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Introduction: This systematic review examines whether individualized gonadotropin dosing in in vitro fertilization (IVF) leads to better outcomes with respect to safety, costs, and live birth rates compared with standard dosing., Material and Methods: Electronic databases searched were PubMed, Embase, and Cochrane. The primary outcome was live birth rate. The secondary outcomes included pregnancy rate, costs, and safety. Papers were critically appraised by two reviewers., Results: A total of 7022 articles were retrieved and assessed for eligibility, of which seven randomized controlled trials were selected. All studies used gonadotropin-releasing hormone agonist co-treatment. Clinical and methodological heterogeneity was present, so data could not be pooled for meta-analysis. Only one study, that mainly included women with a good prognosis, revealed an increased chance of ongoing pregnancy in the individualized dosing group compared with standard treatment. With respect to safety, individualized dosing might reduce the occurrence of hyper-response and ovarian hyperstimulation syndrome, without affecting the outcome of pregnancy. In predicted poor responders, higher than standard dosages do not reduce the incidence of poor response. A cost-efficacy analysis was not performed in any of the studies included., Conclusion: It is currently not possible to conclude whether individualized dosing leads to higher pregnancy or live birth rates compared with standard dosing, because evidence from well-designed studies that are adequately powered for one of these outcomes is lacking. So, large well-designed studies that evaluate the impact of individualized dosing on live birth rates are needed to assess whether individualized dosing should become the standard in IVF practice., (© 2016 Nordic Federation of Societies of Obstetrics and Gynecology.)

Study Question: What is the added value of anti-Müllerian hormone (AMH) on top of patient characteristics for predicting the risk to enter menopause within 10 years?, Summary Answer: For women who did enter menopause, the risk of entering menopause within 10 years assigned by the model with AMH was on average 3% higher than that assigned by the model without AMH, and in the subgroup of young women with regular cycles, this increase was 14%., What Is Known Already: Prediction of age at menopause may be useful in predicting the end of female fertility. AMH may be useful for this, but the current evidence is based on small studies or specific subgroups, and does not take into account predictors other than age., Study Design, Size, Duration: This was a retrospective cohort study among 1163 premenopausal women participating in the second follow-up round of the Doetinchem Cohort Study with follow-up assessments of menopausal status and age after 5 and 10 years of follow-up., Participants/materials, Setting, Methods: This study included premenopausal women from the general population with a mean age of 41 (SD 7) years. A Cox proportional hazards' model without AMH was fitted using variables selected based on Akaike's information criterion. Performance of the prediction rule was assessed with C-statistics and compared with a model additionally including AMH and to a model with age only. The added value of AMH was assessed with Net Reclassification Index and change in absolute predicted risk. Performance of these three models was compared in subgroups based on age and reproductive characteristics., Main Results and the Role of Chance: The final model included age, BMI, packyears of smoking and menstrual cycle status (regular, irregular, pregnant or taking oral contraceptives). This model had a C-statistic of 0.89 (0.01 SD), compared with 0.88 (0.01 SD) for the model including age only. Addition of AMH increased it to 0.91 (0.03 SD). In a subgroup of 25-43 year olds with regular menstrual cycles, the model with age only had a C-statistic of 0.79 (0.04 SD) and for the models without and with AMH the C-stastic was 0.79 (0.04 SD) and 0.87 (0.03 SD), respectively. The risk of entering menopause within 10 years assigned by the model with AMH was on average 3% higher than that assigned by the model without AMH, for women who did enter menopause. In the subgroup of young women with regular cycles, this increase was 14%., Limitations, Reasons for Caution: Longer follow-up would have resulted in more of the young women becoming menopausal, improving the precision of the predictions for these women., Wider Implications of the Findings: This study clearly shows the added value of AMH in predicting time to menopause on top of clinical predictors, in particular for younger women. New studies in specific target populations in clinical practice are needed to develop a prediction model for use in that target population., Study Funding/competing Interests: The Doetinchem Cohort Study is carried out by the National Institute for Public Health and the Environment which works under the authority of the Ministry of Health, Welfare and Sport of The Netherlands. F.J.M.B. declares to have received fees and grant support from the following companies (in alphabetical order); Ferring, Gedeon Richter, Merck Serono, MSD and Roche. The remaining authors declare no conflict of interest., (© The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: To investigate the role of serum antimüllerian hormone (AMH) as a predictor of live birth and reproductive stage in subfertile women with elevated basal FSH levels., Design: A prospective observational cohort study conducted between February 2005 and June 2009., Setting: Tertiary fertility center., Patient(s): Subfertile women with [1] a regular menstrual cycle (mean cycle length 25-35 days); [2] basal FSH concentrations ≥12.3 IU/L; and [3] younger than 40 years (n = 96)., Intervention(s): None., Main Outcome Measure(s): Live birth and reproductive stage according to the Stages of Reproductive Aging Workshop., Result(s): A cumulative live birth rate of 63.5% was observed during a median follow-up of 3.3 years (n = 85). The AMH level was significantly associated with live birth. There was evidence of a nonlinear prediction pattern, with an increase in chances of live birth until an AMH level of 1 μg/L. Other ovarian reserve tests and chronological age appeared of limited value in predicting live birth. In addition, AMH was significantly associated with the timing of reproductive stages (n = 68) (i.e., the occurrence of menopausal transition or menopause during follow-up)., Conclusion(s): The present findings suggest applicability of AMH determination as a marker for actual fertility in subfertile women with elevated basal FSH levels., (Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)