Ovarian response and cumulative live birth rate of women undergoing in-vitro fertilisation who had discordant anti-Mullerian hormone and antral follicle count measurements: a retrospective study.

Hang Wun Raymond Li,Pak Chung Ho,Vivian Chi Yan Lee,William Shu Biu Yeung,Ernest Hung Yu Ng,Estella Yee Lan Lau,Meijia Zhang

doi:10.1371/journal.pone.0108493

Hang Wun Raymond Li, Pak Chung Ho + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0108493

Copy DOI

Journal: PloS one	Publication Date: Oct 14, 2014
Citations: 42	License type: CC BY 4.0

Affiliation: University of Hong Kong, Queen Mary Hospital

Abstract

ObjectiveTo evaluate ovarian response and cumulative live birth rate of women undergoing in-vitro fertilization (IVF) treatment who had discordant baseline serum anti-Mullerian hormone (AMH) level and antral follicle count (AFC).MethodsThis is a retrospective cohort study on 1,046 women undergoing the first IVF cycle in Queen Mary Hospital, Hong Kong. Subjects receiving standard IVF treatment with the GnRH agonist long protocol were classified according to their quartiles of baseline AMH and AFC measurements after GnRH agonist down-regulation and before commencing ovarian stimulation. The number of retrieved oocytes, ovarian sensitivity index (OSI) and cumulative live-birth rate for each classification category were compared.ResultsAmong our studied subjects, 32.2% were discordant in their AMH and AFC quartiles. Among them, those having higher AMH within the same AFC quartile had higher number of retrieved oocytes and cumulative live-birth rate. Subjects discordant in AMH and AFC had intermediate OSI which differed significantly compared to those concordant in AMH and AFC on either end. OSI of those discordant in AMH and AFC did not differ significantly whether either AMH or AFC quartile was higher than the other.ConclusionsWhen AMH and AFC are discordant, the ovarian responsiveness is intermediate between that when both are concordant on either end. Women having higher AMH within the same AFC quartile had higher number of retrieved oocytes and cumulative live-birth rate.

Highlights

Ovarian response markers, such as serum follicle stimulating hormone (FSH) concentration, antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) concentration are often employed in in vitro fertilisation (IVF) programmes to predict ovarian response to gonadotrophin stimulation [1,2]
There were 1,152 women undergoing the first IVF treatment cycle during the study period, out of which we studied on 1,046 subjects who fulfilled the inclusion criteria and being treated on the long GnRH agonist protocol
This means that the rest 337 subjects (32.2%) showed discordance between AMH and AFC

Summary

Introduction

Ovarian response markers, such as serum follicle stimulating hormone (FSH) concentration, antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) concentration are often employed in in vitro fertilisation (IVF) programmes to predict ovarian response to gonadotrophin stimulation [1,2]. Systematic reviews showed that among the common ovarian response markers, AFC and AMH had the best and comparable performance in predicting both poor and excessive ovarian responses [3,4,5]. The prediction of pregnancy outcomes by these markers is poor [4,6,7]. AMH is exclusively produced by granulosa cells of preantral and small antral follicles, and has been shown to have excellent correlation with the primordial follicle pool [8].

Methods

Results

Conclusion