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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 Antral Follicle count: practical recommendations for better standardization.
Fertility and sterility, 2009Co-Authors: Frank J.m. Broekmans, Dominique De Ziegler, Colin M. Howles, Alain Gougeon, Geoffrey Trew, François OlivennesAbstract: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. 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. None. None. 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. 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. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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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 counts are related to age at natural fertility loss and age at menopause
Menopause, 2004Co-Authors: Frank J.m. Broekmans, Gabrielle J. Scheffer, Malcolm J Faddy, Egbert Te R VeldeAbstract:Objective: The variability in ultrasound-based Antral Follicle counts sized 2-10 mm after allowing for age-related decline is considerable. This may represent differences in actual reproductive age among women. This hypothesis was tested by cohort comparison for distribution of age at occurrence of reproductive events. Design: A model with a nonlinear mean decline with age was fitted to Antral Follicle counts (AFC) obtained in 163 regularly cycling fertile volunteers. Ages at last child birth and menopause were predicted from the individual AFC by using thresholds to represent these events and the model for decline with age. Distributions of the observed ages at last childbirth (proxy variable for loss of natural fertility) and ages at menopause were obtained from the BALSAC demographic database and the Prospect-EPIC study, respectively. The observed distributions were compared with the predicted distributions by using visual comparison and quantile-quantile plots. Predictions of age at last child and age at menopause were done using percentiles of the modeled AFC distribution for given age, and corresponding percentiles of the predicted distributions of age at these reproductive events, with predictions following from the position of a woman’s AFC relative to these percentiles. Results: The predicted distributions of age at last child and age at menopause showed good agreement with the observed distributions in the BALSAC and EPIC cohort. Compared with age alone, Antral Follicle counts gave some additional information for individual prediction of age at last child and menopause. Conclusions: The link between declining Antral Follicle counts and reproductively significant events like loss of natural fertility and menopause is strengthened by the high degree of similarity among the predicted and observed age distributions. Predictive usefulness of this relationship in a clinical setting may be more marginal, except in the case of women who have low AFCs for their age.
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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, J. Dik F. Habbema, Egbert R. Te VeldeAbstract: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. Prospective. Tertiary fertility center. One hundred twenty women undergoing their first IVF cycle. Measurement of the number of Antral Follicles on cycle day 3 in two spontaneous cycles. Ovarian response. 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. 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.
Egbert Te R Velde - One of the best experts on this subject based on the ideXlab platform.
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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 counts are related to age at natural fertility loss and age at menopause
Menopause, 2004Co-Authors: Frank J.m. Broekmans, Gabrielle J. Scheffer, Malcolm J Faddy, Egbert Te R VeldeAbstract:Objective: The variability in ultrasound-based Antral Follicle counts sized 2-10 mm after allowing for age-related decline is considerable. This may represent differences in actual reproductive age among women. This hypothesis was tested by cohort comparison for distribution of age at occurrence of reproductive events. Design: A model with a nonlinear mean decline with age was fitted to Antral Follicle counts (AFC) obtained in 163 regularly cycling fertile volunteers. Ages at last child birth and menopause were predicted from the individual AFC by using thresholds to represent these events and the model for decline with age. Distributions of the observed ages at last childbirth (proxy variable for loss of natural fertility) and ages at menopause were obtained from the BALSAC demographic database and the Prospect-EPIC study, respectively. The observed distributions were compared with the predicted distributions by using visual comparison and quantile-quantile plots. Predictions of age at last child and age at menopause were done using percentiles of the modeled AFC distribution for given age, and corresponding percentiles of the predicted distributions of age at these reproductive events, with predictions following from the position of a woman’s AFC relative to these percentiles. Results: The predicted distributions of age at last child and age at menopause showed good agreement with the observed distributions in the BALSAC and EPIC cohort. Compared with age alone, Antral Follicle counts gave some additional information for individual prediction of age at last child and menopause. Conclusions: The link between declining Antral Follicle counts and reproductively significant events like loss of natural fertility and menopause is strengthened by the high degree of similarity among the predicted and observed age distributions. Predictive usefulness of this relationship in a clinical setting may be more marginal, except in the case of women who have low AFCs for their age.
