title: AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation: a meta-analysis.
abstract: BACKGROUND
  Anti-Mullerian hormone (AMH) is a marker of ovarian reserve status and represents a good predictor of ovarian response to ovarian hyperstimulation. The aim of this study was to assess the accuracy of AMH and antral follicle count (AFC) as predictors of an excessive response in IVF/ICSI treatment.
  
  
  METHODS
  A systematic review and meta-analysis of the existing literature was performed. Studies were included if 2 × 2 tables for the outcome excessive response in IVF patients in relation to AMH/AFC could be constructed. Using a bivariate meta-analytic model, both summary point estimates for sensitivity and specificity were calculated, as well as summary ROC curves. Clinical value was analysed by calculating post-test probabilities of excessive response at optimal cut-off levels, as well as the corresponding abnormal test rates.
  
  
  RESULTS
  Nine studies reporting on AMH and five reporting on AFC were found. Summary estimates of sensitivity and specificity for AMH were 82 and 76%, respectively, and 82 and 80%, respectively, for AFC. Comparison of the summary estimates and ROC curves for AMH and AFC showed no statistical difference. Abnormal test rates for AMH and AFC amounted to ∼14 and 16%, respectively, at cut-off levels where test performance is optimal [likelihood ratio for a positive result (LR + ) > 8], with a post-test probability of ± 70%.
  
  
  CONCLUSIONS
  Both AMH and AFC are accurate predictors of excessive response to ovarian hyperstimulation. Moreover, both tests appear to have clinical value. This opens ways to explore the potential of individualized FSH dose regimens based on ovarian reserve testing.
authors.affiliation: Department of Reproductive Medicine and Gynecology, University Medical Center, GA Utrecht, The Netherlands. s.l.broer@umcutrecht.nl
authors.forename: S L
authors.initials: SL
authors.lastname: Broer
authors.forename: M
authors.initials: M
authors.lastname: Dólleman
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: B C
authors.initials: BC
authors.lastname: Fauser
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.forename: F J M
authors.initials: FJ
authors.lastname: Broekmans
mesh_terms: D054304:Anti-Mullerian Hormone / Q000032:analysis*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D006080:Ovarian Follicle / Q000166:cytology*; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced / Q000175:diagnosis*; D010062:Ovulation Induction / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone