AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation: a meta-analysis

Purpose To validate the use of the ovarian sensitivity index (OSI) as a measure of ovarian response during in-vitro fertilization (IVF) treatment. Methods This is a retrospective study carried out in an assisted reproduction unit in a teaching hospital. We analysed data from 2,556 women undergoing the first IVF cycle between 2002 and 2009. OSI was calculated as the number of retrieved oocytes divided by total dose of FSH administered (per 1,000 IU). Its correlation to other parameters of ovarian response was compared to that of the oocyte number. Results The correlation coefficients of OSI with age, AFC, AMH, total dose of gonadotrophin, average daily dose of gonadotrophin and duration of stimulation were significantly higher than that of oocyte number with these respective parameters. OSI demonstrated a higher intraclass correlation coefficient (ICC) than the oocyte number when comparing the two parameters across the first and second stimulated IVF cycles. Conclusions OSI is a better measure of ovarian responsiveness to gonadotrophin stimulation than the oocyte number, and is particularly useful when different subjects are treated with different stimulation regimens which would have confounding effect on the oocyte number.

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Ovarian sensitivity index is a better measure of ovarian responsiveness to gonadotrophin stimulation than the number of oocytes during in-vitro fertilization treatment

Lee

et al. 2013

“…Broer et al (2010) performed a meta-analysis to assess the accuracy of AMH and AFC as predictors of excessive response in IVF/ICSI treatment. They identified nine studies reporting on AMH, and five on AFC, reporting no significant difference between the two parameters in predicting excessive response [20]. These findings are consistent with our survey, since both AMH and AFC appear to have clinical value in predicting ovarian hyper-response.…”

Section: Discussionsupporting

confidence: 90%

Measurement of antral follicle count in patients undergoing in vitro fertilization treatment: results of a worldwide web-based survey

Christianson

Shoham

Tobler

et al. 2015

Purpose The purpose of the present study was to identify trends in the therapeutic approaches used to measure antral follicle count (AFC) in patients undergoing in vitro fertilization (IVF) treatment worldwide. Methods A retrospective evaluation utilizing the results of a web-based survey, IVF-Worldwide (www.IVF-Worldwide. com), was performed. Results Responses from 796 centers representing 593,200 cycles were evaluated. The majority of respondents (71.2 %) considered antral follicle count as a mandatory part of their practice with most (69.0 %) measuring AFC in the follicular phase. Most respondents (89.7 %) reported that they would modify the IVF stimulation protocol based on the AFC. There was considerable variation regarding a limit for the number of antral follicles required to initiate an IVF cycle with 46.1 % designating three antral follicles as their limit, 39.9 % selecting either four or five follicles as their limit, and 14.0 % reporting a higher cutoff criteria. With respect to antral follicle size, 61.5 % included follicles ranging between 2 and 10 mm in the AFC. When asked to identify the best predictor of ovarian hyper-response during IVF cycles, AFC was selected most frequently (49.4 %), followed by anti-Mullerian hormone level (42.7 %). Age was selected as the best predictor of ongoing pregnancy rate in 81.7 % of respondents. Conclusions While a large proportion of respondents utilized AFC as part of their daily practice and modified IVF protocol based on the measurement, the majority did not consider AFC as the best predictor of ongoing pregnancy rate.

“…In a recent meta-analysis that assessed the accuracy of AMH and AFC as predictors of an excessive response in IVF/ICSI cycles, sensitivity and specificity rates for AMH were found as 82 and 76 %, and for AFC were 82 and 80 %, respectively. Investigators concluded that both AMH and AFC are accurate predictors of excessive response and both tests appear to have clinical value [3]. Luisi et al [10] more recently showed that secretion of AMH is not influenced by the hypothalamic-ovarian axis activity and is not impaired in hypothalamic amenorrhea.…”

Section: Discussionmentioning

confidence: 99%

Serum anti-Mullerian hormone levels correlate with ovarian response in idiopathic hypogonadotropic hypogonadism

Sönmezer

Özmen

Atabekoglu

et al. 2012

Purpose The role of serum AMH levels in prediction of ovarian response in idiopathic hypogonadotropic hypogonadism (IHH) was evaluated. Material method(s) Twelve patients with IHH underwent controlled ovarian hyperstimulation (COH) for IVF were enrolled in this prospective study. Serum AMH levels were studied on the 2nd or 3rd day of an induced menstrual cycle by a preceding low-dose oral contraceptive pill treatment. A fixed dose (150-300 IU/day) of hMG was given in all COH cycles. Correlations between serum AMH levels, COH outcomes and embryological data were investigated. Results Mean serum AMH levels was 3.47±2.15 ng/mL and mean serum peak estradiol was 2196±1705 pg/mL. Mean number of follicles >14 mm, >17 mm on hCG day and MII oocytes were 4.14±3.2, 4±2.5 and 7.28±3.5, respectively. Mean number of grade A embryos and transferred embryos were 3.28 ± 2.4 and 2.5 ± 0.7, respectively. The clinical pregnancy rate per patient was 41.6 % (5/12). Positive correlations were observed between serum AMH levels and MII oocytes (r00.84), grade A embryos (r00.85), serum peak estradiol levels (r00.87), and number of follicles >14 mm (r00.83) and >17 mm (r00.81) on hCG day, respectively. Conclusion AMH appears as a promising marker of ovarian response in patients with IHH undergoing IVF.