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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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Antral Follicle counts by transvaginal ultrasonography are related to age in women with proven natural fertility
Fertility and Sterility, 1999Co-Authors: Gabrielle J. Scheffer, Frank J.m. Broekmans, Caspar W. N. Looman, Marinus Dorland, J.d.f. Habbema, Egbert Te R VeldeAbstract:Objective: To investigate the relation between reproductive age and ultrasound (US)-based Follicle counts and the reproducibility of Follicle counts in regularly cycling women with proven fertility. Design: Prospective observational study. Setting: Tertiary fertility center. Patient(s): Healthy female volunteers with proven fertility, recruited by advertisement in local newspapers. Intervention(s): The number of Antral Follicles sized 2-10 mm and ovarian volume were estimated by transvaginal US in the early follicular phase of the menstrual cycle in 162 women. A subgroup of 81 women underwent transvaginal US at several times in three subsequent cycles. Main Outcome Measure(s): Antral Follicle count and total ovarian volume. Result(s): Women aged 25-46 years (n = 162) were studied. The relation of age with the US indices was computed after natural log transformation. Antral Follicle count showed the clearest correlation with age (R = -0.67). A biphasic linear model gave the best fit to the data. Before the age of 37 years, the Antral Follicle count showed a mean yearly decline of 4.8%, compared with 11.7% thereafter. The reproducibility of the Antral Follicle count in two subsequent cycles was moderate. Conclusion(s): The number of small Antral Follicles in both ovaries as measured by US is clearly related to reproductive age and could well reflect the size of the remaining primordial Follicle pool.
Marcelle I. Cedars - One of the best experts on this subject based on the ideXlab platform.
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links between age at menarche Antral Follicle count and body mass index in african american and european american women
Fertility and Sterility, 2019Co-Authors: Sonya M Schuh, Mitchell P. Rosen, Barbara Sternfeld, Renee Reijo A Pera, Julia Kadie, Marcelle I. CedarsAbstract:Objective To examine the relationships between age at menarche, Antral Follicle count (AFC), and body mass index (BMI) in a multi-ethnic population of women. Design Community-based, cross-sectional study. Setting Academic setting. Patient(s) A total of 245 African American women and 273 European American women, aged 25–45 years, with regular menstrual cycles and no reproductive disorders. The ethnicity of these women was self-reported and genetically validated. Intervention(s) The AFCs were measured by transvaginal ultrasound during the early follicular phase. Anthropometric measurements were taken, and age at menarche was gathered by questionnaire. Main Outcome Measure(s) Determination of the associations between age of menarche and adult AFC and BMI. Result(s) Earlier age of menarche was associated with both higher BMIs and higher AFCs in adulthood, with control for female age. The Antral Follicle difference between early ( Conclusion(s) This study provides the first evidence that timing of menarche may influence AFC. Because of limited studies on African American women, this work provides additional needed data and may enhance our ability to prospectively screen and better treat various diseases associated with the female reproductive lifespan.
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long term hormonal contraceptive use is associated with a reversible suppression of Antral Follicle count and a break from hormonal contraception may improve oocyte yield
Journal of Assisted Reproduction and Genetics, 2017Co-Authors: J Letourneau, Marcelle I. Cedars, Hakan Cakmak, Molly M Quinn, Nikita Sinha, Mitchell P. RosenAbstract:Purpose Unlike infertility, patients presenting for fertility preservation (FP) are often using combined hormonal contraceptives (CHC). We studied whether long-term (≥6 months) CHC use is associated with reversible suppression of Antral Follicle count (AFC).
