The predictive value of antral follicle count remains unchanged across the menstrual cycle

Rombauts, Luk; Onwude, Joseph; Chew, Hong W.; Vollenhoven, Beverley

doi:10.1016/j.fertnstert.2011.09.005

Cited by 26 publications

(14 citation statements)

References 38 publications

(35 reference statements)

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“…In any case, timing of antral follicle count determination does not seem to affect the predictive ability of the test for extremes of response from our results. This is consistent with the retrospective study by Rombauts et al (2011) showing that the AFC retains its predictive ability irrespective of the time in the cycle it was determined.…”

Section: Discussionsupporting

confidence: 91%

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Variation in antral follicle counts at different times in the menstrual cycle: does it matter?

Mavrelos

Chami

Talaulikar

et al. 2016

Reproductive BioMedicine Online

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Antral follicle count (AFC) variation was examined across the menstural cycle and its effect on clinical management assessed. In 79 women, AFC was documented in early (iAFC) and late follicular phase (sAFC). Absolute agreement between iAFC and sAFC and agreement for classification into categories of risk of extremes of ovarian response were examined. Ovarian stimulation protocols designed with iAFC and sAFC, and the predictive value of iAFC and sAFC for extremes of ovarian response, were compared in women undergoing ovarian stimulation. Significant differences were found between iAFC and sAFC (16 [IQR 9-24] versus 13 [IQR 7- 21]; P = 0.001), with moderate agreement for the classification into at risk of extremes of response (k = 0.525). Agreement for protocol selection based on either AFC (k = 0.750) and starting gonadotrophin dose was good (concordance correlation coefficient 0.970 [95% CI 0.951 to 0.982]). Predictive value for iAFC and sAFC was maintained for poor ovarian response and risk of ovarian hyperstimulation syndrome (OR 0.634 [0.427 to 0.920], 0.467 [0.233 to 0.935]) and (OR 1.049 [0.974 to 1.131], 1.140 [1.011 to 1.285]). Across the cycle, AFC varies but does not significantly affect ovarian stimulation protocol design and prediction of extreme ovarian response.

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Section: Discussionsupporting

confidence: 91%

“…A degree of intracycle variability that does not jeopardize these objectives may be acceptable in clinical practice. Indeed some data have been published on this subject: a retrospective study of over 3000 patients, for example, argued that the clinical usefulness of AFC remains unchanged across the cycle (Rombauts et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Variation in antral follicle counts at different times in the menstrual cycle: does it matter?

Mavrelos

Chami

Talaulikar

et al. 2016

Reproductive BioMedicine Online

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“…A P <0.05 was considered statistically significant. A univariate logistic regression was used to estimate the value of an independent variable in predicting the likelihood of collecting ≥4 oocytes (criterion for the classification as a poor ovarian response) [22,28-30], collecting ≥4 MII oocytes, collecting ≥15 oocytes (assessing excessive response) [19,31-35] and clinical pregnancy (determined based on the presence of a gestational sac accompanied by an image of the embryonic/foetal cardiac activity on transvaginal ultrasounds 4 weeks after transfer). The odds ratio (OR) and 95% confidence interval (CI) constituted the descriptive analysis.…”

Section: Methodsmentioning

confidence: 99%

A new ovarian response prediction index (ORPI): implications for individualised controlled ovarian stimulation

