Department of Obstetrics and Gynecology, Bursa Uludag University School of Medicine, Bursa, Turkey.
Department of Histology and Embryology, Bursa Uludag University School of Medicine, Bursa, Turkey.
J Obstet Gynaecol. 2022 Jul;42(5):1461-1466. doi: 10.1080/01443615.2021.2003309. Epub 2022 Jan 7.
This retrospective study aims to determine the more predictive ovarian reserve marker when there is discordance between anti-Müllerian hormone (AMH) and antral follicle count (AFC) in patients with diminished ovarian reserve (DOR). Patients who underwent ICSI because of DOR were divided into three groups. Group 1: patients with low AMH (<1.1 ng/ml) and AFC ( < 7), group 2: patients with low AMH (<1.1 ng/ml) and normal AFC ( ≥ 7) and group 3: patients with normal AMH (≥1.1 ng/dl) and low AFC ( < 7). Demographic values, follicle output rate (FORT) score and follicle to oocyte index (FOI) score of the groups were compared. Totally, 662 cycles were enrolled in the study. There were 418 cycles in group 1, 167 cycles in group 2 and 77 cycles in group 3. As the primary result, FORT and FOI scores were higher in group 3 than the other two groups. Median FORT Score with quartiles: group 1: 100 (66-150), group 2: 71 (57-100), group 3: 136 (96-200), <.01 - median FOI score with quartiles: group 1: 83 (50-140), group 2: 71 (40-100), group 3: 116 (66-216), <.01. In conclusion, serum AMH level has more predictive value for stimulation success if there is discordance with AFC.Impact Statement Female age, serum Anti-Müllerian Hormone (AMH) levels, and antral follicle count (AFC) are commonly used to assess ovarian reserve and predict response to ovarian stimulation. AMH and AFC are both positively correlated with ovarian reserve. If there is discordance between AFC and AMH in patients with diminished ovarian reserve (DOR), the ovarian response is better in patients with high AMH and low AFC than the patients with low AMH and high AFC. It is important to assess both AFC and AMH before controlled ovarian hyperstimulation, to predict ovarian response in DOR patients, rather than assessing AFC or AMH alone.
这项回顾性研究旨在确定在卵巢储备功能降低（DOR）患者的抗苗勒管激素（AMH）和窦卵泡计数（AFC）之间存在差异时，哪种卵巢储备标志物更具预测性。因 DOR 而接受 ICSI 的患者被分为三组。第 1 组：AMH（<1.1ng/ml）和 AFC（<7）均低的患者；第 2 组：AMH（<1.1ng/ml）低但 AFC（≥7）正常的患者；第 3 组：AMH（≥1.1ng/dl）正常但 AFC（<7）低的患者。比较三组的人口统计学值、卵泡输出率（FORT）评分和卵泡与卵母细胞指数（FOI）评分。研究共纳入 662 个周期。第 1 组 418 个周期，第 2 组 167 个周期，第 3 组 77 个周期。主要结果显示，第 3 组的 FORT 和 FOI 评分均高于其他两组。中位数 FORT 评分四分位数：第 1 组：100（66-150）；第 2 组：71（57-100）；第 3 组：136（96-200），<.01-中位数 FOI 评分四分位数：第 1 组：83（50-140）；第 2 组：71（40-100）；第 3 组：116（66-216），<.01。结论：如果 AMH 水平与 AFC 不一致，血清 AMH 水平对刺激成功更有预测价值。
