Antral follicle count, anti-mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology?
OBJECTIVE
The objective of this study was to evaluate the relationship between anti-mullerian hormone (AMH), inhibin B and antral follicle count (AFC) with ovarian response.


METHODS
Retrospective study.


METHODS
Fertility unit.


METHODS
AFC was recorded, and a serum sample obtained on day 3 from all patients undergoing in vitro fertilisation (IVF). Patients were given 300 IU/L recombinant follicle stimulating hormone (FSH; Gonal F). The following day blood samples were collected. METHODS Serum samples were assayed for FSH, AMH and inhibin B using commercial immunoassay kits and oestradiol using an in house assay.


METHODS
Response to gonadotrophin stimulation and the number of eggs collected.


RESULTS
AFC was negatively correlated to age (r=-0.426, P < 0.001). Delta inhibin B (levels of inhibin B on day 4 minus day 3) had the best association to the number of eggs collected (r= 0.533, P < 0.001) followed by basal AMH (r= 0.51, P < 0.001) and AFC (r= 0.505, P < 0.001). The number of eggs fertilised was significantly associated with basal AMH (r= 0.592, P < 0.001) and inhibin B (r= 0.548, P < 0.001). AMH with a cutoff of 0.2 ng/mL had the best sensitivity (87%) and specificity (64%) in predicting poor response. A cumulative score using basal FSH, basal AMH, delta E2 (levels of oestradiol on day 4 minus day 3), delta inhibin B, AFC and age gives the best predictive statistics to identify poor responders with 87% sensitivity and 80% specificity and a positive likelihood ratio of 4.36.


CONCLUSIONS
Delta inhibin B had the best positive association with the number of eggs collected and basal AMH is the single best predictor of poor response. AFC has a significant association with the number of eggs collected and is predictive of clinical pregnancy. It is evident that a single parameter is of limited value in predicting ovarian response. However, we have demonstrated a cumulative score using all the above markers could be useful in predicting poor response.
Muttukrishna
S
S
Department of Obstetrics and Gynaecology, University College London, London, UK.
McGarrigle
H
H
Wakim
R
R
Khadum
I
I
Ranieri
D M
DM
Serhal
P
P
D000328:Adult; D054304:Anti-Mullerian Hormone; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D006023:Glycoproteins / Q000378:metabolism*; D006801:Humans; D007265:Inhibins / Q000378:metabolism*; D015588:Observer Variation; D006080:Ovarian Follicle; D010062:Ovulation Induction; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013735:Testicular Hormones / Q000378:metabolism*
D006023:Glycoproteins; D013735:Testicular Hormones; C422364:inhibin B; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone