Antral Follicular Count, Ovarian Volume and Anti-mullerian Hormone in the Prediction of Cycle Cancellation and Poor Response in Women Undergoing Controlled Ovarian Stimulation
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- Category: Vol. 79, March 2011
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Antral Follicular Count, Ovarian Volume and Anti-mullerian Hormone in the Prediction of Cycle Cancellation and Poor Response in Women Undergoing Controlled Ovarian Stimulation,DOAA SALAH EL-DIN, AHMED MAGED, MARYAM MAHMOUD and MARWA M. SHETA
Abstract
Objective: To investigate the value of antral follicular count (AFC), ovarian volume, baseline cycle day 3 anti-mullerian hormone (AMH) serum levels and AMH serum concentrations obtained on the fifth day of gonadotrophin therapy in predicting cycle cancellation and poor responders in women undergoing a first cycle of controlled ovarian stimulation with exogenous gonadotrophins.
Material and Methods: A total of 55 spontaneously ovu-lating women about to undergo their first cycle of in-vitro fertilization treatment were examined on day 2-3 of a sponta-neous menstrual cycle for assay of AMH and transvaginal ultrasound scan was performed to assess the total AFC and the mean ovarian volume. Next cycle re-measuring of AMH was obtained on day 5 of stimulation after pituitary desensi-tization.
Results: Comparing AFC and ovarian volume in both cancelled and non-cancelled cases showed significant differ-ence (p-value <0.001 and 0.007 respectively). Also basal AMH and day 5 AMH in these cases showed significant difference (p-value <0.001 for both). Comparing the four variables (AFC, ovarian volume, basal and day 5 AMH in both good and poor responders showed significant difference (p-value <0.001). AFC showed non significant positive cor-relation with basal AMH (r=0.294, p=0.480) and day 5 AMH (r=0.268, p=0.521) in cancelled cases. While in poor respond-ers the AFC showed significant positive correlation with basal AMH (r=0.665, p=0.0001) and day 5 AMH (r=0.454, p=0.023). AFC in good responders showed non significant correlation with basal AMH (r=0.255, p=0.252) and day 5AMH (r=0.175, p=0.436). ROC curves were done, to analyze the diagnostic accuracy of the ovarian reserve markers. Sensitivity, specificity and over all accuracy in diagnosing cycle cancellation and poor response were studied for all markers.
Conclusion: Different cut-off values helped to discrimi-nation between women with cancelled cycles and those with poor response. The ROC curves do not suggest a clearly better predictive ability for AMH (whether basal or day 5) than for AFC. Adding the advantage that AMH appears to fluctuate only marginally and the cut-off values for basal and day 5 AMH appear to be very near. This supports its role as a cost effective reliable marker of ovarian fertility potential.