Value Of Antral Follicle Count Research Articles

P-674 Automatizing ovarian follicle counting and measurement with artificial intelligence

Abstract Study question Can ovarian follicle counting and volumetric measurement in ultrasound cine-loops be automated using deep learning methods? Summary answer A deep-learning model achieved an Area Under Precision-Recall Curve (AUC-PR) of 77.8% for identifying follicles of diverse sizes, in cine-loops from everyday clinical practice. What is known already The measurement of ovarian follicles via transvaginal ultrasound is an established procedure in infertility treatment. The high predictive value of antral follicle count (AFC) is utilized in hormonal dosing algorithms, scheduling of triggering and oocyte retrieval, as a criterion to assess hyperstimulation risk, etc. As it is repeatable and time-consuming, it is a good candidate for automatization. However, traditional methods fail to distinguish follicles from acoustically shadowed areas, ovarian cysts, or anechoic extraovarian structures. Existing approaches assume manual ovary outlining or 3D volume acquisition, which requires additional operator training. Moreover, existing evaluations rarely define criteria for correct follicle identification. Study design, size, duration A retrospective study was conducted on 331 ultrasound cine-loop videos from 100 patients (mean age 35 ± 5.6, AMH level 3.3 ± 2.9 ng/ml) undergoing an IVF or donor cycle between February and December 2021 at six IVF centers in Poland. For training the model, 1903 more cine-loops from 350 other patients were used. To reflect everyday clinical practice, there was no selection based on patient condition or video quality. Participants/materials, setting, methods Folliscan (MIM Solutions) is a model developed based on 3D neural networks architectures. It analyzes a cine-loop without any manual preprocessing and presents a list of follicles together with exact 3D outlines and confidence scores. A total of 24711 follicles were manually annotated and reviewed by sonography experts to ensure exhaustive enumeration. A detected follicle is considered correct if it sufficiently overlaps (Intersection over Union above 35%) with a single expert annotation. Main results and the role of chance The precision was 85.8% (95% Confidence Interval: 83.7–87.7) and recall was 74.2% (CI 71.7–76.6). The area under the precision-recall curve (AUC-PR) was 77.8%. We note that 19.7% of annotations were only added during review, indicating that even expert sonographers fail to annotate a certain number of follicles. For studies performed on days 7-12 of stimulation (N = 163 cine-loops), when only follicles ≥10mm were taken into account, accuracy was significantly higher: precision 95.4% (CI 93.0–96.8), recall 87.7% (CI 73.1–94.2). We observe that the smallest anechoic areas, about 1mm in diameter, often are not imaged in enough resolution to be unanimously classified by experts. Common reasons for errors in medium-sized follicles are poor image quality (acoustic shadowing, unclear boundaries between nearby follicles), ambiguous volumes (where two outlines can seem equally reasonable, but do not overlap sufficiently), non-convex follicle shapes (due to adjacent follicles). When measuring follicle diameters, the Mean Average Error (MAE) was 0.76mm, only slightly larger than the inter-observer MAE of 0.62mm (calculated on 32 cine-loops for which two experts independently measured all follicles). Moreover, 3D outlines enable a more physiological measurement than 2D diameters. Limitations, reasons for caution Follicle recognition is highly dependent on image quality and patient group. To contrast our model with manual methods, more cine-loops would need to be independently annotated by multiple experts. A future study on 3D acquisitions would be useful to compare with software that requires it, such as SonoAVC (GE Healthcare). Wider implications of the findings Automatizing follicle measurement can speed-up the process and diminish acquisition requirements (examination time, operator experience). Deep learning methods consider each follicle’s context, enabling more reliable recognition of ovarian structures. They have potential to increase the predictive value of follicle counting beyond what is already possible with human observers. Trial registration number N/A

Age-Specific Nomograms for Antral Follicle Count in Fertile and Infertile Indian Women: A Comparative Study.

