Inter-cycle and inter-observer variability of the antral follicle count in routine clinical practice

Subirá, Jessica; Alberola-Rubio, José; Núñez, Marı́a José; Escrivá, Alicia Marzal; Pellicer, António; Montañana, Vicente; Díaz-García, César

doi:10.1080/09513590.2017.1291614

Cited by 21 publications

(10 citation statements)

References 27 publications

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“…Secondly, our findings may be of interest also for non-malignant cases. In fact, AFC varies during the menstrual cycles but these variations may not be significant for clinical practice [35], i.e., they may only mildly influence counseling and clinical decisions. Van Disseldorp et al [15] examined the intracycle variability of AFC and showed an up to 30% variability while Mavrelos et al [16] and Rombauts et al [17] showed that this variability may not be clinically significant.…”

Section: Discussionmentioning

confidence: 99%

Fertility preservation in women with malignancies: the accuracy of antral follicle count collected randomly during the menstrual cycle in predicting the number of oocytes retrieved

Filippi

Martinelli

Paffoni

et al. 2018

J Assist Reprod Genet

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Purpose To evaluate the capacity of random antral follicle count (AFC), i.e., AFC recorded at any time during the menstrual cycle, to predict the number of retrieved mature oocytes in women with malignancies undergoing random start ovarian hyperstimulation Methods A consecutive series of 72 women with malignancies who underwent ovarian hyperstimulation aimed at egg freezing between July 2014 and December 2016 was retrospectively reviewed. A standardized random start protocol was used for all women. AFC and serum AMH were systematically assessed prior to initiating ovarian hyperstimulation. The main outcome was the retrieval of ≥ 10 mature oocytes. The accuracy of random AFC was tested with the c-statistics (area under the ROC curve). Results For the whole cohort, the c-statistics for the prediction of ≥ 10 mature oocytes using AFC and serum AMH were similar. Specifically, the areas under the curve were 0.76 (95%CI 0.66-0.87) and 0.82 (95%CI 0.72-0.92), respectively (p = ns). Moreover, when considering the subgroup of women recruited after day 5 of the cycle (proper random start, n = 52), the areas under the curve did not also differ. Specifically, they resulted in 0.77 (95%CI 0.64-0.89) and 0.83 (95%CI 0.72-0.95), respectively (p = ns). Conclusions AFC collected at any time during the menstrual cycle can provide valuable information for the counseling of women with malignancies scheduled for oocyte cryopreservation. Its reliability appears to be non-inferior to that of serum AMH.

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Section: Discussionmentioning

confidence: 99%

Fertility preservation in women with malignancies: the accuracy of antral follicle count collected randomly during the menstrual cycle in predicting the number of oocytes retrieved

Filippi

Martinelli

Paffoni

et al. 2018

J Assist Reprod Genet

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“…On the other hand, some previous studies demonstrated significant intercycle variation with AFC, especially in young infertile women 16 . Some have also demonstrated moderate intercycle variation with AFC 17,18 .…”

Section: Discussionmentioning

confidence: 86%

Comparing the intercycle variation of serum anti‐Mullerian hormone and antral follicle count measurements over four consecutive menstrual cycles

