Role of Baseline Antral Follicle Count and Anti-Mullerian Hormone in Prediction of Cumulative Live Birth in the First In Vitro Fertilisation Cycle: A Retrospective Cohort Analysis

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Purpose This retrospective cohort study evaluated the cumulative live birth rate in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovaries (PCO) undergoing in-vitro fertilisation (IVF) treatment. Methods We studied 104 women with PCOS, 184 with PCO and 576 age-matched controls undergoing the first IVF treatment cycle between 2002 and 2009. The main outcome measure was cumulative live birth in the fresh plus all the frozen embryo transfers combined after the same stimulation cycle. Results Women in both the PCOS (n =104) and isolated PCO groups (n =184) had higher ovarian response parameters compared to age-matched controls (n =576), and higher rates of withholding fresh embryo transfer for risk of ovarian hyperstimulation syndrome (OHSS). The actual incidence of moderate to severe OHSS was significantly higher in the PCOS (11.5 %) but not the isolated PCO group (8.2 %) compared to controls (4.9 %). The live birth rates in the fresh cycle were comparable among the 3 groups, but the PCOS group had a significantly higher miscarriage rate compared to the other 2 groups. Cumulative live birth rate was significantly higher in the isolated PCO group (60.3 %), but not the PCOS group (50.0 %), compared to controls (47.5 %).Conclusions Women in the isolated PCO group, but not the PCOS group, had a significantly higher cumulative live birth rate compared to controls. This could be explained by the quantitative effect of the higher number of transferable embryos obtained per stimulation cycle, which is uncompromised by the unfavourable embryo competence otherwise observed in PCOS.

“…Details of the stimulation cycle have been previously reported [17]. All patients included under this study were treated on the long GnRH agonist protocol for pituitary down-regulation.…”

Section: Stimulation Cyclementioning

confidence: 99%

Cumulative live-birth rate in women with polycystic ovary syndrome or isolated polycystic ovaries undergoing in-vitro fertilisation treatment

Lee

Lau

et al. 2013

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“…Details of the stimulation cycle have been previously reported [1]. Subjects were treated on either the long GnRH agonist or GnRH antagonist protocol, the latter mostly being applied to expected poor ovarian responders.…”

Section: Ovarian Stimulation Cyclementioning

confidence: 99%

“…The responsiveness to gonadotrophin stimulation is a factor which has important implications on treatment success [1] as well as the risk of complications such as cycle cancellation and ovarian hyperstimulation syndrome (OHSS). On one hand, a good ovarian response upon stimulation implies a higher number of oocytes and thus transferrable embryos after the same stimulation cycle, leading to an increased chance of achieving cumulative live birth, compared to situations of poor ovarian response.…”

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

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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.

“…Hsu et al (2011), in a retrospective cohort study of 1049 IVF cycles, showed that while AFC did predict ovarian response, it did not predict pregnancy or live birth rate [21]. Li et al (2013) demonstrated in a retrospective study of 1156 women undergoing their first IVF cycle that while both AMH and AFC revealed significant correlation with age and ovarian response, regression analysis showed that both AMH and AFC were not significant predictors of cumulative live birth after adjusting for age [22].…”

Section: Discussionmentioning

confidence: 98%

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.