Objectives The aim of this study was to develop age-specific nomograms for antral follicle count (AFC) in fertile and infertile Indian women and (2) to compare the influence of age on AFC in both groups. Setting and Design It is a prospective cross-sectional study in a tertiary-care hospital in north-central India. Methods and Material One-thousand four-hundred seventy-eight fertile and 1,447 infertile women (primary infertility) of reproductive age (18-49 years) were recruited. One-thousand one-hundred eighty-one fertile and 1,083 infertile women fulfilled the selection criteria for the study. Transvaginal ultrasonography was done on the second or third day of the menstrual cycle. Statistical Analysis Age-specific nomograms for AFC were built for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles in both groups. Correlation and regression analysis was done to estimate the relationship between the study variables. Statistical analysis was done by using IBM SPSS Statistics for Windows, version 20. Results At every age, each percentile value of AFC was lower in infertile than in fertile women. The decline of AFC with increasing age was linear in both fertile ( r = - 0.431, p < 0.001) and infertile ( r = - 0.520, p < 0.001) women; however, the rate was higher in the latter (0.50 follicle/year) than in former (0.44 follicle/year) group. The variation in AFC explained by age was 16.3% in fertile and 22.7% in infertile women. Conclusion AFC decreased linearly with advancing age in both fertile and infertile women, but more rapidly in the latter. The age only modestly explained the decline of AFC. The age-specific percentile thresholds for AFC should be used instead of age-independent constant thresholds in infertility counselling.

The Predictive Levels of Serum Anti-Müllerian Hormone and the Combined Index of the Number of Retrieved Oocytes and Good-Quality Embryos in Advanced-Age Infertile Women.

The primary objective of the study was to assess the values of serum anti-Müllerian hormone (AMH) levels and the combined index for the prediction of number of oocytes retrieved (NOR) and number of good-quality embryos (GQE) in infertile women undergoing IVF/ICSI treatment. A group of 521 infertile women aged 21–46 years were recruited as subject in this study. Serum AMH, hormones, and antral follicle count (AFC) were measured. The infertile women were categorized into three groups: 21–34 years (reproductive age), 35–39 years (reproductive age), and 40–46 years (advanced-age infertile). The predictive accuracy of variables was analyzed by the receiver operating characteristic (ROC) curve. AFC, AFC/age ratio, AMH/age ratio, and ovarian response prediction index (ORPI) decreased gradually, while AMH decreased significantly with increase in age. Moreover, NOR and GQE were positively correlated with AFC, AMH, AFC/age ratio, AMH/age ratio, and ORPI (P < 0.001). A statistical significance was observed in predicted oocyte retrieval including AMH, AMH/age ratio, and ORPI between 21–34 years and 35–46 years; especially in the 35–46 years group, these variables reached a “high” grade in the diagnostic accuracy because area under curve (AUC) ranged from 0.982 to 0.988 significantly. No statistical significance was observed for FSH, AMH, AFC, and related combined index predicting GQE. The predictive value of AFC and AFC/age ratio was limited regarding oocyte retrieval; however, AMH, AMH/age ratio, and ORPI concurrently had an excellent value for predicting NOR in reproductive-age women, especially in advanced-age infertile women.

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

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 &gt; 3.75 ng/mL, &gt; 23, and &gt; 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 &lt; 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.

Investigating the effect of lifestyle risk factors upon number of aspirated and mature oocytes in in vitro fertilization cycles: Interaction with antral follicle count.

