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Frank J.m. Broekmans - One of the best experts on this subject based on the ideXlab platform.
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the Antral Follicle Count practical recommendations for better standardization
Fertility and Sterility, 2010Co-Authors: Frank J.m. Broekmans, Dominique De Ziegler, Colin M. Howles, Alain Gougeon, Geoffrey Trew, François OlivennesAbstract:Objective To provide recommendations for the standardized use of the Antral Follicle Count (AFC) which is used to predict ovarian response to gonadotrophin stimulation during assisted reproductive technology treatment. However, the nature of the Follicles that are visualized by ultrasound and the competence of the oocytes held within are largely unknown. In addition, there is considerable variability in the clinical definitions and technical methods used to Count and measure Antral Follicles in both published studies and clinical practice. Design and Setting In December 2007, specialist reproductive medicine clinicians and scientists attended a workshop in an effort to address these issues. Literature concerning the physiology and measurement of ovarian Antral Follicles was reviewed, clinical and technical considerations regarding Antral Follicle measurement were discussed, and an operational definition of AFC was developed. Patient(s) None. Intervention(s) None. Outcome Measures Simple recommendations were established for the standardization of AFC assessment in routine clinical practice. The basic clinical and technical requirements required for AFC evaluation were agreed upon, and a systematic method of measuring and Counting Antral Follicles in routine practice was proposed. Conclusion(s) The use of a standardized approach according to the practical recommendations for Antral Follicle Counting as presented is encouraged in future clinical trials and routine practice. The authors also advocate a systematic evaluation of these recommendations as standardized study data become available.
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the role of antimullerian hormone in prediction of outcome after ivf comparison with the Antral Follicle Count
Fertility and Sterility, 2009Co-Authors: Simone L Broer, Ben Willem J Mol, Dave J Hendriks, Frank J.m. BroekmansAbstract:Objective To assess the value of antimullerian hormone (AMH) as a test to predict poor ovarian response and pregnancy occurrence after IVF and to compare it with the performance of the Antral Follicle Count (AFC). Design A systematic review of existing literature and a meta-analysis were carried out. After a comprehensive search, studies were included if 2 × 2 tables for outcomes poor response and pregnancy in IVF patients in relation to AMH or AFC could be constructed. Setting Academic referral center for tertiary care. Patient(s) Cases indicated for IVF. Intervention(s) None. Main Outcome Measure(s) Poor response and nonpregnancy after IVF. Result(s) A total of 13 studies were found reporting on AMH and 17 on AFC. Because of heterogeneity among studies, calculation of a summary point estimate for sensitivity and specificity was not possible. However, for both tests summary receiver operating characteristic curves for the outcome measures poor response and nonpregnancy could be estimated and compared. The curves for the prediction of poor response indicated no significant difference between the performances of AMH and AFC. For the prediction of nonpregnancy, poor performance for both AMH and AFC was found. Conclusion(s) In this meta-analysis it was shown that AMH has at least the same level of accuracy and clinical value for the prediction of poor response and nonpregnancy as AFC.
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ultrasonography as a tool for the prediction of outcome in ivf patients a comparative meta analysis of ovarian volume and Antral Follicle Count
Fertility and Sterility, 2007Co-Authors: Dave J Hendriks, Janet Kwee, Egbert Te R Velde, Ben Willem J Mol, Frank J.m. BroekmansAbstract:Objective To investigate by meta-analysis the predictive capacity of ovarian volume as an ovarian reserve test in comparison to the Antral Follicle Count (AFC). Design Meta-analysis. Setting Tertiary fertility center. Patient(s) Patients undergoing IVF. Intervention(s) None. Main Outcome Measure(s) Poor ovarian response, nonpregnancy. Result(s) A total of 10 studies were detected reporting on ovarian volume and 17 studies on AFC. Because of heterogeneity among studies, calculation of one summary point estimate for sensitivity and specificity was not meaningful. However, for both tests, summary receiver operating characteristic curves for the outcome measures poor response and nonpregnancy could be estimated and compared. The AFC performed statistically significantly better than ovarian volume in the prediction of poor response. The overall accuracy for predicting nonpregnancy was poor for both tests. The clinical value in poor response prediction was only evident for the AFC as a considerable number of cases can be identified who will have a high chance of producing a poor response to stimulation. The clinical value for nonpregnancy was virtually absent for both tests. Conclusion(s) In conclusion, the predictive performance of ovarian volume toward poor response is clearly inferior compared with that of AFC. Therefore, the AFC may be considered the test of first choice when estimating quantitative ovarian reserve before IVF. For the prediction of cases with a very low chance for pregnancy, ovarian reserve testing with the use of ultrasound appears inadequate.
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the Antral Follicle Count is a better marker than basal Follicle stimulating hormone for the selection of older patients with acceptable pregnancy prospects after in vitro fertilization
Fertility and Sterility, 2005Co-Authors: Ellen R Klinkert, Frank J.m. Broekmans, Caspar W. N. Looman, Dik J F Habbema, Egbert Te R VeldeAbstract:This observational study shows that the Antral Follicle Count is a better predictor of ongoing pregnancy in IVF patients aged >38 years of age than is basal FSH. Patients aged <44 years with a normal Antral Follicle Count still have acceptable pregnancy rates after IVF and therefore deserve treatment.
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expected poor responders on the basis of an Antral Follicle Count do not benefit from a higher starting dose of gonadotrophins in ivf treatment a randomized controlled trial
Human Reproduction, 2005Co-Authors: Ellen R Klinkert, Frank J.m. Broekmans, Caspar W. N. Looman, J.d.f. Habbema, E Te R VeldeAbstract:BACKGROUND: The aim of this study was to evaluate the effect of doubling the starting dose of gonadotrophins on the ovarian response in IVF patients with a low Antral Follicle Count (AFC). METHODS: Fifty-two patients with an AFC of <5 Follicles of 2‐ 5 mm diameter before starting their first IVF cycle participated in this randomized controlled trial. They were randomized by opening a sealed envelope, receiving either 150 IU (group I, n 5 26) or 300 IU (group II, n 5 26) of rFSH as a starting dose. The main outcome measures of the study were number of oocytes, poor response (<4 oocytes at retrieval or cancellation due to insufficient Follicle growth) and ongoing pregnancy (12 weeks of gestation). RESULTS: The groups were comparable regarding patient characteristics and outcome of the IVF treatment. The median number of oocytes collected was 3 for both groups (P 5 0.79). The difference in the mean number of oocytes was 0.3 oocytes in favour of group I (P 5 0.69). Sixtyfive per cent of the patients in group I experienced a poor response and 62% in group II. The ongoing pregnancy rate was 8% in group I and 4% in group II (P 5 0.55). CONCLUSIONS: Expected poor response patients, defined as patients with an AFC <5, are likely not to benefit from a higher starting dose of gonadotrophins in IVF.
Egbert Te R Velde - One of the best experts on this subject based on the ideXlab platform.
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ultrasonography as a tool for the prediction of outcome in ivf patients a comparative meta analysis of ovarian volume and Antral Follicle Count
Fertility and Sterility, 2007Co-Authors: Dave J Hendriks, Janet Kwee, Egbert Te R Velde, Ben Willem J Mol, Frank J.m. BroekmansAbstract:Objective To investigate by meta-analysis the predictive capacity of ovarian volume as an ovarian reserve test in comparison to the Antral Follicle Count (AFC). Design Meta-analysis. Setting Tertiary fertility center. Patient(s) Patients undergoing IVF. Intervention(s) None. Main Outcome Measure(s) Poor ovarian response, nonpregnancy. Result(s) A total of 10 studies were detected reporting on ovarian volume and 17 studies on AFC. Because of heterogeneity among studies, calculation of one summary point estimate for sensitivity and specificity was not meaningful. However, for both tests, summary receiver operating characteristic curves for the outcome measures poor response and nonpregnancy could be estimated and compared. The AFC performed statistically significantly better than ovarian volume in the prediction of poor response. The overall accuracy for predicting nonpregnancy was poor for both tests. The clinical value in poor response prediction was only evident for the AFC as a considerable number of cases can be identified who will have a high chance of producing a poor response to stimulation. The clinical value for nonpregnancy was virtually absent for both tests. Conclusion(s) In conclusion, the predictive performance of ovarian volume toward poor response is clearly inferior compared with that of AFC. Therefore, the AFC may be considered the test of first choice when estimating quantitative ovarian reserve before IVF. For the prediction of cases with a very low chance for pregnancy, ovarian reserve testing with the use of ultrasound appears inadequate.
