Abstract
BackgroundSeveral studies have reported a correlation between antral follicle count by conventional 2D transvaginal sonography and serum anti-Müllerian hormone levels. However, few studies have investigated the effectiveness of 3D SonoAVC transvaginal ultrasound technology, particularly in infertile women. Therefore, this study aims to evaluate the usefulness of three-dimensional (3D) SonoAVC transvaginal ultrasound technology for antral follicle count and its correlation to conventional two-dimensional (2D) transvaginal ultrasound and serum levels of anti-Müllerian hormone in infertile women.MethodsThis cross-sectional study included 42 infertile women with age lower than 40 years that underwent treatment at a private fertility clinic between June and December 2015. Patient data included age, body mass index and cause of infertility. On cycle day 3 the following hormone levels were measured: serum levels of anti-Müllerian hormone, follicle-stimulating hormone, cancer antigen 125, prolactin, thyroid-stimulating hormone and oestradiol; the number of antral follicles was counted as well. The scanning were performed through 2D and 3D technology transvaginal ultrasound.ResultsUsing a Bland-Altman test we demonstrated that both technologies are quite equivalent. However, antral follicle count is higher using 3D ultrasound technology compared to 2D technology (p < 0.001; Wilcoxon test), this finding is mainly remarkable in ovaries with more than 20 antral follicles. Moreover, the mean time required for manual 2D ultrasound and 3D SonoAVC measurements were 275 ± 109 and 103 ± 57 s, respectively (p < 0.001). Serum AMH concentration correlated to the total number of early antral follicles (correlation coefficients = 0.678 and 0.612; p < 0.001 by 2D ultrasound and 3D SonoAVC, respectively; Spearman’s correlation test).ConclusionsAntral follicle count is better estimated using 3D ultrasound compared to 2D technology. A great advantage of 3D SonoAVC was less time required for an examination and the visual advantage when it need to count more than 20 follicles.Trial registrationCAAE: 35141114.4.0000.5327. Registered 10 June 2015.
Highlights
Several studies have reported a correlation between antral follicle count by conventional 2D transvaginal sonography and serum anti-Müllerian hormone levels
The use of follicle - stimulating hormone (FSH), oestradiol (E2), inhibin B, and, more recently, anti-Müllerian hormone (AMH) to evaluate reproductive potential have been described as good markers [4]
The causes of infertility found in this study were sterility without apparent cause (n = 8), anatomical factors (n = 11), hormonal factors (n = 1), endometriosis (n = 11), polycystic ovarian syndrome (PCOS; n = 6), ovarian factors (n = 3) and male factors (2)
Summary
Several studies have reported a correlation between antral follicle count by conventional 2D transvaginal sonography and serum anti-Müllerian hormone levels. This study aims to evaluate the usefulness of three-dimensional (3D) SonoAVC transvaginal ultrasound technology for antral follicle count and its correlation to conventional two-dimensional (2D) transvaginal ultrasound and serum levels of anti-Müllerian hormone in infertile women. One of the biggest challenges in the management of infertile patients is the loss of reproductive potential with increasing age. The use of follicle - stimulating hormone (FSH), oestradiol (E2), inhibin B, and, more recently, anti-Müllerian hormone (AMH) to evaluate reproductive potential have been described as good markers [4]. Antral follicle count (AFC) has been assessed by twodimensional (2D) transvaginal ultrasound for several years with good resolution and accuracy. Using multiplanar and inversion mode 3D, they showed that AFC is a reliable marker for ovarian reserve, but did not compared to 2D; in addition, the sample was composed mainly by fertile patients [6]
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