534.
  12. Dynamic assays of inhibin B, anti-mullerian hormone and estradiol following FSH stimulation and ovarian ultrasonography as predictors of IVF outcome. Hum Reprod 2005 Nov;20(11):3178-3183.
  13. Fertil Steril 2000 Sep;74(3):508-516.
  14. Evaluation of basal estradiol levels in assisted reproductive technology cycles. Fertil Steril 2000 Sep;74(3):518-524.
  15. Effect of smoking on ovarian reserve and ovarian stimulation in in vitro fertilization and embryo transfer. Hum Reprod 1998 Aug;13(8):2192-2198.
  16. Morphological and cytogenetic analysis of human giant oocytes and giant embryos. Hum Reprod 2002;17:2394-2401.
  17. The significance of the number of antral follicles prior to stimulation in predicting ovarian responses in an IVF programme. Hum Reprod 2000 Sep;15(9):1937-1942.
  18. In vitro fertilisation treatment and factors affecting success. Best Prac and Res Clin Obstet and Gynaecol 2012;26:777-788.
  19. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update 2006;12(6):685-718.
  20. An analysis of the effect of age on implantation rates. J Assist Reprod Genet 2000; 17(6):303-306.
  21. Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes. Fertil Steril 2007;87(1):74-76.
  22. A prospective randomized clinical trial comparing an individual dose of recombinant FSH based on predictive factors vs a standard dose of 150 IU/day in standard patients undergoing IVF/ICSI treatment. Hum Reprod. Hum Reprod 2003;18(11):2275-2282.
  23. Taking a basal follicle stimulating hormone history is essential before initiating in vitro fertilization. Fertil Steril 2005;83(1):37-41.
  24. Female infertility, in clinical gynaecologic endocrinology and infertility. Speroff L, Fritz MA, editors. p. 1015-1022. Lippincott Williams and Wilkins, Philadelphia, Pa, USA. 7th ed, 2005.
  25. Evaluation of basal estradiol levels in assisted reproductive technology cycles. Fertility and Sterility 2000;74(3):518-524.
  26. early follicular anti mullerian hormone as an indicator of ovarian reserve. Fertility Sterility 2006;85(3):592-596.
  27. Day 3 estradiol serum concentrations as prognosticators of ovarian stimulation response and pregnancy outcome in patients undergoing in vitro fertilization. Fertility and Sterility 1995;64(5):991-994.
  28. Prognostic value of day 3 estradiol on in vitro fertilization outcome. Fertility and Sterility 1995;64(6):1136-1140.
  29. Use of ovarian reserve markers and variables of response to gonadotropic stimulus as predictors of embryo implantation in ICSI cycles. Journal Brasileiro de Reproducao Assistida 2009;13(3):26-29.
  30. Predictors of poor ovarian response in invitro fertilization: a prospective study comparing basal markers of ovarian reserve. Fertility and Sterility 2002;77(2): 328-336.
  31. The accuracy of multivariate models predicting ovarian reserve and pregnancy after in vitro fertilization: a metaanalysis. Human Reproduction Update 2008;14(1):95-100.
  32. ultrasound tests of ovarian reserve; a systematic review of accuracy in predicting fertility outcomes. Human Fertility 2009;12(2):95-106.
  33. Antral follicle count, anti-Mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology. Int j Obstet Gynaecol 2005;112(10):1384-1390.
  34. Anti-Mullerian hormone: correlation of early follicular. Ovulatory and mid luteal levels with ovarian response and cycle outcome in intracytoplasmin sperm injection patients. Fertility and Sterility 2008;89(6):1670-1676.
  35. Antral follicle count is a significant predictor of live birth in in vitro fertilization cycles. Fertility and Sterility 2009;91(4):1595-1597.
  36. Predictive value of the results of a first in vitro fertilization cycle on the outcome of subsequent cycles. Hum Reprod 1998;13(2):403-408.
  37. National Centre for Chronic Disease Prevention and Health Promotion.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.