Background: The use of assisted reproductive technique (ART) is becoming more common in infertility. During ART most patients undergo ovarian stimulation. In this study we study the correlation between ovarian reserve markers: Anti-Mullerian hormone (AMH) and antral follicle count (AFC), and the response to ovarian stimulation at in vitro fertilization (IVF) centres in Douala Cameroon. Methods: This was a hospital based cross-sectional sectional analytic study carried out over a period of 3 years, 4 months at Clinique de l’Aéroport, Clinique Odyssée and Clinique Urogyn. Inclusion criteria were: Female partners of infertile couples undergoing ovarian stimulation for an invitro fertilization cycle, patients who had both ovaries and had done either AMH, AFC or both before ovarian stimulation. Patients were divided into three groups based on the number of oocytes retrieved: low ovarian response for ≤3 oocytes, normal ovarian response for 4 - 15 oocytes and high ovarian response for >15 oocytes. Data obtained was analyzed by SPSS version 25.0. Results: The ages of participants ranged from 20 - 4 7 years, with a mean age of 34.11 ± 5.11 years. Most of them had secondary infertility (57.9%). The GnRH antagonist protocol was mainly used, and ovulation was triggered using HCG predominantly. On Multivariate analysis, age and history of PCOS were significantly associated with ovarian response in the low and high ovarian response groups, respectively. Conclusion: AMH has a better predictive value than AFC, however, it is less sensitive but more specific than AFC.
References
[1]
WHO (2023) 1 in 6 People Globally Affected by Infertility 2023. https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility
[2]
WHO (2023) Infertility Prevalence Estimates, 1990-2021. https://www.who.int/publications/i/item/978920068315
[3]
Carson, S.A. and Kallen, A.N. (2021) Diagnosis and Management of Infertility: A Review. JAMA, 326, 65-76. https://doi.org/10.1001/jama.2021.4788
[4]
(2024) The FIGO Ovulatory Disorders Classification System. https://europepmc.org/article/MED/35983674
[5]
Practice Committee of the American Society for Reproductive Medicine (2020) Electronic Address: asrm@asrm.org, Practice Committee of the American Society for Reproductive Medicine. Testing and Interpreting Measures of Ovarian Reserve: A Committee Opinion. Fertility and Sterility, 114, 1151-1157.
[6]
Moiseeva, A.V., Kudryavtseva, V.A., Nikolenko, V.N., Gevorgyan, M.M., Unanyan, A.L., Bakhmet, A.A., et al. (2021) Genetic Determination of the Ovarian Reserve: A Literature Review. JournalofOvarianResearch, 14, Article No. 102. https://doi.org/10.1186/s13048-021-00850-9
[7]
Lonegroa, N., Nápolia, N., Pesceb, R. and Chacóna, C. (2017) Antral Follicle Count as a Predictor of Ovarian Response. https://www.semanticscholar.org/paper/Antral-follicle-count-as-a-predictor-of-ovarian-Lonegroa-N%C3%A1polia/6c4368669a9fae3114d21591127bc4b71b8e2d5e
[8]
Peck, J.D., Quaas, A.M., Craig, L.B., Soules, M.R., Klein, N.A. and Hansen, K.R. (2015) Lifestyle Factors Associated with Histologically Derived Human Ovarian Non-Growing Follicle Count in Reproductive Age Women. HumanReproduction, 31, 150-157. https://doi.org/10.1093/humrep/dev271
[9]
Barbakadze, L., Kristesashvili, J., Khonelidze, N. and Tsagareishvili, G. (2015) The Correlations of Anti-Mullerian Hormone, Follicle-Stimulating Hormone and Antral Follicle Count in Different Age Groups of Infertile Women. International Journal of Fertility and Sterility, 8, 393-398.
[10]
Moolhuijsen, L.M.E. and Visser, J.A. (2024) Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. The Journal of Clinical Endocrinology & Metabolism, 105, 3361-3373. https://pubmed.ncbi.nlm.nih.gov/32770239/
[11]
Kasia Jean Marie, K.J., Cyrille, N.N.C., Vanina, N.A. and Etienne, B. (2020) Threshold Value of AMH Correlated with an Acceptable Response to Ovarian Stimulation in Patients over 38 Years Old at the Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction. Health Sciences & Disease, 21. http://www.hsd-fmsb.org/
[12]
European Society of Reproductive Medicine (2024) Ovarian Stimulation for IVF/ICSI. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Ovarian-Stimulation-in-IVF-ICSI
[13]
Vuong, T.N.L., Vo, M.T. and Ho, T.M. (2015) Predictive Value of AMH, FSH and AFC for Determining Ovarian Response in Vietnamese Women Undergoing Assisted Reproductive Technologies: A Prospective Study. Journal of Fertilization in Vitro—IVF-Worldwide Reproductive Medicine Genetics & Stem Cell Biology, 3, Article ID: 1000151.
[14]
Permadi, W., Wahyu Ferdian, M., Tjahyadi, D., Ardhana Iswari, W. and Djuwantono, T. (2021) Correlation of Anti-Mullerian Hormone Level and Antral Follicle Count with Oocyte Number in a Fixed-Dose Controlled Ovarian Hyperstimulation of Patients of in Vitro Fertilization Program. International Journal of Fertility and Sterility, 15, 40-43.
[15]
Himabindu, Y., Sriharibabu, M., Gopinathan, K., Satish, U., Louis, T. and Gopinath, P. (2013) Anti-Mullerian Hormone and Antral Follicle Count as Predictors of Ovarian Response in Assisted Reproduction. JournalofHumanReproductiveSciences, 6, 27-31. https://doi.org/10.4103/0974-1208.112377
[16]
Tsakos, E., Tolikas, A., Daniilidis, A. and Asimakopoulos, B. (2014) Predictive Value of Anti-Müllerian Hormone, Follicle-Stimulating Hormone and Antral Follicle Count on the Outcome of Ovarian Stimulation in Women Following GNRH-Antagonist Protocol for IVF/ET. ArchivesofGynecologyandObstetrics, 290, 1249-1253. https://doi.org/10.1007/s00404-014-3332-3
[17]
Sun, X., Xiong, W., Liu, L., Xiong, J., Liao, C., Lan, Y., et al. (2022) Comparison of the Predictive Capability of Antral Follicle Count Vs. the Anti-Müllerian Hormone for Ovarian Response in Infertile Women. FrontiersinEndocrinology, 13, Article 862733. https://doi.org/10.3389/fendo.2022.862733
[18]
Nelson, S.M., Klein, B.M. and Arce, J. (2015) Comparison of Antimüllerian Hormone Levels and Antral Follicle Count as Predictor of Ovarian Response to Controlled Ovarian Stimulation in Good-Prognosis Patients at Individual Fertility Clinics in Two Multicenter Trials. FertilityandSterility, 103, 923-930.e1. https://doi.org/10.1016/j.fertnstert.2014.12.114
[19]
Baker, V.L., Gracia, C., Glassner, M.J., Schnell, V.L., Doody, K., Coddington, C.C., et al. (2018) Multicenter Evaluation of the Access AMH Antimüllerian Hormone Assay for the Prediction of Antral Follicle Count and Poor Ovarian Response to Controlled Ovarian Stimulation. Fertility and Sterility, 110, 506-513.e3.
[20]
Alviggi, C., Andersen, C.Y., Buehler, K., Conforti, A., De Placido, G., Esteves, S.C., et al. (2016) A New More Detailed Stratification of Low Responders to Ovarian Stimulation: From a Poor Ovarian Response to a Low Prognosis Concept. FertilityandSterility, 105, 1452-1453. https://doi.org/10.1016/j.fertnstert.2016.02.005
