Evaluating the relationships between serum level of FSH, E2, AMH and AFC with ovarian response in women undergoing ovarian stimulation for invitro fertilization

Abstract

Background: Optimal evaluation of ovarian reserve is essential for success of assisted reproductive technology (ART). Serum level of FSH, E2, AMH and AFC have been demonstrated to be correlated with ovarian response in ART. However, their predictive value remains somewhat controversial. Objectives: This prospective study was designed to compare the predictive values of serum level of FSH, E2, AMH and AFC in ovarian response to ovarian stimulation for in vitro fertilization. Materials & methods: 53 infertility women undergoing the first cycle of IVF were prospectively studied. On day 2 of the menstrual cycle, measurements of FSH, E2, AMH and ultrasound evalutation of antral follicle count (AFC) were performed. All patients underwent IVF treatment using GnRH antagonist protocol with rFSH and hp-hMG. The outcome measures were the total dose of FSH, the number of follicles ≥14mm and peak Estradiol levels on the day of hCG, and the number of retrieved oocytes. The relationships between the serum level of FSH, E2, AMH AFC and these parameters were evaluated. Results: There was a significant difference of serum AMH levels in poor responders, normal responders and high responders (1,19 ± 0,39 ng/mL; 3,41 ± 1,82; 6,55 ± 2,07 ng/mL; p<0,01). The serum basal FSH levels was significant higher in poor responders than in normal and in high responders (7,32 ± 2,19 vs 5,99 ± 1,43 mIU/m và 5,50 ± 1,51 mIU/mL; p< 0,01). AFC was significant lower in poor responders than in the other groups (3,57 ± 1,13 vs 8,59 ± 3,80 và 10,57 ± 3,41; p<0,01). No significant differences were observed in the serum Estradiol levels in the different groups. The number of follicles ≥14mm and the number of retrieved oocytes significantly strongly correlated with AMH ( r = 0,73 and r = 0,62); with AFC (r = 0,75 and r = 0,56); significantly weakly correlated with basal FSH levels (r = -0,37 and r= -0,42) but didn’t correlate with basal Estradiol levels. Conclusion: AMH and AFC correlates better than FSH and E2 with the ovarian response. AMH may offer a better prognostic value for poor, normal and high response. Serum basal FSH correlates weakly with ovarian response, and predicts only poor response. There is not a correlation between serum basal Estradiol and ovarian response.