Comparison of antral follicle count, antimullerian hormone and day 2 follicle stimulating hormone as predictor of ovarian response and clinical pregnancy rate in patient with an abnormal ovarian reserve test

Jayakrishnan Krishnakumar, Akansha Agarwal, Divya Nambiar, Shankar Radhakrishnan


Background: Patients having abnormal ovarian reserve test are likely to have poor response to controlled ovarian stimulation (COS) in artificial reproduction technique, where large number of follicles is desirable. Although direct measurement of the primordial follicle pool is impossible, it has been shown that the number of antral follicles in the ovaries is proportionally related to the size of primordial follicle stock from which they were recruited. Therefore, the antral follicle count (AFC) is believed to represent the quantitative aspect of ovarian aging. The aim of the study was to To compare the  day two Antral follicle count, antimullerian hormone and  Follicle stimulating hormone levels as a predictor of ovarian response among the patients undergoing controlled ovarian stimulation using GnRH antagonist and its implications in clinical pregnancy rate.

Methods: A prospective study was conducted in KJK Hospital Trivandrum on 119 patients having abnormal ovarian reserve test undergoing controlled ovarian stimulation (COS) with GnRH antagonist protocol from January 2010- December 2015. Patients AFC, AMH and FSH levels were measured and their association in predicting the ovarian reserve in terms of oocyte maturation, fertilization and embryo cleavage and their pregnancy rate.

Results: AFC had the highest accuracy for predicting ovarian response in patient with abnormal ovarian reserve test and was statistically significant (number of oocyte aspirated p value <0.001) than AMH (p value 0.06) and FSH (p value 0.212) in predicting ovarian response. For prediction of poor ovarian response a model including AFC+AMH was found to be almost similar to that of (p value 0.001) using AFC alone. However AFC (p value 0.458), AMH (p value 0.267) and FSH (p value 0.486) did not predict pregnancy rate in patient with abnormal ovarian reserve test and it was statistically not significant.

Conclusions: This study indicates that AFC is the most useful marker in predicting the ovarian response. Doing AFC assessment alone would be more cost effective for predicting the ovarian response in patients undergoing controlled ovarian stimulation with GnRH antagonist.


AFC, AMH, FSH, Controlled ovarian hyperstimulation, Gonadotropin releasing hormone antagonist

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