Measurement of antral follicle count in patients undergoing in vitro fertilization treatment: results of a worldwide web-based survey.
OBJECTIVE
The purpose of the present study was to identify trends in the therapeutic approaches used to measure antral follicle count (AFC) in patients undergoing in vitro fertilization (IVF) treatment worldwide.


METHODS
A retrospective evaluation utilizing the results of a web-based survey, IVF-Worldwide ( www.IVF-Worldwide.com ), was performed.


RESULTS
Responses from 796 centers representing 593,200 cycles were evaluated. The majority of respondents (71.2 %) considered antral follicle count as a mandatory part of their practice with most (69.0 %) measuring AFC in the follicular phase. Most respondents (89.7 %) reported that they would modify the IVF stimulation protocol based on the AFC. There was considerable variation regarding a limit for the number of antral follicles required to initiate an IVF cycle with 46.1 % designating three antral follicles as their limit, 39.9 % selecting either four or five follicles as their limit, and 14.0 % reporting a higher cutoff criteria. With respect to antral follicle size, 61.5 % included follicles ranging between 2 and 10 mm in the AFC. When asked to identify the best predictor of ovarian hyper-response during IVF cycles, AFC was selected most frequently (49.4 %), followed by anti-Mullerian hormone level (42.7 %). Age was selected as the best predictor of ongoing pregnancy rate in 81.7 % of respondents.


CONCLUSIONS
While a large proportion of respondents utilized AFC as part of their daily practice and modified IVF protocol based on the measurement, the majority did not consider AFC as the best predictor of ongoing pregnancy rate.
Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. mchris21@jhmi.edu.
Mindy S
MS
Christianson
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Gon
G
Shoham
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Womack Army Medical Center, Fort Bragg, NC, USA.
Kyle J
KJ
Tobler
Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Yulian
Y
Zhao
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Christina N
CN
Cordeiro
The Women's Clinic, Hong Kong, SAR, China.
Milton
M
Leong
Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, 76100, Israel.
Zeev
Z
Shoham
D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000639:trends; D006801:Humans; D020407:Internet; D008423:Maternal Age; D006080:Ovarian Follicle / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D054304:Anti-Mullerian Hormone
Antral follicle count; In vitro fertilization; Ovarian reserve