A comparison of the accuracy of AMH, FSH, and AFC for predicting poor ovarian response and cycle cancellation in in-vitro fertilization

Abstract

Introduction: Poor ovarian response to controlled ovarian stimulation is associated with low numbers of oocytes retrieved and low pregnancy rate. Prediction of ovarian response is vital for the pre-treatment counseling and management of these patients, reducing their psychological, physical and financial burden. Objectives: To compare the accuracy of AMH, FSH, and AFC and to indentify their cut-offs for predicting ovarian response. Methods: A prospective cohort study was conducted on 820 patients. Each patient had AMH, FSH and AFC measured on cycle day 2. Poor ovarian response was diagnosed when patients had ≤ 3 oocytes retrieved or had the cycle cancelled due to no follicular development. Results: The rate of poor response was 13.8% and cycle cancellation was 3.4%. The AMH test was the most accurate in predicting poor ovarian response, followed by AFC, and the least accurate predictive test was the FSH. AMH ≤ 1.25 ng/ml predicted poor ovarian response of ≤ 3 oocytes with a sensitivity of 86.7% and specificity of 84.8%; AMH ≤ 0.77 ng/ml predicted cycle cancellation with a sensitivity of 96.4% and specificity of 84.5%. Conclusion: AMH has the highest accuracy in predicting poor ovarian response. Clinicians who adopt the study results and cut-off values into clinical practice should further consider the capability of the center and other patients’ information in order to counsel the patients about the possibility of being poor responders, their success rate, their choice of treatment methods, and the appropriate protocol and dosage of FSH for ovarian stimulation.