OVARIAN VOLUME AND ANTRAL FOLLICLE COUNT FOR THE PREDICTION OF OVARIAN RESPONSE DURING IN VITRO FERTILIZATION

Abstract

Background: IVF is the most sophisticated and effective treatment for infertility. Ovarian
response to gonadotrophin stimulation is crucial for successful IVF outcome. Presently
there is no consensus on the best predictor of ovarian response between AFC, ovarian
vol, day 3 FSH and maternal age.
Objective: The current study was designed to compare the prediction of ovarian
response during IVF treatment by AFC, ovarian volume, day 3 FSH and maternal age.
Methods: This was a prospective cohort study in a university teaching hospital assisted
conception unit involving 222 women undergoing IVF treatment. All patients had
transvaginal sonography to measure the basal ovarian volume and basal antral follicle
count on day 3 of the treatment cycle. Basal FSH was assayed prior to the treatment
cycle. In all patients, the test was followed by a standard IVF treatment. The result of
controlled ovarian hyperstimulation during IVF treatment, expressed by the total number
of follicles and oocyes retrieved, was used to assess ovarian response.
Results: Of the 222 women who were eligible for the study, 76 (34.2%) had primary
infertility while 116(52.3%) had secondary infertility. There was no identifiable cause for
infertility in 30 (13.5%) couples. The mean day 10 follicle count, mean number of
oocytes retrieved and embryo transferred significantly increased with increasing basal
antral follicle count (AFC) (p<0.0001) and ovarian volume (0.0001) while the mean dose
of HMG used for stimulation significantly decreased with increasing AFC and ovarian
volume (p<0.0001). The mean day 10 follicle count, mean number of oocytes retrieved
and mean number of embryos transferred significantly decreased with increasing age
(0.0001). Multiple linear regression analysis, showed that basal antral follicles [(r= 0.632), (p0.001)] and basal ovarian volume [(r=0.555), (p<0.001)] were positively
correlated with the number of oocytes retrieved hence predicted good response. Age [(r
= -0.623) (p<0.001)] and day 3FSH [(r= -0.303) (p<0.001) showed a negative correlation
with the no of oocytes retrieved. The overall pregnancy rate was 26.1%.
Conclusion: This study suggests that the antral follicle count provides better prognostic
information on the occurrence of poor response during hormone stimulation for IVF than
does the patient’s chronological age and day 3 FSH. However, endocrine tests remain
informative.

OVARIAN VOLUME AND ANTRAL FOLLICLE COUNT FOR THE PREDICTION OF OVARIAN RESPONSE DURING IN VITRO FERTILIZATION