The Antral Follicle Count Predicts the Outcome of Pregnancy in a Controlled Ovarian Hyperstimulation/Intrauterine Insemination Program

AbstractPurpose:Our purpose was to test whether age-related changes in antral follicle counts can predict the pregnancy outcome in the early follicular phase of a controlled ovarian hyperstimulation/intrauterine insemination (COH/IUI) program. Methods:A selected group of 107 women (36 healthy women requesting child sex preselection, 52 women with unexplained infertility, and 19 with minimal endometriosis) who underwent controlled ovarian hyperstimulation with clomiphene citrate (CC) plus human menopausal gonadotrophin (hMG) and subsequent intrauterine insemination were enrolled in the study. Transvaginal ultrasonography (7.0 MHz) was used to determine the total number of antral follicles (2–8 mm) in the right and left ovaries. The association among the antral follicle count, age, dominant follicle, and estradiol (E2) level on the day of human chorionic gonadotropin (hCG) was analyzed. The association of the pregnancy rate and OHSS with the antral follicle count, dominant follicle count, and age was also examined. Results:The total antral follicle number decreased with age (P<0.0001). Dominant follicle number increased with total antral follicle number in women who received CCplus hMG/ IUI (P<0.0001). The pregnant group had a higher number of antral follicle and dominant follicles in comparison with the nonpregnant group (P<0.01 and P<0.02, respectively). The E2level on the day of hCG injection increased positively with the total number of antral follicles (P<0.0001) and the total number of dominant follicles (P<0.0001). In women aged younger than 35 years, the pregnancy rate and dominant follicle number rose as the number of antral follicles increased (P<0.03 and P<0.0001, respectively). The pregnancy rate was low (2/39) in women aged older than 35 years regardless of the number of antral follicles (P<0.05) and the extent of hMG administration (P<0.02). Women aged older than 35 also produced fewer dominant follicles (P<0.001). No pregnancy was achieved in a patient with an antral follicle number of less than five (17 cases). Conclusions:Age-related changes in antral follicle count significantly predicted the dominant follicle count and the pregnancy outcome. In women with antral follicle counts of less than five or who are older than 35 years, the application of COH/IUI may not be indicated.

[1]  S. Muasher,et al.  Basal follicle-stimulating hormone level is a better predictor of in vitro fertilization performance than age. , 1991, Fertility and sterility.

[2]  T. Mukherjee,et al.  An elevated day three follicle-stimulating hormone:luteinizing hormone ratio (FSH:LH) in the presence of a normal day 3 FSH predicts a poor response to controlled ovarian hyperstimulation. , 1996, Fertility and sterility.

[3]  E. Wallach.  Pitfalls in evaluating ovarian reserve. , 1995, Fertility and sterility.

[4]  Z. Rosenwaks,et al.  The role of maternal age in assisted reproduction. , 1995, Human reproduction.

[5]  M. Faddy,et al.  Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. , 1992, Human reproduction.

[6]  Z. Rosenwaks,et al.  Follicle-stimulating hormone levels on cycle day 3 are predictive of in vitro fertilization outcome. , 1989, Fertility and sterility.

[7]  Z. Rosenwaks,et al.  Results of in vitro fertilization attempts in women 40 years of age and older: the Norfolk experience. , 1987, Fertility and sterility.

[8]  I. Timor-Tritsch,et al.  Age and the ovarian follicle pool assessed with transvaginal ultrasonography. , 1996, American journal of obstetrics and gynecology.

[9]  J. Garcia,et al.  Prognostic value of the early serum estradiol response to leuprolide acetate in in vitro fertilization. , 1990, Fertility and sterility.

[10]  J. Hall,et al.  Prognostic value of day 3 estradiol on in vitro fertilization outcome. , 1995, Fertility and sterility.

[11]  Z. Rosenwaks,et al.  PROGNOSTIC ASSESSMENT OF FEMALE FECUNDITY , 1987, The Lancet.

[12]  H. Martikainen,et al.  Pretreatment transvaginal ultrasound examination predicts ovarian responsiveness to gonadotrophins in in-vitro fertilization. , 1997, Human reproduction.

[13]  J. Nisker,et al.  Future in vitro fertilization pregnancy potential of women with variably elevated day 3 follicle-stimulating hormone levels. , 1996, Fertility and sterility.

[14]  D. Navot,et al.  Evaluation of the reproductive performance of women with elevated day 10 progesterone levels during ovarian reserve screening. , 1995, Fertility and sterility.

[15]  E. Block,et al.  Quantitative morphological investigations of the follicular system in women; variations at different ages. , 1952, Acta anatomica.

[16]  R. Casper,et al.  The response to ovarian hyperstimulation and in-vitro fertilization in women older than 35 years. , 1990, Human reproduction.

[17]  S. Oehninger,et al.  The gonadotropin-releasing hormone agonist stimulation test--a sensitive predictor of performance in the flare-up in vitro fertilization cycle. , 1991, Fertility and sterility.

[18]  W. Dodson,et al.  Effect of age on response to human menopausal gonadotropin stimulation. , 1990, The Journal of clinical endocrinology and metabolism.