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impact of pituitary suppression on Antral Follicle count and oocyte recovery after ovarian stimulation
Fertility and Sterility, 2016Co-Authors: Nam D Tran, Marcelle I. Cedars, Lusine Aghajanova, C N Kao, Mitchell P. RosenAbstract:Objective To investigate the potential influence of short-term pituitary suppression on Antral Follicle count (AFC) and correlate the AFC with the number of oocytes retrieved after ovarian stimulation. Design Retrospective study. Setting University fertility center. Patient(s) A total of 1,479 infertile patients. Intervention(s) Patients had baseline AFC, when they were not on any medications known to cause pituitary suppression, and follow-up AFC (suppressed AFC) while on E 2 , GnRH agonist (GnRH-a), oral contraceptive (OC) pills, or OC pills/GnRH-a in preparation for ovarian stimulation, performed within 6 months of initial baseline AFC. Main Outcome Measure(s) The AFC at baseline, AFC during pituitary suppression, and the number of oocytes retrieved. Result(s) Although there was an average unadjusted decline of 0.4, 0.9, 2.2, and 3.0 in AFC while patients were on E 2 , GnRH-a, OC pills, and OC pills/GnRH-a, respectively, this decline was driven by age, baseline AFC, and the hormones used. Although baseline and suppressed AFC were found to be good predictors of the number of oocytes retrieved after ovarian stimulation, statistically, suppressed AFC was found to be a marginally better predictor. Conclusion(s) Short-term pituitary suppression has a negative impact on AFC. This decline in AFC may influence the number of oocytes retrieved, suggesting the suppressive impact of exogenous hormones on the biological capacity of the ovary during stimulation.
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a lower Antral Follicle count is associated with infertility
Fertility and Sterility, 2011Co-Authors: Mitchell P. Rosen, E B Johnstone, C Addauanandersen, Marcelle I. CedarsAbstract:Objective To determine whether infertile women have lower Antral Follicle counts (AFC) than age-matched normal women. Design Case-control. Setting Academic center. Patient(s) A total of 881 infertile women and 771 women from the community. Intervention(s) Antral Follicle count and basal hormone measurements. Main Outcome Measure(s) Median AFCs and FSH levels were compared between the two groups within 5-year age strata by using the median test. A subanalysis was performed by identifying women in the control group with a history of attempting conception without success (subfertile group) and with a spontaneous conception in fewer than 12 months resulting in a live birth (fertile group). Age-specific AFC percentiles were calculated and compared within strata determined by age at the time of attempted conception. Result(s) AFCs were significantly lower in infertile women than in control women across age groups up to 40 years of age. Average FSH levels were significantly higher in the younger-age infertile group versus the community. AFC percentiles differ significantly between fertile and subfertile women within the community up to 40 years of age. Conclusion(s) Decreased AFC in infertile women suggests that factors affecting the size of the remaining Follicle pool in younger women also affect oocyte quality and the likelihood of conception.
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Antral Follicle count absence of significant midlife decline
Fertility and Sterility, 2010Co-Authors: Mitchell P. Rosen, Barbara Sternfeld, Charles E. Mcculloch, Sonya M Schuhhuerta, Renee Reijo A Pera, Marcelle I. CedarsAbstract:Objective To examine the conventional wisdom that declines in Antral Follicle count accelerate after approximately 37 years of age, which has influenced clinical decision making. We critically examine evidence for this sudden acceleration. Design Cross-sectional study. Setting Academic setting. Patient(s) Two hundred fifty-two white women aged 25 to 45 years with regular cycles, a community-based study. Intervention(s) Antral Follicle counts were measured by transvaginal ultrasound in early follicular phase. Main Outcome Measure(s) Determination of the rate of Antral Follicle count decline with age. Result(s) The relationship of Antral Follicle count with age was determined by comparing a linear model with four nonlinear models (biphasic, quadratic, spline, and power). The linear model estimates the Follicle decline as 0.97 Follicles per year. The biphasic model had estimates of 0.76 Follicles per year before 39.6 years of age and 1.92 Follicles per year thereafter. At age 35 years the linear, quadratic, broken line, spline, and power models gave estimated declines (respectively) of 0.97, 0.94, 0.76, 0.17, and 0.90 Follicles per year. At age 43 years the values were 0.97, 1.51, 1.92, 1.78, and 1.64 Follicles per year. The quality of model fit was comparable for all models. Conclusion(s) Antral Follicle count decline with age in a white population is best described as a gradual acceleration in decline with age. Therefore Antral Follicle count alone should not be used to determine aggressive treatment because of fear of rapid loss of Follicles.
