Comparison of antral follicle count and serum anti‐Müllerian hormone level for determination of gonadotropin dosing in in‐vitro in‐vitro fertilization: randomized trial

摘要

ABSTRACT Objective To compare the proportion of women achieving a desired ovarian response following ovarian stimulation when gonadotropin dosing was determined based on antral follicle count (AFC) vs serum anti‐Müllerian hormone (AMH) level, in women undergoing in‐vitro fertilization (IVF) using the gonadotropin‐releasing hormone (GnRH) antagonist protocol. Methods This was a randomized double‐blind trial carried out in a university‐affiliated assisted reproduction unit. A total of 200 women undergoing their first IVF cycle using the GnRH‐antagonist protocol between April 2016 and February 2018 were randomized to determination of gonadotropin dosing based on either AFC or serum AMH level measured in the pretreatment cycle 1?month before the IVF cycle. Patients underwent IVF as per our center's standard protocol. The proportion of subjects achieving a desired ovarian response, defined as retrieval of six to 14 oocytes, was compared between the two study arms. Subgroup analysis of patients with baseline AFC ?5 and those with baseline AFC?≤?5 was performed. Concordance in AFC and AMH categorization between the pretreatment cycle and the ovarian‐stimulation cycle was assessed using Cohen's kappa ( κ ). Results There was no significant difference in the proportion of patients achieving a desired ovarian response between the AFC (54%) and AMH (49%) groups ( P ?=?0.479). The median number of oocytes retrieved was nine vs seven ( P ?=?0.070), and the median follicular output rate was 0.54 vs 0.55 ( P ?=?0.764) in the AFC and AMH groups, respectively. Similar findings were observed on subgroup analysis of subjects with AFC?≤?5 and AFC??5 at the start of ovarian stimulation ( P ??0.05 for all comparisons). There was moderate concordance between AFC and AMH measured in the pretreatment cycle and the stimulation cycle ( κ ?=?0.478 and 0.587, respectively). Conclusion The proportion of women achieving a desired ovarian response following ovarian stimulation using the GnRH‐antagonist protocol is similar when the gonadotropin‐dosing algorithm used is based on AFC or serum AMH level. Copyright ? 2019 ISUOG. Published by John Wiley & Sons Ltd.