Comparison between antral follicle count and anti-Müllerian hormonal level in the prediction of ovarian response and pregnancy outcome in intracytoplasmic sperm injection patients: implications in personalizing ovarian stimulation

Abstract

Antral follicle count (AFC) and anti-Müllerian Hormone (AMH) are considered the best markers of ovarian reserve and ovarian response to stimulation. It is not clear whether they complement each other or act interchangeably in predicting ovarian response and individualizing gonadotropin dosage. Objective: To compare the predictive value of AFC and serum AMH for ovarian response and pregnancy outcome in intracytoplasmic sperm injection (ICSI) patients stimulated by an antagonist protocol. Moreover, to decide if measuring both markers adds to the power of predicting a response. Materials and Methods: A prospective diagnostic test study of infertile women. Setting: A private in vitro fertilization unit, Agial Hospital, Alexandria, Egypt. Women aged 20-39 years (n=700) and undergoing their first ICSI cycle were included in this study. AFC and AMH measurements were taken. All patients were stimulated with a fixed antagonist protocol with a starting dose of 200 IU of recombinant follicle stimulating hormone (rFSH). Main outcome measures included the number of oocytes retrieved and the clinical pregnancy rate. Results: Age, AMH, AFC, and a score combining both AMH and AFC (AMHxAFC) were statistically significant discriminators of the occurrence of an excessive response. The cutoff values for AMH, AFC, and AMHxAFC were > 3.75 ng/mL, > 23, and > 64.8. While AMH and AFC were equally effective in predicting an excessive response, the combined score AMHxAFC was significantly better than AFC or AMH alone. AMH, AFC, and AMHxAFC were significantly better predictors of an excessive response than age. Age, AFC, AMH, and the AMHxAFC were statistically significant discriminators of the occurrence of a poor response; however, AFC was the best predictor of a poor response, with a cutoff < 12. Age, AFC, and AMH were statistically significant discriminators of the occurrence of pregnancy, yet their predictive power is low. Conclusion: Measuring both AMH and AFC adds to their predictive power for a high or an excessive response. AFC alone is an excellent predictor of a poor response and is significantly better than age and AMH. Age, AMH, and AFC have poor predictive power for pregnancy.