A prospective assessment of the predictive value of basal antral follicles in in vitro fertilization cycles

Frattarelli, John L.; Levi, Andrew; Miller, Bradley T.; Segars, James H.

doi:10.1016/s0015-0282(03)00664-2

Cited by 108 publications

(57 citation statements)

References 25 publications

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“…While there is no widely used AFC threshold at which ovarian response is significantly decreased, multiple studies in non-cancer IVF populations have demonstrated a correlation between low antral follicle count and poor response to controlled ovarian hyperstimulation [27][28][29][30]. In an analysis of 1,049 stimulated IVF cycles by Hsu et al, AFC was predictive of both cancellation rate and oocytes retrieved [29].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of ovarian stimulation after treatment with chemotherapy

Chan

Johnson

Efymow

et al. 2015

J Assist Reprod Genet

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Purpose Chemotherapeutic agents have a known gonadotoxic effect; however, it is difficult to predict the impact they may have on ovarian stimulation. The objective of this study was to evaluate response to ovarian stimulation in patients exposed to chemotherapy compared with patients who were chemotherapy-naïve. Methods A retrospective cohort study of 130 patients with cancer or autoimmune disease was performed. Demographics, ovarian reserve, ovarian response and stimulation parameters, and oocyte data were compared between patients who were pre-and post-chemotherapy. Logistic regression modeling was performed to identify risk factors for cancellation and low oocyte yield, adjusting for confounders as appropriate. Results Antral follicle count (AFC) was significantly lower in post-chemo patients (9 vs. 17, p<0.001). Post-chemotherapy patients were more likely to be cancelled during stimulation (23 vs. 4 %, p=0.003). Among those that went to retrieval, there was no difference in total number of oocytes (10 vs. 10, p=0.31) or mature oocytes retrieved (8 vs. 8, p=0.38), despite higher starting (300 vs. 450 IU, p<0.001) and total gonadotropin (3075 vs. 4612.5 IU, p=0.008) doses in post-chemotherapy patients. Low AFC (≤6) was associated with cycle cancellation (OR 7.7, 95 % CI 1.8-33.2) and low oocyte yield (<6) (OR 5.4, 95 % CI 1.6-17.7). Conclusions Patients post-chemotherapy have lower AFC compared with the chemotherapy-naïve and have higher cancellation rates. Among those who underwent oocyte retrieval, oocyte yield was similar in both groups. Low AFC was most strongly associated with cycle cancellation and oocyte yield. Post-chemotherapy patients had higher rates of cycle cancellation but did equally well as pre-chemotherapy patients if they reached retrieval.

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Section: Discussionmentioning

confidence: 99%

Outcomes of ovarian stimulation after treatment with chemotherapy

Chan

Johnson

Efymow

et al. 2015

J Assist Reprod Genet

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“…As a result, various sensitivities and specificities of the screening tests are reported. Table 1 ( 15,16,21,22,[26][27][28] compares a selected summary of screening tests commonly used to evaluate for ovarian response in ART with reported sensitivities and specificities. (29), as the threshold considered to be normal is increased, there is improvement in specificity, but a corresponding reduction in sensitivity.…”

Section: Screening For Ovarian Insufficiencymentioning

confidence: 99%

“…Such tests include basal FSH on cycle day 3 (4,16), CCCT (17,20,21), inhibin-B (21-23), estradiol (21,24), anti-Mullerian hormone (25,26), antral follicle counts (AFC) (16,27) and ovarian volume (16,21). The success of each test can be measured against ovarian response and/or live birth rate per cycle.…”

Section: Screening For Ovarian Insufficiencymentioning

confidence: 99%

A new approach to ovarian reserve testing

Sun

Stegmann

Henne

et al. 2008

Fertility and Sterility

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Objective-To critically examine ovarian reserve testing prior to assisted reproduction. Design-A PUBMED computer search to identify relevant literature. Setting-Multiple sites Interventions-Testing for ovarian reserve Main Outcome Measures-IVF and pregnancy outcomesResult(s)-The prevalence of ovarian insufficiency varies significantly for women aged 30-45 years. Generalization or averaging of threshold values across different aged women leads to very poor sensitivity, specificity, and positive predictive value for all tests of ovarian reserve. Because of the changing prevalence of ovarian insufficiency, there is no single, suitable threshold value for any screening test of ovarian reserve. Our analysis supports dividing impaired ovarian reserve into two groups: age-dependent ovarian aging (physiologic) and premature (non-physiologic) reductions in the oocyte pool. Interpretation of any screening test used requires that age is considered as a variable. To guide clinical interpretation of test results, we suggest using a nomogram of FSH values versus expected delivery rate-per-cycle-start with ART for a given age. Conclusions(s)-Proper interpretation of screening tests for ovarian insufficiency in couplesconsidering ART is important since the presence of impaired ovarian reserve is associated with a low likelihood of pregnancy. The condition of premature (non-physiologic) ovarian insufficiency warrants additional research. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. More than 100 years ago, population studies clearly documented a decrease in fertility with increasing age (1). In today's culture of widely available birth control and workforce equality, women often delay child-bearing to pursue a career. As a result, the childbearing age for women has been delayed from the 20's to the 30's and even into the early 40s (2). This societal shift has resulted in an increase in the number of women who are interested in fertility and have regular cycles, but who are subfertile due to a reduction in their oocyte (egg) supply. Recognition of the profound adverse effect of a reduction in oocyte supply on fertility led to the concept of ovarian reserve and the moniker of 'Diminished Ovarian Reserve' (DOR (5,13,14). NIH Public AccessThe pathophysiology associated with the age-related reduction in fertility (1) is a reduction in the oocyte pool accompanied by an increase in FSH due to reduced feedback from estrogen and inhibins (15). There are also reduced levels of hormones such as anti-Mullerian hormone (AMH) (16). Theoretically, in some women the reduction in the oocyte po...

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“…The difference from our result may be attributed to the small sample size and the fact that our patients had a narrow age range with older patient aged 40 years according to inclusion criteria. [36]. Also, AFC is strongly related to circulating AMH levels since the hormone is produced by antral follicles themselves [12].…”

Section: Items Area Under the Curve (Auc)mentioning

confidence: 99%

Comparison of the Predictive Value of Antral Follicle Count, Anti-Müllerian Hormone and Follicle-Stimulating Hormone in Women Following GnRH-Antagonist Protocol for Intracytoplasmic Sperm Injection

El-Shorbagy¹

2017

OJOG

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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-mülle-rian 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 < 5), normal (oocytes 5 -12) or high responders (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.

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A prospective assessment of the predictive value of basal antral follicles in in vitro fertilization cycles

Cited by 108 publications

References 25 publications

Outcomes of ovarian stimulation after treatment with chemotherapy

Outcomes of ovarian stimulation after treatment with chemotherapy

A new approach to ovarian reserve testing

Comparison of the Predictive Value of Antral Follicle Count, Anti-Müllerian Hormone and Follicle-Stimulating Hormone in Women Following GnRH-Antagonist Protocol for Intracytoplasmic Sperm Injection

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A prospective assessment of the predictive value of basal antral follicles in in vitro fertilization cycles

Cited by 108 publications

References 25 publications

Outcomes of ovarian stimulation after treatment with chemotherapy

Outcomes of ovarian stimulation after treatment with chemotherapy

A new approach to ovarian reserve testing

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

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Comparison of the Predictive Value of Antral Follicle Count, Anti-Müllerian Hormone and Follicle-Stimulating Hormone in Women Following GnRH-Antagonist Protocol for Intracytoplasmic Sperm Injection