IntroductionThere is evidence demonstrating that certain lifestyle factors have a detrimental effect on fertility. Since such factors often coexist, possible synergistic effects merit further investigation. Thus we aimed to examine the cumulative impact of lifestyle factors on in vitro fertilization (IVF) early reproductive treatment outcomes and their interaction with measures of ovarian reserve.Materials and methodsBy following women who were starting their first fresh IVF cycle in 2 cohorts, the “Lifestyle study cohort” (hypothesis generating cohort, n = 242) and the “UppSTART study” (validation cohort, n = 432) in Sweden, we identified two significant risk factors acting independently, smoking and BMI, and then further assessed their cumulative effects.ResultsWomen with both these risk factors had an Incidence Rate Ratio (IRR) of 0.75 [(95% CI 0.61–0.94)] regarding the number of aspirated oocytes compared to women without these risk factors. Concerning the proportion of mature oocytes in relation to the total number of aspirated oocytes, the interaction between BMI and Antral Follicle Count (AFC) was significant (p-value 0.045): the lower the value of AFC, the more harmful the effect of BMI with the outcome.ConclusionsData shows that there is an individual as well as a cumulative effect of smoking and BMI on the number of aspirated and mature oocytes in fresh IVF treatment cycles. AFC might modify associations between BMI and the proportion of mature oocytes in relation to the total number of aspirated oocytes. These results highlight the importance of lifestyle factors on IVF early reproductive outcomes and provide additional evidence for the importance of preconception guidance for the optimization of IVF cycle outcome.

Predictive value of antral follicle count and serum anti-Müllerian hormone: Which is better for live birth prediction in patients aged over 40 with their first IVF treatment?

ObjectiveTo evaluate clinical utility of antral follicle count (AFC) and anti-Müllerian hormone (AMH) in predicting in vitro fertilization (IVF) outcomes among the patients over 40 years old in their first IVF cycles. Study designTotal 219 patients aged 40 or older who underwent their first IVF with gonadotropin-releasing hormone antagonist protocol from January 2013 to September 2014 in CHA Gangnam fertility center were retrospectively analyzed. AFC and serum samples were measured prior to IVF treatment. The main outcomes were clinical pregnancy rate and live birth. Results36 out of 219 patients achieved clinical pregnancy (16.4%) and 27 out of 219 patients delivered (12.3%). The receiver operating characteristic curve analysis to predict clinical pregnancy showed that both age and AFC equally had higher accuracy by area under the curve (AUC = 0.657, P < 0.01) than serum AMH (AUC 0.613, P = 0.03). The optimum cut-off value of age was ≤41 and that of AFC was >3 to predict clinical pregnancy. For the prediction of live birth, AFC had the highest accuracy (AUC 0.698, P < 0.01), followed by age (AUC 0.674, P < 0.01) and the number of total retrieved oocytes (AUC 0.620, P = 0.02). The optimum cut-off value of age was ≤41, that of AFC was >3 and that of the number of total retrieved oocytes were >6. With multivariate regression analysis, age and AMH were significantly correlated with clinical pregnancy (age, odds ratio [OR] 0.53, P < 0.01; AMH, OR 1.31, P = 0.04), whereas age and AFC were association with live birth significantly (age, OR 0.41, P < 0.01; AFC, OR 1.10, P = 0.02). ConclusionIn patients aged over 40, AFC and AMH were shown to be good biomarkers for the prediction of clinical pregnancy and live birth. Although AMH was positively correlated with clinical pregnancy and had no association with live birth, the predictive value of AFC and AMH were similar for both clinical pregnancy and live birth. To predict the live birth, age ≤41, AFC >3 and total retrieved oocytes >6 appeared to be meaningful. This study demonstrated the significance of AMH and AFC as predictors of clinical pregnancy and live birth for old aged women at their first IVF cycle with gonadotropin-releasing hormone antagonist protocol.

