Elsevier

Fertility and Sterility

Volume 96, Issue 3, September 2011, Pages 594-599
Fertility and Sterility

Original article
Assisted reproduction
Antral follicle counts are strongly associated with live-birth rates after assisted reproduction, with superior treatment outcome in women with polycystic ovaries

https://doi.org/10.1016/j.fertnstert.2011.06.071Get rights and content

Objective

To evaluate the association of antral follicle count (AFC) with in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) outcome in a large unselected cohort of patients covering the entire range of AFC.

Design

Prospective observational study.

Setting

University-affiliated private infertility center.

Patient(s)

2,092 women undergoing 4,308 IVF-ICSI cycles.

Intervention(s)

AFC analyzed for associations with treatment outcome and statistically adjusted for repeated treatments and age.

Main Outcome Measure(s)

Pregnancy rate, live-birth rate, and stimulation outcome parameters.

Result(s)

The AFC was log-normally distributed. Pregnancy rates and live-birth rates were positively associated with AFC in a log-linear way, leveling out above AFC ∼30. Treatment outcome was superior among women with polycystic ovaries, independent from ovulatory status. The findings were significant also after adjustment for age and number of oocytes retrieved.

Conclusion(s)

Pregnancy and live-birth rates are log-linearly related to AFC. Polycystic ovaries, most often excluded from studies on ovarian reserve, fit as one extreme in the spectrum of AFC; a low count constitutes the other extreme, with the lowest ovarian reserve and poor treatment outcome. The findings remained statistically significant also after adjustment for the number of oocytes retrieved, suggesting this measure of ovarian reserve comprises information on oocyte quality and not only quantity.

Section snippets

Materials and methods

For demographic data, see Table 1. Before their first treatment, all patients were scanned with two-dimensional ultrasound for AFC by one of two investigators (JH, TBe), both with more than 10 years of experience of ovarian scanning. Patients were scanned regardless of the day in their cycle by means of a 7.5 MHz vaginal probe, either with a Pie Medical Scanner 150 or 240 (Pie Medical) or Sonoace X6 (Medison Co., Ltd.). The AFC was recorded as the sum of all follicles of 2 to 10 mm in size.

Results

The AFC ranged from 3 to 80. The mean overall AFC (±standard deviation) was 19.2 (11.7). The pregnancy rate and live-birth rate per started treatment cycle were positively associated with the AFC in a log-linear way (Fig. 1). The pregnancy rate intervals 0% to 15%, 16% to 25%, 26% to 35%, and >35% corresponded to the AFC strata 0–5, 6–11, 12–23, and >23, respectively (see Fig. 1). Above an AFC ∼30 (approximately 25% of all treatments) there was no further increase in pregnancy and live-birth

Discussion

This study demonstrates strong associations between ovarian reserve, measured by AFC, and assisted reproduction outcome. Both pregnancy and live-birth rates were strongly associated with AFC in a log-linear manner, a relationship not previously shown. Women with an AFC above 30, comprising women with polycystic ovaries, showed the highest pregnancy rates. Our findings also suggest that ovarian reserve measured by AFC is not only a quantitative measure but also reflects an age-independent

References (38)

Cited by (0)

J.H. has nothing to disclose. T.B. has nothing to disclose. L.B. has nothing to disclose. N.H. has nothing to disclose. M.O. has nothing to disclose. T.B. has nothing to disclose.

View full text