Comparing antral follicle count and serum anti‐Mullerian hormone level for determination of gonadotrophin dosing in in‐vitro fertilisation: a randomized trial

Abstract

Objectives: To compare the proportion of women having a desired ovarian response following ovarian stimulation with gonadotrophin dosing determined based on AFC versus serum AMH level in women undergoing IVF using the GnRH antagonist protocol.

Methods: This was a randomised double‐blinded trial carried out in a university‐affiliated assisted reproduction unit. A total of 200 women undergoing the first IVF cycle between April 2016 and February 2018 were randomised to algorithms for gonadotrophin dosing based on either AFC or AMH in the pre‐treatment cycle. They underwent IVF as per standard protocol. The proportion of subjects achieving desired ovarian response, defined as having 6 to 14 oocytes retrieved, was compared between arms.

Results: There was no significant difference in the proportion achieving desired ovarian response between the AFC (56.3%) and AMH (51.6%) groups (p=0.523). The median number of oocytes retrieved were 9 vs 7 (p=0.064), and the median follicular output rate (FORT) was 0.56 vs 0.55 (p=0.759) in the AFC and AMH groups respectively. The same conclusion applied to subgroup analyses on subjects with AFC<=5 and AFC>5 at commencement of ovarian stimulation (P>0.05 for all comparisons). There was moderate concordance between AFC and AMH measured in the pre‐treatment cycle and the stimulation cycle (ĸ = 0.460 and 0.573 respectively).

Conclusions: Gonadotrophin dosing algorithms based on either AFC or serum AMH result in no significant difference in the proportion achieving desired ovarian response.