Comparison of the Predictive Value of Antral Follicle Count, Anti-M&amp;#252;llerian Hormone and Follicle-Stimulating Hormone in Women Following GnRH-Antagonist Protocol for Intracytoplasmic Sperm Injection

Background: Prediction of ovarian response is one of the prerequisites for women undergoing intracytoplasmic sperm injection (ICSI) treatment prior to the first controlled ovarian stimulation (COS) cycle. Predictive factors may be variable in patients pre-treated with oral contraceptives (OC) for scheduling purposes. Objective: To evaluate antral follicle count (AFC), anti-müllerian hormone (AMH) and basal follicle stimulating hormone (FSH) for predicting ovarian responses in patients under controlled ovarian hyperstimulation randomized to receive either oral contraceptives (OC) or no treatment (non-OC) prior to their first controlled ovarian stimulation (COS) cycle. Study Design: One hundred infertile women randomized to receive OC treatment or no treatment, prior to their first COS cycle; were stimulated with Gonadotropin Releasing Hormone (GnRH) antagonist protocol. During the early follicular phase (day 2) of the two subsequent cycles (cycle A & cycle B) sonographic (AFC, ovarian volume) and endocrine data (AMH, basal FSH) were recorded. Transvaginal ultrasound was performed for all patients to monitor the ovarian response. Total number of oocytes retrieved and number of generated embryos were recorded and patients were categorized according to retrieved oocytes as poor (oocytes 12). Result(s): AFC, AMH and basal FSH were lower in users than in non-users of hormonal contraception. Poor responders showed less number of oocytes retrieved and had lower AFC and AMH but a higher basal FSH level was recorded in both groups (OC and non-OC). Conclusion: The better predictive value of AMH or AFC, as a single test or in combination will prevent cycle cancellations due to too low or too high ovarian response. AMH in OC group is not affected by OC pretreatment and is superior to other parameters, while AFC is superior to AMH and basal FSH in non-OC group.

Early Follicular Anti-Mullerian Hormone and Antral Follicle Count as an Indicator of Ovarian Reserve: A First Pilot Study in the Nepalese Population

Background: Anti-Mullerian Hormone (AMH) is produced by the granulosa cells of primary, preantral and greater antral follicles, and plays an imperative role in human folliculogenesis. It is a measure of ovarian function, useful in assessing conditions such as polycystic ovary syndrome and premature ovarian failure. The objective of this study was to evaluate the correlation between chronological age with levels of antral follicle count (AFC), and AMH. Methods: Anti-Mullerian Hormone (AMH) is produced by the granulosa cells of primary, preantral and greater antral follicles, and plays an imperative role in human folliculogenesis. It is a measure of ovarian function, useful in assessing conditions such as polycystic ovary syndrome and premature ovarian failure. The objective of this study was to evaluate the correlation between chronological age with levels of antral follicle count (AFC), and AMH. Results: The correlations between AFC, AMH, and age were statistically significant. The lowest value of AMH and AFC were 0.09 ng/ml and 1 respectively. The highest values of AMH and AFC were 15.90 ng/ml and 14 respectively. The study revealed consistent levels of AMH up to 25 years of age, whereas decline in the levels post 25 years. Conclusion: AFC is being used as a marker of ovarian reserve; AMH levels have a positive correlation with AFC and can be measured on any day of the cycle. Anti-Mullerian hormone is believed to be of paramount importance in its role as an endocrine marker for assessment of decline of the ovarian pool in healthy women; thus, it has a potential ability to predict future reproductive lifespan.

Analysis of ovarian reserve markers (AMH, FSH, AFC) in different age strata in IVF/ICSI patients

The predictive roles of follicle stimulating hormone (FSH), anti-mullerian hormone (AMH) and antral follicle count (AFC) as ovarian reserve markers in women with different age groups are not established well. This study compares the value of FSH, AMH and AFC at the time of in vitro fertilization (IVF) treatment in different age groups. In this cross-sectional study, 103 women aged 20-43 years candidates for IVF/ICSI cycle were recruited. FSH, AMH and AFC on day 3 of menstrual cycle were measured. The relationship of these measured markers with outcome variables (oocytes number, number of frozen/fresh embryo and chemical and clinical pregnancy) was assessed in different age groups (i.e. 20-32, 33-37 and 38-43 years). our results show that age was correlated with clinical pregnancy, oocyte count and fresh and frozen embryo (p<0.001). AMH, AFC and FSH were not correlated with clinical or chemical pregnancy at total population or age subgroups except the significant correlation of AFC with clinical pregnancy at 33-37 years old group. AFC was correlated with oocyte count and the number of fresh and frozen embryos in the ages group 20-32 years. In this age group, AMH was correlated with fresh and frozen embryos. AMH, AFC and FSH were correlated with oocyte count and the number of fresh embryos in age group 33-37 years. AMH was correlated with oocyte count and the number of fresh embryos in 38-43 years old group. We concluded that the age is the superior predictor of IVF outcome and AMH and AFC are variable predicting markers of ovarian reserve in different age groups.