Caspar W. N. Looman - One of the best experts on this subject based on the ideXlab platform.
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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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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, J. Dik F. Habbema, Egbert R. Te VeldeAbstract: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. Prospective. Tertiary fertility center. One hundred twenty women undergoing their first IVF cycle. Measurement of the number of Antral Follicles on cycle day 3 in two spontaneous cycles. Ovarian response. 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. 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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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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quantitative transvaginal two and three dimensional sonography of the ovaries reproducibility of Antral Follicle counts
Ultrasound in Obstetrics & Gynecology, 2002Co-Authors: G J Scheffer, Frank J.m. Broekmans, Caspar W. N. Looman, J.d.f. Habbema, L F J M M Bancsi, E Te R VeldeAbstract:Objective To assess the intra- and interobserver reproducibilities in addition to the between-method reliability of Antral Follicle counts using two (2D)- and three (3D)-dimensional transvaginal sonography (TVS). Methods Two groups of women with regular menstrual cycles were studied. One group consisted of healthy volunteers with proven fertility and the other group consisted of patients visiting the general infertility clinic. In each woman, 2D or 3D TVS was performed in the early follicular phase (day 2, 3 or 4) of the menstrual cycle to measure the number of Antral Follicles (2–10 mm). Results Intraobserver reproducibility was calculated from Follicle counts using 3D TVS in 41 women. The intraclass correlation coefficient was 0.99 and the 95% coverage interval of the difference (CID) was −3.2 to +3.2. Interobserver reproducibility was assessed from both 2D (n = 37) and 3D (n = 49) TVS-based Follicle counts. An interclass correlation coefficient of 0.98 was found for both methods. The 95% CID was −5.0 to +4.1 for 2D and −5.6 to +5.7 for 3D measurements. The latter CID appeared to increase in the higher range of counts. Finally, the degree of agreement between 2D and 3D TVS counts (n = 76) was characterized by a 95% CID of −5.3 to +8.3. This coverage interval widened when higher numbers of Follicles were counted. With the exception of the between-method analysis, kappa values indicated overall that Follicle counts will hardly change from one category to another when repeatedly carried out.
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Antral Follicle counts by transvaginal ultrasonography are related to age in women with proven natural fertility
Fertility and Sterility, 1999Co-Authors: Gabrielle J. Scheffer, Frank J.m. Broekmans, Caspar W. N. Looman, Marinus Dorland, J.d.f. Habbema, Egbert Te R VeldeAbstract:Objective: To investigate the relation between reproductive age and ultrasound (US)-based Follicle counts and the reproducibility of Follicle counts in regularly cycling women with proven fertility. Design: Prospective observational study. Setting: Tertiary fertility center. Patient(s): Healthy female volunteers with proven fertility, recruited by advertisement in local newspapers. Intervention(s): The number of Antral Follicles sized 2-10 mm and ovarian volume were estimated by transvaginal US in the early follicular phase of the menstrual cycle in 162 women. A subgroup of 81 women underwent transvaginal US at several times in three subsequent cycles. Main Outcome Measure(s): Antral Follicle count and total ovarian volume. Result(s): Women aged 25-46 years (n = 162) were studied. The relation of age with the US indices was computed after natural log transformation. Antral Follicle count showed the clearest correlation with age (R = -0.67). A biphasic linear model gave the best fit to the data. Before the age of 37 years, the Antral Follicle count showed a mean yearly decline of 4.8%, compared with 11.7% thereafter. The reproducibility of the Antral Follicle count in two subsequent cycles was moderate. Conclusion(s): The number of small Antral Follicles in both ovaries as measured by US is clearly related to reproductive age and could well reflect the size of the remaining primordial Follicle pool.
N Rainefenning - One of the best experts on this subject based on the ideXlab platform.
