Expert opinion on refined and extended key performance indicators for individualized ovarian stimulation for assisted reproductive technology.

Objective: To assess the adequate ovarian follicular development and oocyte recovery between ovarian potential (antral follicle count [AFC]) before the start of ovarian stimulation (OS) and oocyte quantity and quality at oocyte retrieval. A holistic overview of the current key performance indicators (KPIs) was applied to identify the complementary strengths and identify where the current repertoire can be expanded.
Design: Expert opinion.
Setting: Not applicable.
Patient(s): Not applicable.
Intervention(s): None.
Main Outcome Measure(s): To formulate a proposal for a refined and expanded repertoire of KPIs for individualized OS for assisted reproductive technology.
Result(s): The performance and outcomes of OS on ovarian follicular development can be evaluated through the application of defined KPIs. Current KPIs for OS are the ovarian sensitivity index, follicular output rate (FORT), oocyte retrieval rate, and follicle-to-oocyte index (FOI). Notably, there are no specific KPIs dedicated to the assessment of follicular development (i.e., recruitment, selection, growth, and dominance). In light of this, we recommend expanding the current KPIs for OS to include "early FORT" (accounting for the number of follicles measuring ≥10 to 11 mm on day 5/6 of OS relative to AFC) and "modified FORT" (the ratio between the number of follicles measuring ≥12 mm at the time of oocyte maturation triggering and AFC); the extension of oocyte retrieval rate to include two discrete categories at oocyte retrieval-follicles measuring ≥12 mm and ≥16 mm-to ensure that all responsive follicles are accounted for; and FOI to be measured at oocyte maturation triggering and oocyte retrieval ("advanced FOI").
Conclusion(s): Once validated and adopted in clinical practice, we envisage that the proposed expanded KPIs measuring the effect of OS on follicular development (recruitment, selection, growth, and dominance) will increase the understanding of the relationship between ovarian reserve, measured by AFC, and oocyte quantity and quality at oocyte retrieval. This understanding will enable physicians to better evaluate the direct effect of different gonadotropins and doses on ovarian response, leading to a more personalized approach to OS in the context of assisted reproductive technology treatment.
Competing Interests: Declaration of Interests S.K.S. reports receipt of payment or honoraria for nonpromotional educational lectures from Merck, Ferring, and MSD. J.-E.S. is an employee of Merck Healthcare KGaA, Darmstadt, Germany. R.O. reports receipt of consulting fees from Merck and Ferring and payment or honoraria for lectures from Merck and Ferring. RF has received honoraria for lectures from Merck Healthcare KGaA, Medea and Event Planet. M.H.D. has nothing to disclose. S.C.E. has received unrestricted research grants from Merck KGaA and consulting fees from Merck, Medea, and Event Planet; payment or honoraria for lecture fees from Merck, Sanitanova, Medea, and Event Planet; has a patent on the ART calculator; and is an advisory board member for Nature Reviews Urology (unpaid), Head of the Andrology Committee of the Brazilian Society of Human Reproduction (unpaid), and Co-chair of the Male Infertility Group, WHO Infertility Guidelines (unpaid). M.L. is an employee of Merck Healthcare KGaA, Darmstadt, Germany. T.D. is an employee of Merck Healthcare KGaA, Darmstadt, Germany. C.A. declares receipt of personal fees from Merck, Medea, Event Planet, IBSA, Ely Lilly, and Biogen and payment or honoraria from Merck, Medea, Event Planet, IBSA, and Ferring.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)