Biomarkers of ovarian response Current and future applications
Assessment of current strengths and limitations of antimullerian hormone and antral follicle count as ovarian biomarkers for assisted reproduction and evaluation of their future clinical applications by other health-care providers.
Scott M. Nelson, M.R.C.O.G., Ph.D.
Volume 99, Issue 4, Pages 963-969, 15 March 2013
With our increasing appreciation that simply maximising oocyte yield for all patients is no longer an appropriate stimulation strategy, and that age alone cannot accurately predict ovarian response there has been an explosion in the literature regarding the utility of biomarkers to predict and individualise treatment strategies. Antral follicle count (AFC) and antimüllerian hormone (AMH) have begun to dominate the clinical scene, and although frequently pitted against each other as alternatives, both may contribute and indeed be synergistic. Their underlying technologies are continuing to develop rapidly and overcome the standardisation issues which have limited their development to date. In the context of IVF, their linear relationship with oocyte yield and thereby extremes of ovarian response has led to improved pre-treatment patient counselling, individualisation of stimulation strategies, increased cost-effectiveness and enhanced safety. This review highlights that although biomarkers of ovarian response started in the IVF clinic their future extends well beyond the boundaries of ART. The automation of AMH and its introduction into the routine repertoire of clinical biochemistry will have tremendous potential. A future where primary care physicians, endocrinologists and oncologists can rapidly assess ovarian dysfunction and the ovarian reserve more accurately than the current standard of FSH, is an exciting possibility. For women the ability to know the duration of their own reproductive lifespan will be empowering and allow them to redefine the meaning of family planning.