Clinical value of transvaginal three-dimensional ultrasound combined with anti-Müllerian hormone in assessment of ovarian reserve function

Abstract

Objective To assess the value of transvaginal three-dimensional (3D) ultrasound combined with anti-Mullerian hormone (AMH) in the assessment of ovarian reserve function. Methods One hundred and twenty-one women who were ready for pregnancy were selected, all of whom underwent transvaginal 3D ultrasound on the third day of menstruation. The data of antral follicle count (AFC), ovarian volume (OV), and peak systolic velocity of the ovarian stromal artery (PSV) were collected by sonography-based automated volume calculation (Sono AVC). The levels of basic sex hormone and AMH, which are related to ovarian reserve function, were also detected. According to the level of basic sex hormone, the patients were divided into either group A (having a normal level of basic sex hormone) or group B (having an abnormal level of basic sex hormone). The two groups were further divided into two subgroups based on the age: <40 yrs (subgroups A1 and B1) and ≥40 yrs (subgroups A2 and B2). The data of ultrasound, AMH, and pregnancy outcome among the subgroups were compared. The correlations among AFC, OV, and ovarian stromal artery PSV as well as their correlation with AMH were also analyzed. According to the pregnancy outcome, all the pregnant women were divided into a good pregnancy outcome group and a poor pregnancy outcome group, and the differences in the above ultrasound measurements and AMH between the two groups were compared. Results The four subgroups of women showed a statistical difference in AFC, OV, and AMH (F=12.572, 5.862, and 15.194, respectively; P≤0.001 for all). The AFC, OV, and AMH in subgroup A1 were significantly higher than the those in subgroups B1 and B2 (P<0.05). The AFC was significantly higher in subgroup A1 than in subgroup A2 (P<0.05), in subgroup A2 than in subgroup B2 (P<0.05), and in subgroup B1 than in subgroup B2 (P<0.05). There was a positive correlation between AFC and OV, between AFC and AMH, and between OV and AMH (r=0.488, 0.498, and 0.462, respectively; P<0.001 for all). Subgroup A1 had the highest pregnancy rate [22/51 (43.14%)] and lowest poor pregnancy outcome [5/22 (22.73%)]. Subgroup B2 had the lowest pregnancy rate [1/17 (5.88%)] and a poor pregnancy outcome. The AFC, OV, and AMH in the good pregnancy outcome group were significantly higher than those in the poor pregnancy outcome group (t=2.079, 2.885, and 2.164, respectively; P<0.05 for all). Conclusion Transvaginal 3D ultrasound-based AVC can obtain AFC and OV easily and precisely. Combined with AMH, transvaginal 3D ultrasound can provide objective, precise, and reliable data for ovarian reserve function assessment and pregnancy outcome prediction. Key words: Ultrasonography; Volume calculation; Ovarian; Anti-Mullerian hormone; Sex hormone