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prediction of in vitro fertilization outcome at different Antral Follicle count thresholds in a prospective cohort of 1 012 women
Fertility and Sterility, 2012Co-Authors: K Jayaprakasan, Yeeyin Chan, Rumana Islam, Zeina Haoula, James Hopkisson, Arri Coomarasamy, N RainefenningAbstract:Objective To estimate the probability of live birth, adverse treatment outcome, and extremes of ovarian response at different Antral Follicle count (AFC) cutoff levels in a large prospective cohort of women undergoing IVF treatment. Design Prospective study. Setting University-based assisted conception unit. Patient(s) A total of 1,012 consecutive subjects of all ages undergoing their first cycle of assisted reproductive techniques. Intervention(s) Transvaginal three-dimensional ultrasound assessment and venipuncture in the early follicular phase of the menstrual cycle. Main Outcome Measure(s) Live birth rate, poor ovarian response, and ovarian hyperstimulation syndrome (OHSS). Result(s) Analysis was performed in 1,012 subjects. Both age ( r = 0.88) and AFC ( r = 0.92) thresholds show significant linear relationship with the probability of live birth, but AFC demonstrates a stronger correlation. At AFC quartiles of 3–10, 11–15, 16–22, and ≥23, the mean live birth rates were 23%, 34%, 39%, and 44%, respectively. No live birth was observed in women with AFC Conclusion(s) Although age and AFC are significantly correlated with live birth, AFC demonstrates a stronger correlation. Antral Follicle count thresholds are useful to predict live birth rates and risks of poor ovarian response and OHSS during IVF treatment.
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quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti mullerian hormone and small Antral Follicle count using three dimensional ultrasound
Ultrasound in Obstetrics & Gynecology, 2012Co-Authors: Shilpa Deb, B K Campbell, J S Clewes, C Pincottallen, G Cumberpatch, N RainefenningAbstract:OBJECTIVES: Oral contraceptive pills suppress the hypothalomo-pituitary axis which can affect the ultrasound and endocrine markers used to examine ovarian reserve. The objective of this study was to quantify the ultrasound and endocrine markers of functional ovarian reserve in women using a combined oral contraceptive pill (COCP) for more than a year. METHODS: This was a prospective case-control study involving healthy volunteers: 34 women using for more than a year a COCP with hormone-free interval (HFI) were compared to 36 normo-ovulatory age-matched controls who had not used hormonal contraception within the last year. Volunteers using a COCP underwent a 3D ultrasound examination and had a blood sample taken within the first 4 days of active pill ingestion and those in the control group had the scan and blood test in the early follicular phase (days 2-5) of menstrual cycle. The main outcome measure was the difference in Antral Follicle counts stratified according to size and anti-Mullerian hormone (AMH) Follicle-stimulating hormone (FSH) luteinizing hormone (LH) and estradiol (E2) levels. RESULTS: There were no significant differences in the number of small Antral Follicles measuring 2-6 mm. The COCP group had significantly fewer Antral Follicles measuring >/= 6 mm (P < 0.001) and had significantly smaller ovaries (P < 0.001) which also had lower vascular indices than the control group (P < 0.05). While serum FSH LH and E2 levels were significantly lower in the COCP group (P < 0.05) there was no significant difference in serum AMH levels between the two groups. CONCLUSIONS: Prolonged use of COCP suppressed pituitary gonadotropins and Antral Follicle development beyond 6 mm but had no effect on levels of serum AMH and number of small Antral Follicles. Copyright (c) 2012 ISUOG. Published by John Wiley & Sons Ltd.
