Antral follicle count valuable marker for predicting treatment outcomes in diminished ovarian reserve patients undergoing IVF: Study
Diminished ovarian reserve is defined as a decrease in oocyte quality and quantity in the ovaries of patients with infertility. The prevalence of diminished ovarian reserve is 26% among infertile patients treated with assisted reproductive technology (ART). Assessment of ovarian reserve involves using biochemical markers in the blood and ultrasound imaging of the ovary. Markers such as basal estradiol (E2), follicle-stimulating hormone (FSH), inhibin B, Anti Müllerian hormone (AMH), and Antral follicle count (AFC) are used to evaluate ovarian reserve.
While ovarian reserve markers may not predict reproductive potential in the general population, they can help predict the success of ovarian stimulation in infertile patients. Using ovarian reserve markers outside the context of infertility treatment may lead to unnecessary interventions and cause anxiety and depression among patients. These markers should not be used to exclude patients from undergoing in vitro fertilization (IVF) treatment, even if their AMH levels are extremely low.
Although definitive criteria for diminished ovarian reserve do not exist, certain organizations define cut-off values to identify this patient group. These include an AMH value 10 IU/L, and a history of poor response to IVF stimulation, as described by the American Society for Reproductive Medicine (ASRM). This study aimed to investigate the relationship between ovarian reserve markers and clinical pregnancy outcomes in women with diminished ovarian reserve treated with IVF therapy.
The study included 480 DOR patients who underwent IVF treatment. Serum levels of AMH and follicle-stimulating hormone (FSH) were measured, and AFC was determined through ultrasound examination. Patients were divided into embryo transfer-positive and -negative groups based on the outcome of their treatment cycles. Clinical pregnancy rates were compared among quartiles of AMH, FSH, and AFC.
The study found that AFC was a more valuable for predicting positive results (OR: 2.7, R2=0.324, p<0.001), while AMH was more valuable for predicting negative results (OR: 4.6, R2=0.324, p=0.02) regarding achieving embryo transfer in DOR patients. The clinical pregnancy rates did not differ significantly among quartiles of AMH and FSH levels. However, there was a significant difference in clinical pregnancy rates among quartiles of AFC (p=0.015). The ROC analysis revealed that AFC had a higher area under the curve compared to AMH, indicating better predictive value.
In the present study, authors found that the clinical pregnancy group had significantly higher mean AFC among patients with diminished ovarian reserve (DOR). Additionally, patients who achieved embryo transfer had significantly higher mean AMH levels and AFC counts, while FSH and E2 levels were significantly lower. The mean age of women was similar between groups when stratified by clinical pregnancy and embryo transfer outcomes. This similarity minimized the confounding effect of age on IVF success and allowed us to more accurately assess the predictive performance of ovarian reserve markers independent of age.
In conclusion, the present study found that AFC was a positive predictor, while AMH was a negative predictor for achieving embryo transfer in DOR patients. However, the clinical pregnancy rates did not differ significantly among quartiles of AMH and FSH levels. These findings suggest that AFC may be a more reliable marker than AMH for predicting treatment outcomes in DOR patients undergoing IVF. Further research is needed to better understand the predictive value of ovarian reserve markers in this patient population and to identify other factors that may influence treatment success.
Source: Arica et al. / Indian Journal of Obstetrics and Gynecology Research 2025;12(4):651–656
