title: Reproductive aging and variability in the ovarian antral follicle count: application in the clinical setting.
abstract: OBJECTIVE
  To determine the extent of intercycle and interobserver variability in antral follicle (AF) count and their impact on stimulation quality in IVF.
  
  
  METHODS
  Prospective evaluation of the impact on AF count of GnRH agonist down-regulation and interobserver variability. Retrospective evaluation of intercycle variability in AF count.
  
  
  METHODS
  University ART clinic.
  
  
  METHODS
  Twenty subjects were used to evaluate the effect of GnRH agonist down-regulation upon AF count; six of whom were used to evaluate interobserver variability. Fifty patients experiencing two or three cycles of IVF within a 1-year interval.
  
  
  METHODS
  Transvaginal ultrasound exams before and after down-regulation with a GnRH agonist. Videotaped day-3 transvaginal ultrasound exams.
  
  
  METHODS
  [1] Intercycle and interobserver variability in antral follicle count. [2] Oocytes retrieved, peak estradiol, gonadotropin dose, duration of stimulation and cancellation rates.
  
  
  RESULTS
  There is moderate intercycle and interobserver variability in AF counts. GnRH agonist down-regulation does not significantly change AF count. In infertility patients undergoing IVF, paired analysis between the low- and high-AF count cycles did not show a difference in quality of stimulation or cycle cancellation rates.
  
  
  CONCLUSIONS
  Within an individual patient, higher AF count in a given cycle was not predictive of better stimulation compared with the case of a lower count cycle.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Washington Medical Center, Seattle, Washington 98105, USA. krhansen@u.wahsington.edu
authors.forename: Karl R
authors.initials: KR
authors.lastname: Hansen
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Morris
authors.forename: Angela C
authors.initials: AC
authors.lastname: Thyer
authors.forename: Michael R
authors.initials: MR
authors.lastname: Soules
mesh_terms: D000328:Adult; D000375:Aging / Q000502:physiology*; D016022:Case-Control Studies; D015536:Down-Regulation; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D008597:Menstrual Cycle / Q000502:physiology; D015588:Observer Variation; D006080:Ovarian Follicle / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology*; D010902:Pituitary Gland / Q000187:drug effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012098:Reproduction / Q000502:physiology; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D007987:Gonadotropin-Releasing Hormone