Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: A meta-analysis and comparison with basal follicle-stimulating hormone level

Abstract

Result(s):We identified 11 studies on AFC and an updated total of 32 studies on basal FSH from the literature on the basis of preset criteria. The estimated summary receiver operating characteristic (ROC) curves showed AFC to perform well in the prediction of poor ovarian response. Also, prediction of poor ovarian response seemed to be more accurate with AFC compared with basal FSH. The estimated summary ROC curves for the prediction of nonpregnancy indicated a poor performance for both AFC and basal FSH. Conclusion(s):Transvaginal ultrasonography is an easy-to-perform and noninvasive method that provides essential predictive information on ovarian responsiveness. The predictive performance of AFC toward poor response is significantly better than that of basal FSH. Therefore, AFC might be considered the test of first choice in the assessment of ovarian reserve prior to IVF. (Fertil Steril 2005;83:291-301 Reproductive aging is associated with a reduction of the primordial follicle pool and loss of oocyte quality (1). The number of follicles leaving the pool of resting follicles to enter the growth phase toward the antral stages of development decreases with increasing age (2).In an IVF program, ovarian aging is characterized by decreased ovarian responsiveness to gonadotropin administration and lowered pregnancy rates. Correct identification of patients at risk of poor ovarian response by assessment of ovarian reserve before entering an IVF program is important.It can help physicians to tailor their advice to individual couples and help patients to decide whether to proceed with a costly and often demanding and disappointing IVF treatment.A recent meta-analysis on the performance of basal FSH level in the prediction of poor ovarian response and failure to become pregnant after IVF showed that a possible clinical application of basal FSH refers to only a minority of patients with extremely high basal FSH levels (3). However, to date basal FSH is still widely used in many fertility centers.Several other endocrine ovarian reserve tests have been proposed as predictors for IVF outcome in the past decade (4). In the field of quantitative ultrasonography, achievements in the development of tests that assess ovarian reserve have also been reported. After the initial reports by Reuss et al. (5) and Scheffer et al. (6) that transvaginal ultrasonography could detect age-related decreases in follicle counts,

A new approach to ovarian reserve testing

“…This additional testing would either support or refute the diagnosis of non-physiologic ovarian insufficiency by increasing the pre-test probability of the condition and, as shown by Hendriks et al (33), could improve the test performance. Clearly, the thresholds for women under age 35 will be very different from women over age 40, and these thresholds should be based on the nomogram.…”

Use of anti-mullerian hormone for testing ovarian reserve: a survey of 796 infertility clinics worldwide

“…In a recent committee opinion, the American Society for Reproductive Medicine (ASRM) concluded that AMH is useful for assessing ovarian reserve in the general IVF patient population and for those patients at risk for decreased ovarian reserve. Additionally, ASRM and the European Society of Human Reproduction and Embryology (ESHRE) state in a Bbest practices^publication that AFC and AMH appear to have the best sensitivity and specificity for measuring poor ovarian response to COH [3,10,11]. Given the large constituency that ASRM and ESHRE address, these committee opinions likely reflect an increase in interest and routine use of AMH by IVF providers.…”

Anti-Müllerian hormone levels as a predictor of the pregnancy rate in women of advanced reproductive age

“…Numerous tests such as follicle stimulating hormone (FSH) [2], estradiol [3], inhibin B [4], and antral follicle counts (AFC) [5], have been suggested to improve prediction of oocyte yield and pregnancy outcome following in ART.…”