Evaluation of age, anti-Müllerian hormone, and antral follicle count as predictors of response to treatment in assisted reproductive technology (ART) cycles in a Maltese population

Abstract

Purpose: Infertility is becoming an increasingly important branch of gynaecology as more and more women are postponing childbearing. Assisted reproductive technologies (ART), were established on the Maltese National Health Service in 2014 and there is a paucity of studies in this area. This is especially so in the field of ovarian reserve and the prediction of how the ovaries will respond to stimulation during an ART cycle. The ultimate aim is to improve the success rate of these treatments. Objectives: The objective of this study was to identify which, among age, Anti-Müllerian hormone (AMH) level and antral follicle count (AFC), performs best at predicting how the ovaries will respond to treatment. Method: This was a retrospective correlational non-experimental study, where 117 patients were assessed for age, AMH, and AFC. Data was collected for the number of oocytes retrieved, the dose of follicle stimulating hormone (FSH) used, the duration of stimulation, as well as pregnancy rates. An analysis of patients having polycystic ovarian syndrome (PCOS) was done to determine if the biomarkers would be any different in this cohort of patients. The AFC was measured on different days of the menstrual cycle to see whether this made a difference to the outcome. Results: Assessed separately, all three markers were useful at predicting the number of oocytes retrieved. Used collectively, however, AFC emerged as the strongest one (p-value 0.000). For the dose of FSH used, all markers used singly were significant, but used together, the predictive effect was less strong than for oocyte number. The markers were not useful at predicting how long stimulation would take, or which of the patients would get pregnant. Conclusion: All three markers were useful during an IVF cycle but in this study, AFC emerged as the strongest marker for prediction of ovarian response to treatment across the entire menstrual cycle.