Anti-Müllerian hormone versus antral follicle count for defining the starting dose of FSH

Abstract

This pilot study compared the efficacy and safety of two simple dosing algorithms, one based on anti-Müllerian Hormone (AMH) and the other on the antral follicle count (AFC), to determine the starting dose of recombinant FSH (rFSH) for ovarian stimulation in 348 women. Patients were randomized to a predefined AMH- or AFC-based algorithm. The proportion of cycles with the desired response was similar when rFSH dose was determined using AMH or AFC (35.2% versus 28.4%). There was a significant difference between the groups in the proportion of cycles with a hyperresponse (8.6% and 17.4%, but the incidence of ovarian hyperstimulation syndrome was similar (1.1% and 4.6%). There were no significant differences between two groups in outcomes, including implantation (19.3% versus 19.0%), clinical pregnancy (38.0% versus 46.9%), multiple pregnancy (16.5% versus 15.2%) and miscarriage (7.0% versus 8.3%). However, statistically significant differences in ovarian response were evident among the AMH and AFC subgroups: for AMH, Desired and Hypo; for AFC, Hypo and Hyper. This pilot study provides information for developing protocols to further validate the use of either AMH or AFC to guide the starting dose of rFSH in ovarian stimulation. The ideal outcome for couples undergoing IVF treatment is the birth of a healthy baby. One factor that might influence this is retrieving an adequate number of eggs, which are obtained using various treatment protocols. A group of drugs called gonadotrophins have been used for more than 20years to stimulate the ovaries to produce eggs. However, the dose to start treatment has not been clearly defined. A few studies have looked at ways to use the best gonadotrophin dose for each woman, but to be useful in the clinic any approach needs to be simple and easy to use. This study compared the effectiveness and safety of two simple approaches to determining the starting dose of recombinant FSH (rFSH) for ovarian stimulation in women undergoing IVF. One was based on the concentration of a hormone secreted by developing eggs (anti-Müllerian hormone; AMH) and the other on the number of developing follicles (antral follicle count; AFC). The number of cycles achieving the desired response in terms of number of eggs was similar when rFSH dose was guided using AMH or AFC, and the incidence of ovarian hyperstimulation syndrome was also similar. In addition, rates of clinical pregnancy, multiple pregnancy and miscarriage did not differ between the two groups. However, patients with low AMH concentrations or low AFC had a poor response to ovarian stimulation. This pilot study provides useful information from which new studies can further assess these approaches to personalizing treatment during IVF.

Comparison of antral follicle count and serum anti‐Müllerian hormone level for determination of gonadotropin dosing in in‐vitro fertilization: randomized trial

“…Yet, the GnRH‐antagonist protocol has been adopted increasingly in recent years for its simplicity and lower risk of ovarian hyperstimulation syndrome associated with its use. Therefore, the findings from the present study, which essentially concur with those of Lan et al ,. reinforce our knowledge on this issue as applied to IVF cycles following the GnRH‐antagonist protocol.…”

“…Despite the respectable sample size included, these meta‐analyses were based on different studies with possible heterogeneity and biases incurred. To our knowledge, there has been only one randomized trial comparing the AFC‐based and AMH‐based gonadotropin‐dosing algorithms, which showed no difference in the proportion of women having the desired number of oocytes retrieved in either group. In that study, it was not known if the subjects and clinicians were blinded, and women were treated exclusively following the long GnRH‐agonist protocol.…”

“…When classifying AFC values into low (≤ 5), normal (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) or high (> 15), there was moderate concordance between AFC categorization measured in the pretreatment vs in the stimulation cycle (κ = 0.478) (Table 3). Likewise, by classifying AMH into low (≤ 1.0 ng/mL), normal (> 1.0 and ≤ 3.3 ng/mL) or high (> 3.3 ng/mL), there was moderate concordance between AMH categorization Table 2 Comparison by intention-to-treat analysis of ovarian-stimulation parameters and pregnancy outcome in 200 women undergoing in-vitro fertilization using gonadotropin-releasing hormone (GnRH) antagonist protocol, according to whether gonadotropin dosing was based on antral follicle count (AFC) or serum anti-Müllerian hormone (AMH) level Data are given as n (%) or median (interquartile range).…”

Anti‐Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know?

“…Several different algorithms, in which AMH levels play the main role, have been proposed. These studies have mainly focused on the response to the initial dose of FSH during the assisted reproduction cycle [20][21][22], and successful reduction of unwanted responses (cycle cancellation or OHSS) has been reported [18,22,23].…”

Maximizing the clinical utility of antimüllerian hormone testing in women's health

“…Recent research has targeted developing specific ovarian stimulation protocols individualized by AMH results [16 ▪▪ ,17 ▪ ]. Other recent studies focus on refining information such as demonstrating that an AMH value from a single point in time will remain predictive for approximately 12 months [18], how certain stimulation protocols affect different patient phenotypes such as PCOS vs. low responders [19 ▪▪ ,20], and prospectively demonstrating that application of AMH testing can improve expectation management and possibly treatment costs [21].…”