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Predictive Value of Antral Follicle Count and Anti-Mullerian Hormone on Ovarian Response and Pregnancy Rates in
Selina Tsz Ching Lee1, Rebecca Siu Fan Wan1, Shui Fan Lai2
1Department of Obstetrics and Gynecology, Princess Margaret Hospital, Kowloon, Hong Kong.
Objectives:
This study aimed to evaluate the predictive performance of antral follicle count (AFC) and anti-Mullerian hormone (AMH) on ovarian response and pregnancy rate during ovarian stimulation using the progestin protocol during in vitro fertilization.
Methods:
This retrospective study included 779 infertile patients who had their first in vitro fertilization cycle using the progestin-priming protocol between May 2022 and December 2023. All patients had a transvaginal ultrasound scan for AFC measurement and blood taken for AMH measurement before the start of ovarian stimulation for an in vitro fertilization cycle. The number of oocytes retrieved, high and poor ovarian responses, and pregnancy rates were evaluated.
Results:
Both AFC and AMH were significantly correlated with the number of oocytes retrieved (r = 0.53, P < 0.001; r = 0.644, P < 0.001, respectively). Multivariable linear regression analysis showed that both AMH and AFC were significant predictors of the number of oocytes retrieved (B = 0.18, P < 0.001 and B = 0.012, P = 0.008, respectively). AMH, but not AFC, was found to be a significant predictor of high ovarian response (OR 1.461; 95% CI 1.305-1.636, P < 0.001) and poor ovarian response (OR 0.51; 95% CI 0.38-0.69, P < 0.001). The receiver operating characteristic curve analysis of AMH in predicting high and low ovarian response showed an area under the curve of 0.901 (95% CI 0.875-0.928) and 0.872 (95% CI 0.829-0.916), respectively. As for pregnancy, both AFC and AMH were not significant predictors.
Conclusions:
Both AFC and AMH were significant predictors on the number of oocytes retrieved in the progestin-primed cycle, while AMH but not AFC predicted both high and poor ovarian response. Neither AMH nor AFC were predictive of pregnancy.
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