Anti-Müllerian Hormone (AMH) vs Antral Follicle Count (AFC) for defining the starting dose of Follicle-Stimulating Hormone (FSH) for art

Abstract

Introduction: Despite widespread use, the optimal starting dose of gonadotropins in controlled ovarian stimulation (COS) protocols has not been clearly established.

Objective: This study was designed to compare the efficacy and safety of two simple dosing algorithms, one based on anti-Müllerian Hormone (AMH) and the other on the antral follicle count (AFC), to determine the starting dose of recombinant follicle-stimulating hormone (r-FSH) for COS in women undergoing assisted reproductive technology (ART).

Methods: Controlled ovarian stimulation was performed using down-regulation protocol. After 14 days of GnRH agonist administration, patients were randomized to a predefined AMH- or AFC-based algorithm for determination of the r-FSH starting dose.

Results: The number of cycles with the desired response was similar when r-FSH dose was determined using AMH or AFC (36.1% vs 29%, p = 0.2). However, there was a significant difference between the two groups in the number of cycles with a hyper-response (8.9% in the AMH group vs 17.8% in the AFC group, p = 0.02), but the incidence of ovarian hyperstimulation syndrome (OHSS) was similar. There were no significant differences between groups in outcomes per embryo transfer, including implantation, clinical pregnancy, multiple pregnancy and miscarriage. However, statistically significant differences were evident when the different predefined level subgroups of AMH or AFC were compared.

Conclusion: The two algorithms are equally effective for defining the starting dose of rFSH, however, the cut-offs need to be re-identified. This study provides useful information from which to develop protocols to further validate the use of either AMH or AFC to guide the starting dose of r-FSH in COS protocols.