Predictive value of antral follicle count and anti-Müllerian hormone for follicle and oocyte developmental competence during the early prepubertal period in a sheep model

Circulating anti-Müllerian hormone (AMH) and antral follicle count (AFC) are addressed as suitable markers of oocyte quantity and quality during adulthood. To investigate whether AFC and circulating AMH could predict follicle development and oocyte quality during the prepubertal period we used 40-day-old ewe lambs with high, intermediate and low AFC (≥30, 16-29 and≤15 follicles respectively). The analysis of the response to the exogenous FSH ovarian reserve test showed a positive correlation between AFC, AMH plasma levels, total follicle number and the number of large follicles (≥3mm) grown after exogenous FSH administration. The incorporation of abattoir-derived oocytes collected from ovaries with different AFC in an in vitro embryo production system showed that a high AFC can predict oocyte quality in prepubertal ovaries, reflecting an ovarian status suitable for follicular development. The histological quantification of the ovarian reserve evidenced that AFC was not predictive of differences in either the number of healthy follicles or the size of the primordial follicle pool in prepubertal ovaries. Further studies are needed to investigate the implication on the reproductive performance of the significant inter-individual differences found in the present study in AFC and circulating AMH in the early prepubertal period.

The Predictive Value of Antral Follicle Count (AFC) At Down Regulation Prior to IVF Stimulation is Better Than A Diagnostic AFC

Antral follicles represent the cohort of oocytes surrounded by granulosa cells that may potentially develop into a lead follicle during an ovulatory cycle. During an IVF cycle, this cohort of follicles is stimulated using gonadotropins. AFC is used as a clinical marker for ovarian reserve and predictor of IVF cycle response. The present study aimed to determine if AFC at IVF down regulation is more predictive of stimulation outcomes than a diagnostic AFC. Eighty-three patients undergoing IVF from 2010 to 2011 were prospectively studied. All had a diagnostic AFC, FSH and estradiol as part of their evaluation. The patients' IVF protocol was selected from their diagnostic evaluation. At IVF, all patients underwent an ultrasound at down regulation and an AFC (pre-IVF AFC) was determined prior to stimulation. Analysis of correlation coefficients (R) was calculated using Spearman's rho. Average patient-age was 33.2 ± 5.2 years. Mean diagnostic AFC and pre-IVF AFC were 24.9 ± 14 and 23.2 ± 15 respectively. Mean follicles aspirated and oocytes retrieved were 25 ± 15 and 16.4 ± 9.6 respectively. Pre-IVF AFC was more predictive that diagnostic IVF for both follicles aspirated (R=0.74 vs 0.68, p<.05) and oocytes retrieved (R=0.58 vs 0.51, p<0.05). In cases where there was greater than 15% discordance between AFC values, pre-IVF AFC had a stronger correlation of stimulation outcomes compared to diagnostic AFC (Table).Tabled 1Correlation Coefficient when Discordance >15%Diagnostic AFCPre-IVF AFCFollicles Aspirated0.5610.621Oocytes Retrieved0.3410.4811p<0.05, N=45. Open table in a new tab 1p<0.05, N=45. Pre-IVF AFC is a better predictor of IVF stimulation, than a routine diagnostic AFC. This is likely because the pre-IVF AFC represents the follicles that will be stimulated during the index cycle. If a patient has discordant AFC values particular attention should be paid to the pre-IVF AFC, as this value will more likely to correlate with IVF outcomes and clinical decisions may need to be modified accordingly.