Wong

et al. 2022

Clinical Endocrinology

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Objective To compare the intercycle variation of serum anti‐Mullerian hormone (AMH) and antral follicle count (AFC) measurements over four consecutive menstrual cycles. Design Observational study with secondary analysis using data from two previous randomized controlled trials. Patients Seventy‐eight women from two previous randomized trials on the effect of dehydroepiandrosterone pretreatment on ovarian response in women undergoing in vitro fertilization (IVF) treatment. Measurements The intraclass correlation coefficients (ICC) for AFC and AMH across the four study cycles, as well as their predictive performance on poor ovarian response, were compared. Results No significant difference was observed in AMH (p = .608) across the four study cycles. AFC was significantly higher at 4 weeks before ovarian stimulation compared with 0, 8 and 12 weeks before ovarian stimulation (p < .05, Conover posthoc test). Both single‐measures and average‐measures ICC were significantly higher with AMH than with AFC. The areas under the receiver operating characteristic curve of the four AFC measurements in predicting poor ovarian response (defined as three or less oocytes retrieved) in the IVF cycle ranged from 0.657 to 0.743 with no significant difference (p > .05) among the four cycles, whereas those of the four AMH measurement ranged from 0.730 to 0.780 with no significant difference (p > .05) among the four cycles. Conclusions Although both AFC and AMH are good predictors of ovarian response, intercycle repeatability was significantly better with serum AMH than AFC measurement. Both have no significant difference in their predictive performance on poor ovarian response when assessed within three months before IVF treatment, hence allowing pre‐IVF assessment at more flexible timing.

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“…The AFC was determined by different operators using different machines. Although the reported AFC inter-observer variability is low ( 47 ), we cannot exclude that variations in technique and reporting have influenced patient classification. Besides, we did not assess prevalence rates using AMH due to excessive missing data.…”

Section: Discussionmentioning

confidence: 96%

Low Prognosis by the POSEIDON Criteria in Women Undergoing Assisted Reproductive Technology: A Multicenter and Multinational Prevalence Study of Over 13,000 Patients

Esteves¹,

Yaralı́

Vuong

et al. 2021

Front. Endocrinol.

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ObjectiveTo estimate the prevalence of low-prognosis patients according to the POSEIDON criteria using real-world data.DesignMulticenter population-based cohort study.SettingsFertility clinics in Brazil, Turkey, and Vietnam.PatientsInfertile women undergoing assisted reproductive technology using standard ovarian stimulation with exogenous gonadotropins.InterventionsNone.Main outcome measuresPer-period prevalence rates of POSEIDON patients (overall, stratified by POSEIDON groups and by study center) and the effect of covariates on the probability that a patient be classified as “POSEIDON”.ResultsA total of 13,146 patients were included. POSEIDON patients represented 43.0% (95% confidence interval [CI] 42.0–43.7) of the studied population, and the prevalence rates varied across study centers (range: 38.6–55.7%). The overall prevalence rates by POSEIDON groups were 44.2% (group 1; 95% CI 42.6–45.9), 36.1% (group 2; 95% CI 34.6–37.7), 5.2% (group 3; 95% CI 4.5–6.0), and 14.4% (group 4; 95% CI: 13.3–15.6). In general, POSEIDON patients were older, had a higher body mass index (BMI), lower ovarian reserve markers, and a higher frequency of female factor as the primary treatment indication than non-POSEIDON patients. The former required larger doses of gonadotropin for ovarian stimulation, despite achieving a 2.5 times lower number of retrieved oocytes than non-POSEIDON patients. Logistic regression analyses revealed that female age, BMI, ovarian reserve, and a female infertility factor were relevant predictors of the POSEIDON condition.ConclusionsThe estimated prevalence of POSEIDON patients in the general population undergoing ART is significant. These patients differ in clinical characteristics compared with non-POSEIDON patients. The POSEIDON condition is associated with female age, ovarian reserve, BMI, and female infertility. Efforts in terms of diagnosis, counseling, and treatment are needed to reduce the prevalence of low-prognosis patients.

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Inter-cycle and inter-observer variability of the antral follicle count in routine clinical practice

Cited by 21 publications

References 27 publications

Fertility preservation in women with malignancies: the accuracy of antral follicle count collected randomly during the menstrual cycle in predicting the number of oocytes retrieved

Fertility preservation in women with malignancies: the accuracy of antral follicle count collected randomly during the menstrual cycle in predicting the number of oocytes retrieved

Comparing the intercycle variation of serum anti‐Mullerian hormone and antral follicle count measurements over four consecutive menstrual cycles

Low Prognosis by the POSEIDON Criteria in Women Undergoing Assisted Reproductive Technology: A Multicenter and Multinational Prevalence Study of Over 13,000 Patients

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