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.
AMH; AFC; ICSI; Implantation Rate; Pregnancy Rate
In assisted reproduction programs, a number of 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 invitro fertilization (IVF) treatment. These markers may help to decide on the initial dose and regimen of stimulation [1,2]. Among the commonly used ovarian reserve markers, AFC and AMH provide the best performance in predicting both poor and excessive ovarian response [3-5]. However, most reports consistently showed a poor predictive value of these markers on pregnancy rate in the fresh IVF cycle [4,6]. AMH, also known as Mullerian-inhibiting substance, is a dimeric glycoprotein that belongs to the transforming growth factor-beta family. It is involved in the regression of the Mullerian ducts during development of the male foetus . In the adult female, AMH is exclusively produced by granulosa cells of preantral and small antral follicles, and has been shown to correlate excellently with the primordial follicle pool . Hence it would serve as an ovarian reserve marker. Since AMH performs equally well, if not better, than AFC in predicting ovarian response and that it is both operator and menstrual cycle-independent, there has been a growing trend to adopt AMH assay as the first-line ovarian reserve test [2,9]. In modern-day assisted reproduction programmes, embryo cryopreservation has become an integral component. It allows the storage and subsequent usage of surplus good quality embryos in frozen-thawed embryo transfer (FET) cycles. Hence, to evaluate the outcome of an IVF cycle, it would be more logical to consider the cumulative live birth rate from the fresh and all FET cycles combined, instead of merely looking at the single fresh cycle outcome. There have been limited data on the role of these ovarian reserve markers in predicting cumulative pregnancy or live birth rates in IVF programmes. A study looked at the use of AMH on Day 6 of ovarian stimulation in predicting cumulative ongoing pregnancy outcome . Yet AMH levels can be altered after commencement of ovarian stimulation [11-13].