Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women

Capsule:
While AFC and age are predictive of live birth following IVF treatment, AFC demonstrates a stronger positive correlation. This study illustrates post-test probabilities of live birth at individual AFC thresholds.

Authors:
Kannamannadiar Jayaprakasan, Ph.D., YeeYin Chan, M.B.B.S., Rumana Islam, M.B.B.S., Zeina Haoula, M.R.C.O.G., James Hopkisson, M.D., Arri Coomarasamy, M.D., Nick Raine-Fenning, Ph.D.

Volume 98, Issue 3, Pages 657-663, September 2012

Abstract:

Objective:
To estimate the probability of live birth, adverse treatment outcome, and extremes of ovarian response at different antral follicle count (AFC) cutoff levels in a large prospective cohort of women undergoing IVF treatment.

Design:
Prospective study.

Setting:
University-based assisted conception unit.

Patient(s):
A total of 1,012 consecutive subjects of all ages undergoing their first cycle of assisted reproductive techniques.

Intervention(s):
Transvaginal three-dimensional ultrasound assessment and venipuncture in the early follicular phase of the menstrual cycle.

Main Outcome Measure(s):
Live birth rate, poor ovarian response, and ovarian hyperstimulation syndrome (OHSS).

Result(s):
Analysis was performed in 1,012 subjects. Both age (r = 0.88) and AFC (r = 0.92) thresholds show significant linear relationship with the probability of live birth, but AFC demonstrates a stronger correlation. At AFC quartiles of 3–10, 11–15, 16–22, and ≥23, the mean live birth rates were 23%, 34%, 39%, and 44%, respectively. No live birth was observed in women with AFC

Conclusion(s):
Although age and AFC are significantly correlated with live birth, AFC demonstrates a stronger correlation. Antral follicle count thresholds are useful to predict live birth rates and risks of poor ovarian response and OHSS during IVF treatment.

  • Jayaprakasan

    Thank you for your comment Laurenwroth. I agree completely with your comments about the limitation of this study that we did not use AMH, which we have mentioned in our discussion. We did not have AMH for all patients instead we have for about 200 plus patients. We shall try to publish one when we have a large number with AMH data.

  • laurenwroth

    This is a really interesting study with a somewhat surprising result (AFC was a better predictor of live birth than age!). There are major pluses of the study including its large size and that it was prospective in nature. I think a major limitation to the study was no report of AMHs. We know that AFC and AMH are correlated with each other but it would be interesting to see if one is a better predictor of live birth than the other. Also, gives good information about the use of 3D ultrasound in ART.

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