Oliveira

Baruffi

Petersen

et al. 2012

Reprod Biol Endocrinol

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BackgroundThe objective was to present a new ovarian response prediction index (ORPI), which was based on anti-Müllerian hormone (AMH) levels, antral follicle count (AFC) and age, and to verify whether it could be a reliable predictor of the ovarian stimulation response.MethodsA total of 101 patients enrolled in the ICSI programme were included. The ORPI values were calculated by multiplying the AMH level (ng/ml) by the number of antral follicles (2–9 mm), and the result was divided by the age (years) of the patient (ORPI=(AMH x AFC)/Patient age).ResultsThe regression analysis demonstrated significant (P<0.0001) positive correlations between the ORPI and the total number of oocytes and of MII oocytes collected. The logistic regression revealed that the ORPI values were significantly associated with the likelihood of pregnancy (odds ratio (OR): 1.86; P=0.006) and collecting greater than or equal to 4 oocytes (OR: 49.25; P<0.0001), greater than or equal to 4 MII oocytes (OR: 6.26; P<0.0001) and greater than or equal to 15 oocytes (OR: 6.10; P<0.0001). Regarding the probability of collecting greater than or equal to 4 oocytes according to the ORPI value, the ROC curve showed an area under the curve (AUC) of 0.91 and an efficacy of 88% at a cut-off of 0.2. In relation to the probability of collecting greater than or equal to 4 MII oocytes according to the ORPI value, the ROC curve had an AUC of 0.84 and an efficacy of 81% at a cut-off of 0.3. The ROC curve for the probability of collecting greater than or equal to 15 oocytes resulted in an AUC of 0.89 and an efficacy of 82% at a cut-off of 0.9. Finally, regarding the probability of pregnancy occurrence according to the ORPI value, the ROC curve showed an AUC of 0.74 and an efficacy of 62% at a cut-off of 0.3.ConclusionsThe ORPI exhibited an excellent ability to predict a low ovarian response and a good ability to predict a collection of greater than or equal to 4 MII oocytes, an excessive ovarian response and the occurrence of pregnancy in infertile women. The ORPI might be used to improve the cost-benefit ratio of ovarian stimulation regimens by guiding the selection of medications and by modulating the doses and regimens according to the actual needs of the patients.

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“…However, this finding should be interpreted with caution. The threshold for a poor response should not be used as the criterion for denying treatment to a patient [36] because a substantial portion of patients below this threshold level are likely to respond well to ovarian stimulation. A false positive test might deter these patients from successful treatment.…”

Section: Discussionmentioning

confidence: 99%

What is the value of anti-Müllerian hormone in predicting the response to ovarian stimulation with GnRH agonist and antagonist protocols?

Knez

Kovačič

Medved

et al. 2015

Reprod Biol Endocrinol

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BackgroundAnti-Müllerian hormone (AMH) is a marker of the ovarian reserve with promising prognostic potential in reproductive medicine. We aimed to evaluate the prognostic ability of AMH for predicting excessive or poor responses to ovarian stimulation using gonadotrophin-releasing hormone (GnRH) agonist and GnRH antagonist protocols in patients undergoing medically assisted reproduction (MAR) procedures.MethodsThis retrospective analysis included 623 women who underwent ovarian stimulation for medically assisted reproduction. AMH level measurements were acquired from all couples within six months of the initiation of ovarian stimulation.ResultsAMH was significantly correlated with the number of retrieved oocytes, and age was not relevant in a multivariate regression analysis (unstandardized regression coefficient of 1.130, 95 % confidence interval 0.977-1.283). AMH was a better predictor of both excessive (>19 oocytes) and poor (<4 oocytes) ovarian response than age (areas under the curve (AUCs) of 0.882 and 0.816, respectively). When stratified according to the stimulation protocol (a long GnRH agonist versus a GnRH antagonist protocol), AMH retained its high predictive value for excessive and poor responses in both groups. Serum AMH levels exhibited a strong correlation with the level of the response to ovarian stimulation.ConclusionsAMH is an independent and an accurate predictor of excessive and poor responses to GnRH agonist and GnRH antagonist protocols for ovarian stimulation.

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The predictive value of antral follicle count remains unchanged across the menstrual cycle

Cited by 26 publications

References 38 publications

Variation in antral follicle counts at different times in the menstrual cycle: does it matter?

Variation in antral follicle counts at different times in the menstrual cycle: does it matter?

A new ovarian response prediction index (ORPI): implications for individualised controlled ovarian stimulation

What is the value of anti-Müllerian hormone in predicting the response to ovarian stimulation with GnRH agonist and antagonist protocols?

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