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the Antral Follicle Count is a better marker than basal Follicle stimulating hormone for the selection of older patients with acceptable pregnancy prospects after in vitro fertilization
Fertility and Sterility, 2005Co-Authors: Ellen R Klinkert, Frank J.m. Broekmans, Caspar W. N. Looman, Dik J F Habbema, Egbert Te R VeldeAbstract:This observational study shows that the Antral Follicle Count is a better predictor of ongoing pregnancy in IVF patients aged >38 years of age than is basal FSH. Patients aged <44 years with a normal Antral Follicle Count still have acceptable pregnancy rates after IVF and therefore deserve treatment.
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Antral Follicle Count in the prediction of poor ovarian response and pregnancy after in vitro fertilization a meta analysis and comparison with basal Follicle stimulating hormone level
Fertility and Sterility, 2005Co-Authors: Dave J Hendriks, Egbert Te R Velde, László F.j.m.m Bancsi, Ben Willem J Mol, Frank J.m. BroekmansAbstract:Objective To assess the predictive performance of the Antral Follicle Count (AFC) as a test for ovarian reserve in IVF patients and to compare this performance with that of basal FSH level. Design Meta-analysis. Setting Tertiary fertility center. Patient(s) Patients undergoing IVF. Intervention(s) None. Main outcome measure(s) Poor ovarian response, nonpregnancy. Result(s) We identified 11 studies on AFC and an updated total of 32 studies on basal FSH from the literature on the basis of preset criteria. The estimated summary receiver operating characteristic (ROC) curves showed AFC to perform well in the prediction of poor ovarian response. Also, prediction of poor ovarian response seemed to be more accurate with AFC compared with basal FSH. The estimated summary ROC curves for the prediction of nonpregnancy indicated a poor performance for both AFC and basal FSH. Conclusion(s) Transvaginal ultrasonography is an easy-to-perform and noninvasive method that provides essential predictive information on ovarian responsiveness. The predictive performance of AFC toward poor response is significantly better than that of basal FSH. Therefore, AFC might be considered the test of first choice in the assessment of ovarian reserve prior to IVF.
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impact of repeated Antral Follicle Counts on the prediction of poor ovarian response in women undergoing in vitro fertilization
Fertility and Sterility, 2004Co-Authors: László F.j.m.m Bancsi, Frank J.m. Broekmans, Caspar W. N. Looman, Dik J F Habbema, Egbert Te R VeldeAbstract:Abstract Objective To study the value of a single Antral Follicle Count and the additional value of repeated Counts in different cycles for the prediction of poor ovarian response in IVF. Design Prospective. Setting Tertiary fertility center. Patient(s) One hundred twenty women undergoing their first IVF cycle. Intervention(s) Measurement of the number of Antral Follicles on cycle day 3 in two spontaneous cycles. Main outcome measure(s) Ovarian response. Result(s) A single Antral Follicle Count is clearly predictive of poor ovarian response and there is good agreement between repeated measurements in subsequent cycles (area under the receiver operating characteristic curve [ROC AUC ]; cycle 1: 0.87, cycle 2: 0.85). In a logistic regression analysis, information obtained after the second cycle contributed significantly to the prediction of poor response by the Antral Follicle Count of the first cycle. The predictive accuracy of the highest of two Counts (ROC AUC 0.89) was slightly better than that of each single Count. The predictive model with the highest Count yielded slightly higher values of specificity and positive predictive value. Sensitivity, negative predictive value, and error rates were slightly lower. Conclusion(s) A single Antral Follicle Count is a good predictor of poor ovarian response in IVF. Although the impact of a second Antral Follicle Count on ovarian response predictions in IVF is statistically significant, clinical relevance is very limited. Repeating an Antral Follicle Count in a subsequent cycle is not recommended.
