OBJECTIVE:The objective of this study was to test the hypothesis that AMH and antral follicle count (AFC) are good predictors of ovarian response to controlled ovarian stimulation and to compare them.MATERIALS AND METHODS:This observational cross-sectional study included 56 subjects aged between 25 and 42 years who were enrolled between 1st January and 31st December 2010 for their first intracytoplasmic sperm injection (ICSI) program. Baseline hormone profiles including serum levels of Estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), and Anti-mullerian Hormone (AMH) were determined on day 3 of the previous cycle. The antral follicle count measurements were performed on days 3-5 of the same menstrual cycle. Antral follicles within the bilateral ovaries between 2-6 mm were recorded. The subjects were treated with long protocol for ovarian stimulation. Ovulation was induced with 10,000 IU of human chorionic gonadotropin (hCG) when at least 3 follicles attained the size of more than 17 mm. Transvaginal oocyte retrieval was performed under ultrasound guidance 36 hours after hCG administration. An oocyte count less than 4 and absence of follicular growth with controlled ovarian hyper stimulation was considered as poor ovarian response. Oocyte count of 4 or more was considered as normal ovarian response.RESULTS:Statistical analysis was performed using SPSS software trail version 16.0. Subjects were divided into 2 groups, depending on the ovarian response. The mean oocyte counts were 12.27 ± 6.06 and 2.22 ± 1.24 in normal and poor responders, respectively, (P = 001). Multiple regression analysis revealed AMH and antral follicle count as predictors of ovarian response (β coefficient ± SE for AMH was 1.618 ± 0.602 (P = 0.01) and for AFC, it was, 0.528 ± 0.175 (P = 0.004). AFC was found to be a better predictor of ovarian response compared to AMH in controlled ovarian hyper stimulation.CONCLUSION:The observations made in this study revealed that both AMH and AFC are good predictors of ovarian response; AFC being a better predictor compared to AMH.

Redundant foramen ovale (RFO) is defined as an abnormally redundant foramen ovale flap that extends at least halfway across the left atrium. The exact pathogenesis is unknown. Premature, isolated, in utero RFO is rare. The prevalence in general population is unknown as it may be easily ignored on routine fetal echocardiography. The reported frequency in fetuses referred for echocardiographic examination is 0.6-1.7%. It can cause right ventricular volume overload leading to fetal hydrops and subsequent cardiac failure. In such cases, prompt delivery depending on fetal gestational age may be instrumental for the survival of the neonate. 67% can develop cardiac arrhythmias which generally resolves at birth. The most common is premature atrial contractions though rarely, supraventricular tachycardia can also occur. RFO usually occurs in isolation but when associated with congenital heart disease, it carries a poor prognosis. Several series have reported redundant foramen ovale in echocardiographic and autopsy findings in children and adults but only few reports on the antenatal detection of isolated RFO has been described. We discuss two prenatal cases of isolated redundant foramen ovale diagnosed in the third trimester. They were followed up two weekly without development of any complications and delivered at term. After delivery, the infants had no history or symptoms of cardiac distress. Echocardiography showed a structurally normal heart. Hence, if there are no associated anomalies in a case of redundant foramen ovale, the prenatal management need not be altered.

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The primary aim of this study was to assess the feasibility of fetal cardiac evaluation at 11-13?6 weeks by assessing the four chamber and three vessel views. The secondary aim was to assess detection rates of cardiac anomalies at this gestational age. This was a prospective study done over 1 year. It included 355 patients who presented to a routine antenatal service and opted for prenatal genetic screening and anomaly scan at 11-13?6 weeks corresponding to a CRL of 45-84 mm. Four chamber view and three vessel view were examined in both gray scale and color Doppler using transabdominal scanning and transvaginal scanning. A follow-up was done at 18-22 weeks and at delivery. Major cardiac anomalies were seen in 5 (1.4 %) fetuses screened at 11-13?6 weeks. Two fetuses with cardiac anomalies (0.5 %) could not be detected at this gestation and were picked up at the 18-22 week scan. Extracardiac anomalies detected in the first trimester scan were 14 (3.9 %). Nuchal translucency (NT) of more than 3 mm was found in 19 (5.3 %) patients. Nuchal translucency of more than 3 mm was present in 3 (60 %) fetuses with cardiac defects seen at 11-13?6 weeks. Increased NT of more than 3 mm was found in 6 (43 %) patients having noncardiac anomalies. Four (1.1 %) patients had both cardiac and noncardiac anomalies detected at first trimester scan. When CRL was 76-85 mm, the cardiac anomaly detection rate was maximum (3.8 %) compared to detection at CRL 66-75 mm (1.2 %), 56-65 mm (0), 45-55 mm (2.2 %). Noncardiac defects had a detection rate of 2 (4.4 %) at CRL 45-55 mm, 4 (3.6 %) at CRL 56-65 mm, 7 (4.5 %) at CRL 66-75 mm, 1 (1.9 %) at CRL 76-85 mm. Overall detection of major fetal cardiac anomalies at 11-13?6 weeks was 1.4 % and noncardiac anomalies was 3.9 %. This supports the opinion that first trimester can be used for detection of major congenital heart diseases and noncardiac anomalies along with fetal aneuploidy screening. Detection of anomalies in the first trimester helps patient in early decision making and counseling for further management. Keywords 11-14 week scan Á Echocardiography Á Congenital heart defects Á Nuchal translucency Á Four chamber view Á Three vessel view