The predictive value of antral follicle count remains unchanged across the menstrual cycle

To explore whether the predictive value of antral follicle count (AFC) changes when measured at different times during the menstrual cycle. Antimüllerian hormone (AMH) and AFC are considered to be equally predictive of poor ovarian response; however, AMH is considered to have an advantage over AFC, because AMH concentrations can be measured at any time during the menstrual cycle. Retrospective cohort study. Private IVF clinic. A total of 3,117 patients with a transvaginal ultrasound within 3 months before their first IVF cycle. None. Receiver operating curves (ROCs) were constructed for AFC as a screening test for poor ovarian response (fewer than four eggs collected). The areas under the curve (AUCs) were compared for ROCs from patients at different phases of the cycle. When all patients except those with polycystic ovaries were included, the AUC was 0.79. Further subgroup ROC analyses revealed that the AUCs did not differ significantly when AFC was measured at different phases of the menstrual cycle. AFC can be measured regardless of the phase of the menstrual cycle without apparent effect on its predictive value for poor ovarian response.

Small antral follicle count (2–5 mm) and ovarian volume for prediction of pregnancy in in vitro fertilization cycles

Aims. To assess the value of antral follicle count (AFC) and other parameters as predictors of pregnancy in in vitro fertilization (IVF).Methods. In a cohort study, unselected consecutive women in IVF treatment were evaluated. Pretreatment parameters included AFC (subpopulations of small (2–5 mm) and large (5–10 mm) AFC), ovarian volume, and ovarian stroma Doppler indices.Results. The study included 115 women of whom 38 (33%) were pregnant. Total AFC was significantly higher in the pregnant than in the non-pregnant group (13.7 ± 5.8 vs. 11.3 ± 5.3, p = 0.034). On receiver operator characteristic (ROC) curve analysis, the pretreatment variables that were significantly associated with pregnancy were small AFC (2–5 mm), total AFC, and ovarian volume/AFC ratio. Women with a positive score (total AFC >15; small AFC (2–5 mm) >10; ovarian volume in mm3/AFC, <1400), had a significantly higher number of retrieved oocytes and a higher pregnancy rate than women with a negative score (12.1 ± 5.1 vs. 8.7 ± 5.0, p = 0.027 and 58.3% vs. 30.1%, p = 0.049, respectively). On multivariate logistic regression analysis, total AFC was the only significant and independent predictor of pregnancy (p = 0.034).Conclusion. Pretreatment small AFC and ovarian volume may identify women with a higher probability to achieve pregnancy in IVF.

Predictive value of antral follicle count among anonymous oocyte donors in an egg-sharing donor program

Predictive value of antral follicle count among anonymous oocyte donors in an egg-sharing donor program

Antral follicle count in clinical practice: building the bridge from ovarian reserve to in vitro fertilization outcome

Antral follicle count provides a useful assessment of ovarian reserve to predict ovarian response, estimate risk for cycle cancellation, optimize stimulation protocol selection, and confidently select suitable candidates for IVF.

A Prospective, Comparative Analysis of Anti-Müllerian Hormone, Inhibin-B, and Three-Dimensional Ultrasound Determinants of Ovarian Reserve in the Prediction of Poor Response to Controlled Ovarian Stimulation