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predictors of poor ovarian response in in vitro fertilization a prospective study comparing basal markers of ovarian reserve
Fertility and Sterility, 2002Co-Authors: László F.j.m.m Bancsi, Frank J.m. Broekmans, Dik J F Habbema, Marinus J C Eijkemans, Frank H De Jong, Egbert Te R VeldeAbstract:Abstract Objective: To identify and quantify predictors of poor ovarian response in in vitro fertilization (IVF). Design: Prospective study. Setting: Tertiary fertility center. Patient(s): One hundred twenty women undergoing their first IVF cycle. Intervention(s): Measurement of the number of Antral Follicles and the total ovarian volume by ultrasound, and of basal levels of FSH, E 2 , and inhibin B on cycle day 3. Main Outcome Measure(s): Ovarian response, and clinical and ongoing pregnancy rates. Result(s): The Antral Follicle Count was the best single predictor for poor ovarian response: area under the receiver operating characteristic curve=0.87. Addition of basal FSH and inhibin B levels to a logistic model with the Antral Follicle Count significantly improved the prediction of poor response; the addition of basal E 2 levels and total ovarian volume did not improve the prediction. To express the discriminative performance of this model toward poor response, a maximum area under the receiver operating characteristic curve of 0.92 was calculated. Poor responders had significantly lower clinical and ongoing pregnancy rates than did normal responders. Conclusion(s): Our data demonstrate that the Antral Follicle Count provides better prognostic information on the occurrence of poor response during hormone stimulation for IVF than does the patient's chronological age and the currently used endocrine markers. However, endocrine tests remain informative. Multivariate models can achieve more accurate predictions of outcomes of complex events like ovarian response in IVF.
Togas Tulandi - One of the best experts on this subject based on the ideXlab platform.
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age related normogram for Antral Follicle Count in women with polycystic ovary syndrome
Reproductive Biomedicine Online, 2013Co-Authors: Amir Wiser, Einat Shalompaz, J H Hyman, T Sokalarnon, Nadia Bantan, Hananel Holzer, Togas TulandiAbstract:Abstract Antral Follicle Count (AFC) has been shown to be a reliable marker for ovarian reserve. The aims of this study were to create an age-related normogram for AFC in infertile women with polycystic ovary syndrome (PCOS) and to compare age-related decline in AFC between infertile women with and without PCOS. A retrospective cohort study was conducted. Of a total of 4956 women, 619 women fit criteria for PCOS. In those with PCOS, there were large variations in the AFC between the 10th and 90th percentiles in all age groups. The rate of decline in AFC among women with PCOS was linear, while in those with non-PCOS, it was exponential until 30 years of age, and then became similar to that of PCOS. The rate of Follicle loss per year was significantly slower in PCOS women compared with that in non-PCOS women. In both groups, the fastest period of Follicle loss was between the ages of 18 and 30. The average Follicle loss was 0.8 Follicles/year in PCOS women and 1.7 Follicles/year in those without PCOS ( P Antral Follicle Count (AFC) has been shown to be a reliable marker for ovarian reserve. The aims of this study were to create an age-related normogram for AFC in women with polycystic ovary syndrome (PCOS), and to compare age-related decline in AFC between women with and without PCOS. A retrospective cohort study was conducted. All patients underwent a baseline transvaginal ultrasound that was performed on day 2–4 of the menstrual cycle. The total number of Antral Follicles of 2–9mm in diameter was recorded. Of total 4956 women, 619 women fit criteria for PCOS. In those with PCOS, there were large variations in the AFC between the 10th 90th percentiles in all age groups. The rate of decline in AFC among women with PCOS was linear; while in those with non-PCOS, it was exponential until 30 years of age, and then became similar to that of PCOS. The rate of Follicle loss per year was significantly slower in PCOS women compared with that in non-PCOS women. In both groups, the fastest period of Follicle loss was between the ages 18–30 years. The average Follicle loss was 0.8 Follicles/year in PCOS women and 1.7 Follicles/year in those without PCOS ( P
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age related normogram for Antral Follicle Count mcgill reference guide
Fertility and Sterility, 2011Co-Authors: Benny Almog, Fady Shehata, Seang Lin Tan, Einat Shalompaz, Togas TulandiAbstract:Objective To produce age-related normograms for Antral Follicle Count in an infertile population without polycystic ovaries. Design Retrospective cohort analysis. Setting University teaching center. Patient(s) Eighteen hundred sixty-six infertile patients. Intervention(s) Baseline transvaginal ultrasound examination between days 2 and 4 of the menstrual cycle. Main Outcome Measure(s) Correlation between age and different percentiles of Antral Follicle Count. Result(s) The age-related normogram for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentile of Antral Follicle Count showed a biphasic mode of Antral Follicle Count decline with two different rates of Antral Follicle Count loss: a steep-slope phase (high rate of Antral Follicle Count loss) and a moderate-slope phase (restrained rate of Antral Follicle Count losses). In the low Antral Follicle Count percentiles (3rd, 10th, 25th), the phase of high loss rate of Follicles preceded the phase of slow loss rate, whereas in the high Antral Follicle Count percentiles (75th, 90th, 97th) the opposite was found. Conclusion(s) Age-related normograms in infertile women without polycystic ovaries demonstrate a biphasic pattern of decreased Antral Follicles. These normograms could provide a reference guide for the clinician in consulting with women with infertility. However, future validation with longitudinal data is still needed.
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effects of excision of ovarian endometrioma on the Antral Follicle Count and collected oocytes for in vitro fertilization
Fertility and Sterility, 2010Co-Authors: Benny Almog, Fady Shehata, Einat Shalompaz, Boaz Sheizaf, Ayman Altalib, Togas TulandiAbstract:We compared the response of operated and nonoperated ovaries to gonadotropin stimulation in 38 women who had had excision of ovarian endometrioma. The Antral Follicle Count, numbers of dominant Follicles, and number of oocytes collected in the operated ovaries were significantly lower than in the nonoperated ovaries suggesting reduced ovarian reserve after excision of ovarian endometrioma.
William S.b. Yeung - One of the best experts on this subject based on the ideXlab platform.
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comparison of Antral Follicle Count and serum anti mullerian hormone level for determination of gonadotropin dosing in in vitro fertilization randomized trial
Ultrasound in Obstetrics & Gynecology, 2020Co-Authors: Vivian Chi Yan Lee, Estella Y L Lau, Sofie Shuk Fei Yung, William S.b. YeungAbstract:Objective To compare the proportion of women achieving a desired ovarian response following ovarian stimulation when gonadotropin dosing was determined based on Antral Follicle Count (AFC) vs serum anti-Mullerian hormone (AMH) level, in women undergoing in-vitro fertilization (IVF) using the gonadotropin-releasing hormone (GnRH) antagonist protocol. Methods This was a randomized double-blind trial carried out in a university-affiliated assisted reproduction unit. A total of 200 women undergoing their first IVF cycle using the GnRH-antagonist protocol between April 2016 and February 2018 were randomized to determination of gonadotropin dosing based on either AFC or serum AMH level measured in the pretreatment cycle 1 month before the IVF cycle. Patients underwent IVF as per our center's standard protocol. The proportion of subjects achieving a desired ovarian response, defined as retrieval of six to 14 oocytes, was compared between the two study arms. Subgroup analysis of patients with baseline AFC > 5 and those with baseline AFC ≤ 5 was performed. Concordance in AFC and AMH categorization between the pretreatment cycle and the ovarian-stimulation cycle was assessed using Cohen's kappa (κ). Results There was no significant difference in the proportion of patients achieving a desired ovarian response between the AFC (54%) and AMH (49%) groups (P = 0.479). The median number of oocytes retrieved was nine vs seven (P = 0.070), and the median follicular output rate was 0.54 vs 0.55 (P = 0.764) in the AFC and AMH groups, respectively. Similar findings were observed on subgroup analysis of subjects with AFC ≤ 5 and AFC > 5 at the start of ovarian stimulation (P > 0.05 for all comparisons). There was moderate concordance between AFC and AMH measured in the pretreatment cycle and the stimulation cycle (κ = 0.478 and 0.587, respectively). Conclusion The proportion of women achieving a desired ovarian response following ovarian stimulation using the GnRH-antagonist protocol is similar when the gonadotropin-dosing algorithm used is based on AFC or serum AMH level. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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ovarian response and cumulative live birth rate of women undergoing in vitro fertilisation who had discordant anti mullerian hormone and Antral Follicle Count measurements a retrospective study
PLOS ONE, 2014Co-Authors: Vivian Chi Yan Lee, Estella Y L Lau, William S.b. YeungAbstract:Objective: To evaluate ovarian response and cumulative live birth rate of women undergoing in-vitro fertilization (IVF) treatment who had discordant baseline serum anti-Mullerian hormone (AMH) level and Antral Follicle Count (AFC). Methods: This is a retrospective cohort study on 1,046 women undergoing the first IVF cycle in Queen Mary Hospital, Hong Kong. Subjects receiving standard IVF treatment with the GnRH agonist long protocol were classified according to their quartiles of baseline AMH and AFC measurements after GnRH agonist down-regulation and before commencing ovarian stimulation. The number of retrieved oocytes, ovarian sensitivity index (OSI) and cumulative live-birth rate for each classification category were compared. Results: Among our studied subjects, 32.2% were discordant in their AMH and AFC quartiles. Among them, those having higher AMH within the same AFC quartile had higher number of retrieved oocytes and cumulative live-birth rate. Subjects discordant in AMH and AFC had intermediate OSI which differed significantly compared to those concordant in AMH and AFC on either end. OSI of those discordant in AMH and AFC did not differ significantly whether either AMH or AFC quartile was higher than the other. Conclusions: When AMH and AFC are discordant, the ovarian responsiveness is intermediate between that when both are concordant on either end. Women having higher AMH within the same AFC quartile had higher number of retrieved oocytes and cumulative live-birth rate.
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role of baseline Antral Follicle Count and anti mullerian hormone in the index stimulation cycle of ivf treatment in predicting outcome of subsequent frozen thawed embryo transfers
Gynecological Endocrinology, 2014Co-Authors: H Raymond W Li, William S.b. Yeung, Pak Chung Ho, Ernest Hung Yu NgAbstract:AbstractThis retrospective cohort study aims at determining whether baseline Antral Follicle Count (AFC) and serum anti-Mullerian hormone (AMH) level in the index stimulation cycle predict live-birth outcome in subsequent frozen-thawed embryo transfer (FET) cycles. We studied 500 women undergoing the first IVF cycle who had embryo(s) cryopreserved. The main outcome measures were live-birth in the first FET cycle and cumulative live-birth in all the FETs combined after the same stimulation cycle. Our results showed that baseline AFC and AMH level on the day before ovarian stimulation showed significant correlation. In the first FET cycle, AFC and AMH level were significantly higher in subjects attaining live-birth in the first FET cycle or cumulative live-birth from all FETs than those who did not. Both AMH and AFC were insignificant predictors of live-birth in the first FET cycle or cumulative live-birth after adjusting for age. The areas under the ROC curves for AMH, AFC and age were 0.654, 0.625 and 0.6...
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role of baseline Antral Follicle Count and anti mullerian hormone in prediction of cumulative live birth in the first in vitro fertilisation cycle a retrospective cohort analysis
PLOS ONE, 2013Co-Authors: Vivian Chi Yan Lee, Estella Y L Lau, William S.b. YeungAbstract:Objective This retrospective study determined for the first time the role of baseline Antral Follicle Count (AFC) and serum anti-Mullerian hormone (AMH) level in the first in-vitro fertilisation (IVF) cycle in predicting cumulative live birth from one stimulation cycle.
Ben Willem J Mol - One of the best experts on this subject based on the ideXlab platform.
