Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: A meta-analysis and comparison with basal follicle-stimulating hormone level

Hendriks, Dave J.; Mol, Ben-Willem J.; Bancsi, László F.J.M.M.; te Velde, Egbert R.; Broekmans, Frank J.M.

doi:10.1016/j.fertnstert.2004.10.011

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Volume 83, Issue 2 , Pages 291-301, February 2005

Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: A meta-analysis and comparison with basal follicle-stimulating hormone level

Presented as an oral presentation at the 20th Annual Meeting of the European Society of Human Reproduction and Embryology in Berlin, Germany, June 27–30, 2004.

Dave J. Hendriks, M.D.
- Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
- Reprint requests: D. J. Hendriks, M.D., University Medical Center Utrecht, Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands (FAX: 31-30-2505433
Ben-Willem J. Mol, Ph.D.
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
László F.J.M.M. Bancsi, Ph.D.
- Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
Egbert R. te Velde, Ph.D.
- Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
Frank J.M. Broekmans, Ph.D.
- Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands

Received 14 May 2004; received in revised form 13 August 2004; accepted 13 August 2004.

Objective

To assess the predictive performance of the antral follicle count (AFC) as a test for ovarian reserve in IVF patients and to compare this performance with that of basal FSH level.

Design

Meta-analysis.

Setting

Tertiary fertility center.

Patient(s)

Patients undergoing IVF.

Intervention(s)

None.

Main outcome measure(s)

Poor ovarian response, nonpregnancy.

Result(s)

We identified 11 studies on AFC and an updated total of 32 studies on basal FSH from the literature on the basis of preset criteria. The estimated summary receiver operating characteristic (ROC) curves showed AFC to perform well in the prediction of poor ovarian response. Also, prediction of poor ovarian response seemed to be more accurate with AFC compared with basal FSH. The estimated summary ROC curves for the prediction of nonpregnancy indicated a poor performance for both AFC and basal FSH.

Conclusion(s)

Transvaginal ultrasonography is an easy-to-perform and noninvasive method that provides essential predictive information on ovarian responsiveness. The predictive performance of AFC toward poor response is significantly better than that of basal FSH. Therefore, AFC might be considered the test of first choice in the assessment of ovarian reserve prior to IVF.

Key words: Antral follicle count , basal FSH , IVF , poor response , pregnancy , meta-analysis