Previous studies have shown that antral follicle count (AFC) (determined with conventional two-dimensional ultrasound) and anti-Mullerian hormone (AMH), a conventional endocrine marker of ovarian reserve, provide the highest predictive value for assessing ovarian response to controlled ovarian hyperstimulation (COH) during assisted reproduction treatment (ART) and that these perform equally. More reliable and valid ultrasound data for assessment of AFC are obtained using 3-dimensional (3D) ultrasound. Some investigators have suggested that AFC measured with 3D ultrasound is a better predictor of poor response to COH during ART than AMH. No prior studies have compared the predictive accuracy of AMH and with that of AFC measured with 3D ultrasound data. This prospective study compared the predictive value of AFC and other ovarian parameters using 3D ultrasound with that of AMH and other conventional endocrine markers in determining for the prediction of a poor response to COH during ART. The final study group was comprised of 135 women, with mean age of 33.5 (range: 24–40 years) with regular menstrual cycles and an early follicular phase follicle-stimulating hormone level <12 IU/L, who were undergoing their first cycle of ART using a standard long protocol. All participants underwent venipuncture and a baseline pretreatment 3D ultrasound assessment in the early follicular phase of the spontaneous menstrual cycle before receiving gonadotropin agonists in the luteal phase of the same cycle. Multiple logistic regression and receiver operating characteristic analyses were used to identify significant predictors of poor response and nonconception, which were the primary study outcome measures. Multivariate regression analysis showed that the most significant predictors of poor ovarian response were AFC (Exp(B): 0.65) and AMH (Exp(B): 0.13). Each had similar predictive accuracy; this was demonstrated by their similar area under the curve (AUC) in receiver operating characteristic curve analysis (0.935 and 0.905, for AFC and AMH respectively, P = 0 0.34). The predictive accuracy of AFC and AMH was not significantly improved when used as a combined test (AUC = 0.946). The sensitivity and specificity of AFC for prediction of poor ovarian response was 93% and 88%, whereas the sensitivity and specificity of AMH was 100% and 73%; AFC and AMH were measured at optimum cutoff values of ≤10 and ≤0.99 ng/mL, respectively. The only significant predictor of nonconception was age (Exp(B): 1.191, 95% CI 1.050–1.343; P < 0.01) but its predictive accuracy was low (AUC = 0.674). These findings show that pretreatment AFC measured with 3D ultrasound and AMH are the most significant predictors of poor ovarian response to COH during ART. Although AFC and AMH, either alone or in combination, have similar predictive power, neither is predictive of nonconception which may be dependent on the woman's age.

Circulating basal anti-Müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization

To evaluate the clinical value of basal anti-Müllerian hormone (AMH) measurements compared with other available determinants, apart from chronologic age, in the prediction of ovarian response to gonadotrophin stimulation. Prospective cohort study. Tertiary referral center for reproductive medicine and an IVF unit. Women undergoing their first cycle of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). Basal levels of FSH and AMH as well as antral follicle count (AFC) were measured in 165 subjects. All patients were followed prospectively and their cycle outcomes recorded. Predictive value of FSH, AMH, and AFC for extremes of ovarian response to stimulation. Out of the 165 women, 134 were defined as normal responders, 15 as poor responders, and 16 as high responders. Subjects in the poor response group were significantly older then those in the other two groups. Anti-Müllerian hormone levels and AFC were markedly raised in the high responders and decreased in the poor responders. Compared with FSH and AFC, AMH performed better in the prediction of excessive response to ovarian stimulation-AMH area under receiver operating characteristic curve (ROC(AUC)) 0.81, FSH ROC(AUC) 0.66, AFC ROC(AUC) 0.69. For poor response, AMH (ROC(AUC) 0.88) was a significantly better predictor than FSH (ROC(AUC) 0.63) but not AFC (ROC(AUC) 0.81). AMH prediction of ovarian response was independent of age and PCOS. Anti-Müllerian hormone cutoffs of >3.75 ng/mL and <1.0 ng/mL would have modest sensitivity and specificity in predicting the extremes of response. Circulating AMH has the ability to predict excessive and poor response to stimulation with exogenous gonadotrophins. Overall, this biomarker is superior to basal FSH and AFC, and has the potential to be incorporated in to work-up protocols to predict patient's ovarian response to treatment and to individualize strategies aiming at reducing the cancellation rate and the iatrogenic complications of COH.