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the effectiveness and safety of in vitro maturation of oocytes versus in vitro fertilization in women with a high Antral Follicle Count
Human Reproduction, 2019Co-Authors: S C Braam, Ben Willem J Mol, Toan D Pham, Lan N VuongAbstract:Study question What is the effectiveness and safety of IVM compared with IVF for the treatment of women with high Antral Follicle Count (AFC)? Summary answer In women with high AFC undergoing assisted reproductive technique (ART), IVM is an effective alternative compared with IVF, while it eliminates the risk of ovarian hyperstimulation syndrome (OHSS). What is known already IVM is postulated to be an alternative to conventional IVF to avoid OHSS. It has particular potential in women with high AFC who are known to be at increased risk of OHSS. To date, IVM and IVF have only been compared in small cohort studies. Study design, size and duration We performed a retrospective cohort study including 919 women, of whom 608 underwent IVM and 311 IVF. The treatments were conducted at IVFMD, My Duc Hospital, Ho Chi Minh, Vietnam, from July 2015 to December 2017. Participants/materials, setting, methods We studied infertile women aged 18-38 years with an indication for ART and with an AFC ≥24. Women received either IVM or IVF treatment depending on patient's or physician's preference. In IVM cycles, women received 3 days of FSH 100 IU/day followed by hCG 10 000 IU. In IVF cycles, women underwent a gonadotropin-releasing hormone antagonist protocol and were triggered with hCG 6500 IU. Outcome measures were live birth rate (LBR) after first embryo transfer and cumulative LBR after one complete cycle, defined as the chance of having live birth after all fresh and frozen transfers of embryos derived from one IVM/IVF cycle. We also report on clinical pregnancy, miscarriage, multiple pregnancy and OHSS. Main results and the role of chance Baseline characteristics including age and BMI were comparable between groups. In the IVM group (608 started cycles), there were 511 fresh and 167 frozen transfers. In the IVF group (311 started cycles), there were 209 fresh and 185 frozen transfers. The number of mature oocytes, embryos, good embryos and frozen embryos was significantly lower in the IVM compared with the IVF group. LBRs after the first transfer were 222/608 (36.5%) versus 127/311 (40.8%) (adjusted odds ratio [OR], 0.74; 95% confidence interval [CI], 0.42-1.30). Cumulative LBRs after one completed cycle were 239/608 (39.3%) versus 155/311 (49.8%) (adjusted OR, 0.52; 95% CI, 0.30-0.89). OHSS did not occur in the IVM group versus 11/311 (3.5%) in the IVF group. Limitations and reasons for caution Our study is limited by its non-randomized design. Randomized clinical trials are required to precisely compare the outcomes after IVM versus IVF. Wider implications of the findings In infertile women with a high AFC, IVM is a feasible alternative to standard IVF that markedly reduces OHSS and is potentially more patient friendly and cost effective. Study funding/competing interest(s) No external funding was sought to support this work. B.W.M. is supported by a National Health Medical Research Council Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for ObsEva, Merck and Guerbet. All other authors have no conflicts of interest. Trial registration number NA.
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effectiveness and safety of in vitro maturation of oocytes versus in vitro fertilisation in women with high Antral Follicle Count study protocol for a randomised controlled trial
BMJ Open, 2018Co-Authors: Lan N Vuong, Robert J Norman, Rui Wang, Vinh Quang Dang, Tuan H Phung, Nhu H Giang, Toan D Pham, Johan Smitz, Robert B Gilchrist, Ben Willem J MolAbstract:Introduction In vitro maturation (IVM) is a potential alternative to conventional in vitro fertilisation (IVF) to avoid ovarian hyperstimulation syndrome (OHSS). This is particularly relevant in women with a high Antral Follicle Count (AFC) and/or polycystic ovary syndrome (PCOS), who are at increased risk for OHSS. However, no randomised controlled trials of IVM versus IVF in women with high AFC have reported both pregnancy and OHSS rates. The aim of this study is to compare the effectiveness and safety of one IVM cycle and one IVF with segmentation cycle within women with PCOS or high AFC-related subfertility. Methods and analysis This randomised controlled trial will be conducted at a specialist IVF centre in Vietnam. Eligible subfertile women with PCOS and/or high AFC will be randomised to undergo either IVM or IVF. The primary outcome is live birth after the first embryo transfer of the started treatment cycle. Cycles in which no embryo is available for transfer will be considered as failures. The study has a non-inferiority design, with a maximal acceptable between-group difference of 5%. Rates of OHSS will also be reported. Ethics and dissemination Ethical approval was obtained from the participating centre, and informed patient consent was obtained before study enrolment. Results of the study will be submitted for publication in a peer-reviewed journal. Trial registration number NCT03405701; Pre-results.
