title: Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization.
abstract: BACKGROUND
  The current study was designed to compare antral follicle count (AFC) and basal ovarian volume (BOV), the exogenous FSH ovarian reserve test (EFORT) and the clomiphene citrate challenge test (CCCT), with respect to their ability to predict poor and hyper responders.
  
  
  METHODS
  One hundred and ten regularly menstruating patients, aged 18-39 years, participated in this prospective study, randomized, by a computer designed 4-blocks system study into two groups. Fifty six patients underwent a CCCT, and 54 patients underwent an EFORT. All patients underwent a transvaginal sonography to measure the basal ovarian volume and count of basal antral follicle. In all patients, the test was followed by a standard IVF treatment. The result of ovarian hyperstimulation during IVF treatment, expressed by the total number of follicles, was used as gold standard.
  
  
  RESULTS
  The best prediction of ovarian reserve (Y) was seen in a multiple regression prediction model that included, AFC, Inhibin B-increment in the EFORT and BOV simultaneously (Y = -3.161 + 0.805 x AFC (0.258-1.352) + 0.034 x Inh. B-incr. (0.007-0.601) + 0.511 BOV (0.480-0.974) (r = 0.848, p < 0.001). Univariate logistic regression showed that the best predictors for poor response were the CCCT (ROC-AUC = 0.87), the bFSH (ROC-AUC = 0.83) and the AFC (ROC-AUC = 0.83). Multiple logistic regression analysis did not produce a better model in terms of improving the prediction of poor response. For hyper response, univariate logistic regression showed that the best predictors were AFC (ROC-AUC = 0.92) and the inhibin B-increment in the EFORT (ROC-AUC = 0.92), but AFC had better test characteristics, namely a sensitivity of 82% and a specificity 89%. Multiple logistic regression analysis did not produce a better model in terms of predicting hyper response.
  
  
  CONCLUSIONS
  In conclusion AFC performs well as a test for ovarian response being superior or at least similar to complex expensive and time consuming endocrine tests. It is therefore likely to be the test for general practise.
authors.affiliation: Vrije Universiteit Medical Center, Amsterdam, The Netherlands. j.kwee@vumc.nl
authors.forename: Janet
authors.initials: J
authors.lastname: Kwee
authors.forename: Mariet E
authors.initials: ME
authors.lastname: Elting
authors.forename: Roel
authors.initials: R
authors.lastname: Schats
authors.forename: Joseph
authors.initials: J
authors.lastname: McDonnell
authors.forename: Cornelis B
authors.initials: CB
authors.lastname: Lambalk
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D002996:Clomiphene / Q000494:pharmacology; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis; D009929:Organ Size; D006080:Ovarian Follicle / Q000166:cytology* / Q000000981:diagnostic imaging; D010050:Ovarian Function Tests / Q000379:methods; D010053:Ovary / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000187:drug effects; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011379:Prognosis; D012044:Regression Analysis; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene