Antral follicle count measured at down-regulation as predictor of ovarian response and cumulative live birth: single center analysis including 2731 long agonist IVF cycles

Abstract

Objective

Evaluate antral follicle count measured after pituitary suppression (AFCaps) with a GnRH agonist as predictor of ovarian response and cumulative live birth (CLB).

Methods

This study is a large cohort analysis of retrospective data between January 2011 and September 2020 in a tertiary-care university hospital. All first initiated IVF/ICSI cycles in women under 43 years of age for whom AFCaps was registered in our database were included. To evaluate CLB rates (CLBRs), only finalized cycles were analyzed (at least one live birth and/or all embryos transferred), excluding PGT cycles and severe male factor requiring testicular sperm extraction.

Results

AFCaps showed a good predictive ability in predicting ovarian response to ovarian stimulation. Predicting poor response, AFCaps presented an area under the receiver-operating characteristic curve (AUC_ROC) of 0.85 (95% CI 0.83–0.87), for high response prediction, the AUC_ROC was 0.80 (95% confidence interval [CI] 0.77–0.83).

Although AFCaps was statistically higher in patients who achieved at least one live birth (13.6 ± 6.05 vs. 9.79 ± 6.33) and CLBRs per started cycle significantly increase between AFCaps quartiles (15.9%, 36.2%, 45.1% and 52.9%) its ability to predict CLBR was modest, with an AUC_ROC of 0.67 (95% CI 0.65–0.69).

Conclusions

Women undergoing their first IVF/ICSI cycle following a long agonist GnRH protocol can be counseled with AFCaps measurement about their probability of achieving poor/high response. Based on this marker physicians can personalize ovarian stimulation with the aim of optimizing ovarian response and minimizing its risks. However, AFCaps has failed to predict CLB per started IVF cycle as an isolated marker.

摘要

目的

评估GnRH激动剂垂体抑制（AFCaps）后测量的窦卵泡计数, 作为卵巢反应和累计活产（CLB）的预测指标。

方法

本研究是对2011年1月至2020年9月在一家三级护理大学医院的回顾性数据进行的大型队列分析。所有在我们的数据库中登记了AFCaps的43岁以下女性中首次启动的IVF/ICSI周期都包括在内。为了评估CLB率（CLBRs）, 只分析了最后确定的周期（至少一次活产和/或所有胚胎移植）, 不包括PGT周期和需要睾丸精子提取的严重男性因素。

结果

AFCaps在预测卵巢对卵巢刺激的反应方面显示出良好的预测能力。预测不良响应时, aFcaps在接收机工作特性曲线下的面积（AUCROC）为0.85（95%可信区间0.83–0.87）, 对于高响应预测, AUCROC为0.80（95%置信区间[CI]0.77–0.83）。尽管在至少活产一次的患者中, AFCaps在统计学上更高（13.6±6.05 vs.9.79±6.33）, 并且每个开始周期的CLBR在AFCap四分位数之间显著增加（15.9%、36.2%、45.1%和52.9%）, 但其预测CLBR的能力是中等的, AUCROC为0.67（95%可信区间0.65–0.69）。

结论

在长期激动剂GnRH方案后进行第一次IVF/ICSI周期的女性, 可通过AFCaps测量获得低/高反应的概率。基于这一标记, 医生可以个性化卵巢刺激, 以优化卵巢反应并将其风险降至最低。然而, AFCaps未能预测每开始IVF周期的CLB作为一个孤立的标志物。

Keywords:

• Antral follicle count
• ovarian reserve
• ovarian response
• cumulative live birth
• GnRH agonist
• IVF-ICSI outcome

关键词:

• 窦卵泡计数
• 卵巢储备
• 卵巢反应
• 累计活产
• GnRH激动剂
• IVF-ISCI结果

Acknowledgements

The authors wish to thank N Rodríguez for his statistical support and D. Pringle for her English language assistance.

Disclosure statement

The authors report no conflicts of interest.

Funding

The author(s) reported there is no funding associated with the work featured in this article.