Antral Follicle Count versus Basal Follicle Stimulating Hormone as Predictors of Ovarian Response in Women Undergoing Superovulation with Long Protocol for Assisted Reproduction

Background: the prediction of ovarian response before undertaking the expensive IVF treatment is quite important; it seemed that Patient characteristics, rather than the stimulation protocol are the determinant of the individual response. Advance identification of patient who will elicit a poor response or hyper response to standard treatment would be of great clinical advantage. Several parameters have been postulated as predictors of the ovarian response. Aim of work: to compare between bFSH and AFC in predicting the ovarian response in women undergoing super-ovulation with long protocol for assisted reproduction.
Patients and Methods: this is an observational cohort study that included 80 infertile women who performed IVF/ICSI. It took place at Assisted Reproductive Technology (ART) Unit. Ain shams University Maternity hospital. No extra interventional measures were taken in the study apart from routine investigations and procedures done during ART therapy, being already approved in signed consent to undergo treatment. Patients who are fulfilling the inclusion and exclusion criteria were enrolled in the study. They all underwent superovulation with long GnRH agonist. They were followed up through the stimulation protocol steps, then data were analysed. Results: all basal measured data such as Age p. value =0.035, AFC p. value =0.000, basal FSH p. value =0.000 and basal E2 p. value =0.020 showed statistical significant difference between the good responders and poor responders when both groups were compared, When we apply ROC curve to compare between AFC and basal FSH as regards both (good and poor responders) to detect which one of them is better, there was no statistical significance difference between them with p. value = 0.371, the best cut off point for AFC as a predictor for good responders was found > 3 follicles with sensitivity of 90.5%, specificity of 94.1% and area under curve (AUC) of 97.5%, while while the best cut off point for basal FSH level was found ≤ 8 with sensitivity of 77.78%, specificity of 100% and AUC of 93.7%.
Conclusion: AFC and basal FSH are good predictors of ovarian response in women undergoing superovulation with long protocol. There was no absolute superiority of AFC on basal FSH in predicting ovarian response. Age and basal E2 are also considered good predictors of ovarian response.