title: Comparing four ovarian reserve markers--associations with ovarian response and live births after assisted reproduction.
abstract: BACKGROUND
  We compared the ability of four different ovarian reserve tests (ORTs) to predict live births per started in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycle, and poor and excessive response to controlled ovarian hyperstimulation.
  
  
  METHODS
  This was a cohort study in a private infertility center in collaboration with Uppsala University, comprising 1230 IVF-ICSI cycles in 892 consecutive women between April 2008 and June 2011. Anti-Müllerian hormone (AMH) levels, antral follicle counts (AFC), combinations of basal levels of follicle-stimulating hormone and luteinizing hormone, and menstrual cycle lengths were analyzed for correlation and treatment outcome prediction in age-adjusted statistical models. Stepwise multivariable generalized estimating equation analyses were carried out in a sub-group with complete data on all four ORTs (620 cycles in 443 women). Odds ratios and c-statistics were calculated in the largest available set of data for each significant variable. Primary outcomes were live birth rate per started cycle and poor and excessive ovarian response to controlled ovarian hyper-stimulation (defined by the ovarian sensitivity index).
  
  
  RESULTS
  All ORTs correlated significantly with each other, with the strongest correlation between AFC and AMH (r = 0.71, p < 0.0001). Univariately, AMH and age equivalently predicted live birth (c-statistic 0.61), and together they provided a significantly better model (c-statistic 0.64). For prediction of poor and excessive response the best model included AMH, AFC and age (c-statistic 0.89).
  
  
  CONCLUSIONS
  AMH improves the ability to estimate live birth rates after assisted reproduction compared with female age alone. AMH, AFC and age together constituted the best model for prediction of ovarian response.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.|Carl von Linné Clinic, Uppsala, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brodin
authors.affiliation: Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: Nermin
authors.initials: N
authors.lastname: Hadziosmanovic
authors.affiliation: Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Berglund
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Matts
authors.initials: M
authors.lastname: Olovsson
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.|Carl von Linné Clinic, Uppsala, Sweden.|Centre for Reproductive Biology in Uppsala (CRU), Uppsala, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Holte
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D050498:Live Birth / Q000453:epidemiology; D007986:Luteinizing Hormone / Q000097:blood; D006080:Ovarian Follicle / Q000166:cytology; D010050:Ovarian Function Tests; D065851:Ovarian Reserve / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods; D020554:Sperm Injections, Intracytoplasmic
chemical_list: D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
keywords: Antral follicle counts; anti-Müllerian hormone; follicle-stimulating hormone; in vitro fertilization; menstrual cycle length; ovarian reserve tests