Are Serum Antimulleran Hormone, Follicle Stimulating Hormone and Antral Follicle Count Measurment Can Predict Pregnancy Rates in IVF/ICSI cycle

Abstract

Studies on the use of Antimullerian hormone (AMH) as a marker for ovarian ageing in women have recently started. As AMH is largely expressed throughout folliculogenesis, from the primary follicular stage towards the antral stage, serum levels of AMH may represent both the quantity and quality of the ovarian follicle pool. The development of vaginal colour and pulse Doppler ultrasound has resulted in the recent tendency to evaluate the quality and the developmental competence of the oocyte using the ovarian vascular change in women undergoing IVF. It has been reported that prefollicular blood flow characteristics could be a marker for evaluating the quality of oocytes and the developmental competence of the corresponding embryos. A study was conducted in the Assisted Reproduction Unit, Masr Al dawly. It included 100 infertile women undergoing intracytoplasmic sperm injection (ICSI) for treatment of infertility. All women were subjected to pituitary down regulation using either the short or the long protocols applied by the unit. On day 3 of the induction cycle, serum AMH was measured and a transvaginal ultrasound scan was performed to determine the number of antral follicles and the mean ovarian volume. On the day of HCG administration, serum AMH was measured again and perifollicular blood flow was assessed using colour Doppler transvaginal ultrasound. Results showed that the number of good responders was 33 (33%) and poor responders were 67 (67%). Both day-3 and end-of-cycle AMH levels were significantly higher (p<0.001) in the good response group. There was a highly significant (p<0.01) difference between the two groups as regards Doppler resistance index, being higher in the poor response group. There was also a highly significant positive correlation (p>0.05) between serum AMH and both the number of retrieved oocytes and the number of grade 1 embryos. There was a highly significant negative correlation between Doppler resistance indexes and both the number of retrieved oocytes and the number of grade one embryos. There was a highly significant positive correlation (p<0.01) between serum AMH and both antral follicle count. Serum AMH showed the highest sensitivity (81.8%) and specificity (91.0%) as a test for prediction of ovarian response. On the other hand, the AFC, despite showing high sensitivity (100%), showed a very low specificity (34.3%).