A prospective, comparative analysis of anti-Müllerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation.
OBJECTIVE
To compare three-dimensional ultrasound parameters, antral follicle count (AFC), ovarian volume, and ovarian vascularity indices with anti-Müllerian hormone (AMH) and other conventional endocrine markers for the prediction of poor response to controlled ovarian hyperstimulation (COH) during assisted reproduction treatment (ART).


METHODS
Prospective study.


METHODS
University-based assisted conception unit.


METHODS
One hundred thirty-five women undergoing the first cycle of ART.


METHODS
Transvaginal three-dimensional ultrasound assessment and venipuncture in the early follicular phase of the menstrual cycle immediately before ART.


METHODS
Poor ovarian response and nonconception.


RESULTS
Antral follicle count (Exp(B): 0.65) and AMH (Exp(B): 0.13) were the most significant predictors of poor ovarian response on multiple regression analysis and their predictive accuracy was similar, with an area under the curve (AUC) of 0.935 and 0.905, respectively. The AFC and AMH, as a combined test, did not significantly improve the level of prediction (AUC = 0.946). The sensitivity and specificity for prediction of poor ovarian response were 93% and 88% for AFC and 100% and 73% for AMH at an optimum cutoff values of < or =10 and < or =0.99 ng/mL, respectively. Age (Exp(B): 1.191) was the only significant predictor of nonconception, although its predictive accuracy was also low (AUC = 0.674).


CONCLUSIONS
The AFC and AMH are the most significant predictors of poor response to ovarian stimulation during ART. The AMH and AFC, either alone or in combination, demonstrate a similar predictive power but are not predictive of nonconception, which is dependent on the woman's age.
Jayaprakasan
Kannamannadiar
K
Nottingham University Research and Treatment Unit in Reproduction, Division of Human Development, School of Clinical Sciences, University of Nottingham, Nottingham, Nottinghamshire NG7 2UH, United Kingdom. jayaprakasan@hotmail.co.uk
Campbell
Bruce
B
Hopkisson
James
J
Johnson
Ian
I
Raine-Fenning
Nick
N
D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002452:Cell Count; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D021621:Imaging, Three-Dimensional; D007247:Infertility, Female / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy; D007265:Inhibins / Q000097:blood*; D016014:Linear Models; D015999:Multivariate Analysis; D006080:Ovarian Follicle / Q000166:cytology* / Q000000981:diagnostic imaging*; D010062:Ovulation Induction / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D015203:Reproducibility of Results; D027724:Reproductive Techniques, Assisted; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D015415:Biomarkers; C422364:inhibin B; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone