AMH vs. AFC as Predictive for Pregnancy Rate after ICSI

Abstract

Introduction: In assisted reproduction programs, several parameters known as ovarian reserve markers, such as serum follicle-stimulating hormone (FSH) concentration, antral follicle count (AFC) and serum Anti-Müllerian Hormone (AMH) concentration, are widely used to predict ovarian responses to gonadotropin stimulation during in-vitro fertilization (IVF) treatment.
Aim: To compare the predictive value of Anti-Müllerian Hormone (AMH) and antral follicle count on fertilization rate (FR), implantation rate, blastocyst development, embryo quality, chemical pregnancy, clinical pregnancy and ongoing pregnancy after ICSI.
Method: This quasi-experimental study was conducted in the Department of Obstetrics and Gynecology, El- Minia Infertility Center Faculty of Medicine, El-Minia University, and two private centers during the period from June 2016 to June 2018 after being approved by the department ethical Committee. The study population included 56 subjects aged between 25 and 42 years, enrolled for their first intracytoplasmic sperm injection (ICSI) program. Baseline hormone profiles including serum levels of Estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), and Anti-Müllerian Hormone (AMH) were determined on day 3 of the previous cycle. The antral follicle count measurements were performed on days 3-5 of the same menstrual cycle. Antral follicles within the bilateral ovaries between 2-6 mm were recorded. The subjects were treated with the long protocol for ovarian stimulation. Ovulation was induced with 10,000 IU of human chorionic gonadotropin (hCG) when at least 3 follicles attained the size of more than 17 mm. Transvaginal oocyte retrieval was performed under ultrasound guidance 36 hours after hCG administration.
Results: The mean oocyte counts were 12.27 ± 6.06 and 2.22 ± 1.24 in normal and poor responders, respectively, (P = 001). Multiple regression analysis revealed AMH and antral follicle count as predictors of ovarian response (β coefficient ± SE for AMH was 1.618 ± 0.602 (P = 0.01) and for AFC, it was, 0.528 ± 0.175 (P = 0.004). AFC was found to be a better predictor of pregnancy rate compared to AMH in controlled ovarian hyperstimulation.
Conclusion: This study revealed that both AMH and AFC are good predictors of pregnancy rate; AFC being a better predictor compared to AMH.