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the role of antimullerian hormone in prediction of outcome after ivf comparison with the Antral Follicle Count
Fertility and Sterility, 2009Co-Authors: Simone L Broer, Ben Willem J Mol, Dave J Hendriks, Frank J.m. BroekmansAbstract:Objective To assess the value of antimullerian hormone (AMH) as a test to predict poor ovarian response and pregnancy occurrence after IVF and to compare it with the performance of the Antral Follicle Count (AFC). Design A systematic review of existing literature and a meta-analysis were carried out. After a comprehensive search, studies were included if 2 × 2 tables for outcomes poor response and pregnancy in IVF patients in relation to AMH or AFC could be constructed. Setting Academic referral center for tertiary care. Patient(s) Cases indicated for IVF. Intervention(s) None. Main Outcome Measure(s) Poor response and nonpregnancy after IVF. Result(s) A total of 13 studies were found reporting on AMH and 17 on AFC. Because of heterogeneity among studies, calculation of a summary point estimate for sensitivity and specificity was not possible. However, for both tests summary receiver operating characteristic curves for the outcome measures poor response and nonpregnancy could be estimated and compared. The curves for the prediction of poor response indicated no significant difference between the performances of AMH and AFC. For the prediction of nonpregnancy, poor performance for both AMH and AFC was found. Conclusion(s) In this meta-analysis it was shown that AMH has at least the same level of accuracy and clinical value for the prediction of poor response and nonpregnancy as AFC.
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ultrasonography as a tool for the prediction of outcome in ivf patients a comparative meta analysis of ovarian volume and Antral Follicle Count
Fertility and Sterility, 2007Co-Authors: Dave J Hendriks, Janet Kwee, Egbert Te R Velde, Ben Willem J Mol, Frank J.m. BroekmansAbstract:Objective To investigate by meta-analysis the predictive capacity of ovarian volume as an ovarian reserve test in comparison to the Antral Follicle Count (AFC). Design Meta-analysis. Setting Tertiary fertility center. Patient(s) Patients undergoing IVF. Intervention(s) None. Main Outcome Measure(s) Poor ovarian response, nonpregnancy. Result(s) A total of 10 studies were detected reporting on ovarian volume and 17 studies on AFC. Because of heterogeneity among studies, calculation of one summary point estimate for sensitivity and specificity was not meaningful. However, for both tests, summary receiver operating characteristic curves for the outcome measures poor response and nonpregnancy could be estimated and compared. The AFC performed statistically significantly better than ovarian volume in the prediction of poor response. The overall accuracy for predicting nonpregnancy was poor for both tests. The clinical value in poor response prediction was only evident for the AFC as a considerable number of cases can be identified who will have a high chance of producing a poor response to stimulation. The clinical value for nonpregnancy was virtually absent for both tests. Conclusion(s) In conclusion, the predictive performance of ovarian volume toward poor response is clearly inferior compared with that of AFC. Therefore, the AFC may be considered the test of first choice when estimating quantitative ovarian reserve before IVF. For the prediction of cases with a very low chance for pregnancy, ovarian reserve testing with the use of ultrasound appears inadequate.
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Antral Follicle Count in the prediction of poor ovarian response and pregnancy after in vitro fertilization a meta analysis and comparison with basal Follicle stimulating hormone level
Fertility and Sterility, 2005Co-Authors: Dave J Hendriks, Egbert Te R Velde, László F.j.m.m Bancsi, Ben Willem J Mol, Frank J.m. BroekmansAbstract:Objective To assess the predictive performance of the Antral Follicle Count (AFC) as a test for ovarian reserve in IVF patients and to compare this performance with that of basal FSH level. Design Meta-analysis. Setting Tertiary fertility center. Patient(s) Patients undergoing IVF. Intervention(s) None. Main outcome measure(s) Poor ovarian response, nonpregnancy. Result(s) We identified 11 studies on AFC and an updated total of 32 studies on basal FSH from the literature on the basis of preset criteria. The estimated summary receiver operating characteristic (ROC) curves showed AFC to perform well in the prediction of poor ovarian response. Also, prediction of poor ovarian response seemed to be more accurate with AFC compared with basal FSH. The estimated summary ROC curves for the prediction of nonpregnancy indicated a poor performance for both AFC and basal FSH. Conclusion(s) Transvaginal ultrasonography is an easy-to-perform and noninvasive method that provides essential predictive information on ovarian responsiveness. The predictive performance of AFC toward poor response is significantly better than that of basal FSH. Therefore, AFC might be considered the test of first choice in the assessment of ovarian reserve prior to IVF.