WHICH IS MORE PREDICTIVE OVARIAN RESERVE MARKER WHEN THERE IS DISCORDANCE BETWEEN ANTI - MULLERIAN HORMONE AND ANTRAL FOLLICLE COUNT IN PATIENTS WITH DIMINISHED OVARIAN RESERVE, AMH OR AFC?

To determine the most predictive ovarian reserve parameter in patients with diminished ovarian reserve Retrospective Cohort Study The study was conducted at Bursa Uludag University Hospital, ART Center. Patients who underwent ICSI because of diminished ovarian reserve, age < 40, without chronic systemic disease and without suspicion of malignancy, were screened from electronic database, retrospectively. Patients were subdivided into three groups. The first group (Group A) was consisted of patients with low anti-mullerian hormone (AMH) (<1.1 ng/dl) and low antral follicle count (AFC) (n < 7). The second Group (Group B) was consisted of patients with low AMH (<1.1 ng/dl) and normal AFC (n≥7). The third group (Group C) was consisted of patients with normal AMH (≥1.1 ng/dl) and low AFC (n<7). Demographic values, FORT score (follicle output rate: pre-ovulatory follicle count/antral follicle count x 100) and FOI score (follicle to oocyte index: oocyte number/AFC x 100) of the groups were compared. Totally 662 cycles were enrolled in to the study. There were 418 cycles in Group A, 167 cycles in Group B and 77 cycles in Group C. Demographic values were comparable, except age. Mean age was lower in group B. (Respectively; 34.7 + 3.7, 33.1 + 4.1, 34.7 + 3.6, p<0.01) As primary result; FORT and FOI score was higher in Group C than the other two groups. (Median FORT Score with quartiles: Group A: 100 (66-150), Group B: 71 (57-100), Group C: 136 (96-200), p<0.01 – Median FOI Score with quartiles: Group A: 83 (50-140), Group B: 71 (40-100), Group C: 108 (66-200), p<0.01) FORT and FOI score had no correlation with age. Thus, the difference of age in the groups does not affect the primary result. (Table-1) In this study, we showed that anti-mullerian hormone has more predictive value for stimulation success. Increased AMH level results with increased FORT and FOI score. If there is discordance between AMH and AFC in patients with diminished ovarian reserve, AMH is the more predictive one for stimulation success.Tabled 1Table 1. Study ResultsGroup ALow AMHLow AFCGroup BLow AMHNormal AFCGroup CNormal AMHLow AFCpAge34.7 ± 3.733.1 ± 4.134.7± 3.6<0.01BMI25.8 ± 525.1 ± 525.7 ± 50.18AMH (ng/dl)0.47 (0.22-0.76)0.69 (0.45-0.88)1.2 (1.15-1.71)<0.01AFC4 (3-5)8 (7-10)4 (3-6)<0.01Pre-ovulatory Follicle (>11 mm)4 (2-5)7 (5-9)6 (4-8)<0.01Stimulation Protocol75.4% Antagonist 24.6% Microdose75.4% Antagonist 24.6% Microdose71.4% Antagonist 28.6% Microdose0.75Oocyte No.3 (2-5)5 (3-8)5 (3-7)<0.01FORT100 (66-150)71 (57-100)136 (96-200)<0.01FOI83 (50-140)71 (40-100)108 (66-200)<0.01*Statically significant values are written in bold. Open table in a new tab