Evaluation of three-dimensional SonoAVC ultrasound for antral follicle count in infertile women: its agreement with conventional two-dimensional ultrasound and serum levels of anti-Müllerian hormone

Abstract

BackgroundSeveral studies have reported a correlation between antral follicle count by conventional 2D transvaginal sonography and serum anti-Müllerian hormone levels. However, few studies have investigated the effectiveness of 3D SonoAVC transvaginal ultrasound technology, particularly in infertile women. Therefore, this study aims to evaluate the usefulness of three-dimensional (3D) SonoAVC transvaginal ultrasound technology for antral follicle count and its correlation to conventional two-dimensional (2D) transvaginal ultrasound and serum levels of anti-Müllerian hormone in infertile women.MethodsThis cross-sectional study included 42 infertile women with age lower than 40 years that underwent treatment at a private fertility clinic between June and December 2015. Patient data included age, body mass index and cause of infertility. On cycle day 3 the following hormone levels were measured: serum levels of anti-Müllerian hormone, follicle-stimulating hormone, cancer antigen 125, prolactin, thyroid-stimulating hormone and oestradiol; the number of antral follicles was counted as well. The scanning were performed through 2D and 3D technology transvaginal ultrasound.ResultsUsing a Bland-Altman test we demonstrated that both technologies are quite equivalent. However, antral follicle count is higher using 3D ultrasound technology compared to 2D technology (p < 0.001; Wilcoxon test), this finding is mainly remarkable in ovaries with more than 20 antral follicles. Moreover, the mean time required for manual 2D ultrasound and 3D SonoAVC measurements were 275 ± 109 and 103 ± 57 s, respectively (p < 0.001). Serum AMH concentration correlated to the total number of early antral follicles (correlation coefficients = 0.678 and 0.612; p < 0.001 by 2D ultrasound and 3D SonoAVC, respectively; Spearman’s correlation test).ConclusionsAntral follicle count is better estimated using 3D ultrasound compared to 2D technology. A great advantage of 3D SonoAVC was less time required for an examination and the visual advantage when it need to count more than 20 follicles.Trial registration CAAE: 35141114.4.0000.5327. Registered 10 June 2015.

Women in Advanced Reproductive Age: Are the Follicular Output Rate, the Follicle-Oocyte Index and the Ovarian Sensitivity Index Predictors of Live Birth in an IVF Cycle?

“…First of all, one should consider that each of the parameters used for the calculation of the three metrics are operator dependent. The follicle count, which registered a reduction in inter-individual variability with the introduction of three-dimensional (3D) technology [30], is still widely evaluated in 2D in most centers, as in the present study. Such a variable is inevitably affected by the skill and the accuracy of the operator.…”

Antral follicle responsiveness assessed by follicular output RaTe(FORT) correlates with follicles diameter

“…Some limitations of this study need to be highlighted, such as the absence of the power to correlate the antral follicle size with the main outcomes of interest in human reproduction, the pregnancy and live birth rates, and the fact that an interobserver difference in ultrasound measures can exist, especially because we used manual bidimensional ultrasound equipment. Additionally, studies with novels ultrasound technologies and among other populations, such as those of polycystic ovaries patients and those with different IVF stimulation protocols, are necessary to endorse the use of the antral follicle size as a predictor of ovarian responsiveness [25].…”

Women in Advanced Reproductive Age: Are the Follicular Output Rate, the Follicle-oocyte Index and the Ovarian Sensitivity Index Predictors of Live Birth in an IVF Cycle?

“…First of all, one should consider that each of the parameters used for the calculation of the three metrics are operator-dependent. The follicle count, which registered a reduction in inter-individual variability with the introduction of 3D technology [29], is still widely evaluated in 2D in most of the centers, as in the present study. Such a variable is inevitably affected by the skill and the accuracy of the operator.…”