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a randomised controlled trial of 300 versus 225 iu recombinant fsh for ovarian stimulation in predicted normal responders by Antral Follicle count
British Journal of Obstetrics and Gynaecology, 2010Co-Authors: K Jayaprakasan, B K Campbell, I R Johnson, James Hopkisson, J G Thornton, N RainefenningAbstract:Please cite this paper as: Jayaprakasan K, Hopkisson J, Campbell B, Johnson I, Thornton J, Raine-Fenning N. A randomised controlled trial of 300 versus 225 IU recombinant FSH for ovarian stimulation in predicted normal responders by Antral Follicle count. BJOG 2010;117:853–862. Objective To test the hypothesis that among women predicted to have a normal ovarian response, ovarian stimulation using 300 IU Follicle-stimulating hormone (FSH) results in the retrieval of more mature oocytes than 225 IU during in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) treatment. Design Prospective randomised controlled study. Setting University-based assisted conception unit. Population A cohort of 131 women predicted to have a normal ovarian response to gonadotrophin stimulation, based on Antral Follicle count. Methods Subjects undergoing their first cycle of IVF/ICSI were randomised to receive a fixed daily dose of 300 (experimental arm) or 225 IU (control arm) of recombinant FSH (Gonal-F). Main outcome measures Number of mature oocytes retrieved and live birth rates. Results The number (mean ± standard deviation) of mature oocytes retrieved (8.2 ± 5.0 versus 9.0 ± 4.8, for 300 and 225 IU, respectively; P = 0.34) was similar in each group. There were no differences between the 300- and 225 IU arms in live birth rates (31 versus 41%, respectively; P = 0.25), cycle cancellations resulting from insufficient ovarian response (0 versus 6.1%, respectively; P = 0.12), and prevalence of moderate (3.1 versus 3.0, respectively; P = 1.0) and severe (0 versus 1.5%, respectively; P = 1.0) ovarian hyperstimulation syndrome. Conclusions The use of a higher daily dose of 300 IU of recombinant FSH for ovarian stimulation does not improve the number of mature oocytes retrieved, or live birth rates, among women with a predicted normal response during conventional IVF/ICSI.
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quantitative analysis of Antral Follicle number and size a comparison of two dimensional and automated three dimensional ultrasound techniques
Ultrasound in Obstetrics & Gynecology, 2010Co-Authors: Shilpa Deb, Bruce K. Campbell, Jeanette Clewes, N RainefenningAbstract:Objectives To compare two-dimensional (2D) ultrasound imaging with automated three-dimensional (3D) ultrasound imaging for the measurement of Antral Follicle number and size. Methods Twenty-four subjects aged < 40 years underwent transvaginal ultrasound examination (Voluson E8) in the early follicular phase of the menstrual cycle. A 2D ultrasound scan of both ovaries was performed; each Antral Follicle was identified and then measured by taking the mean of two diameters. A 3D ultrasound dataset of both ovaries was then acquired and analyzed using Sonography-based Automated Volume Count (SonoAVC™). The time taken to measure the size of all Antral Follicles in both ovaries was recorded in seconds for each technique. Antral Follicle size was recorded to the nearest millimeter and counts for each 1-mm group were obtained. Antral Follicle counts were also grouped according to five predefined size categories: 2.0–5.0 mm, 2.0–6.0 mm, 2.0–8.0 mm, 2.0–9.0 mm and 2.0–10.0 mm. Limits of agreement (LOA) and a paired t-test or Wilcoxon signed ranks test were used to analyze the data depending on their distribution. Results When Antral Follicle numbers were compared for each 1-mm Follicle size group, 2D ultrasound imaging recorded more Follicles measuring 3.0–3.99 mm (mean ± SD, 4.11 ± 3.70 vs. 2.63 ± 2.31; P = 0.019) and 4.0–4.99 mm (mean ± SD, 4.63 ± 4.86 vs. 2.68 ± 2.89; P = 0.013) than did SonoAVC. LOA were widest with Follicles measuring 3.0–3.99 mm (LOA, 6.38 and −3.43) and 4.0–4.99 mm (LOA, 7.99 and −4.09). The Antral Follicle count in each of the five predefined size categories was significantly lower with SonoAVC than with 2D ultrasound imaging (P < 0.05). SonoAVC took significantly less time to measure the size and record the number of Antral Follicles than did 2D ultrasound imaging (mean ± SD, 132.05 ± 56.23 s vs. 324.47 ± 162.22 s; P < 0.001). Conclusions Fewer Antral Follicles are evident overall when SonoAVC is used to analyze 3D ultrasound data. The clinical significance of this remains to be determined but the automated technique is significantly quicker than is making measurements using 2D ultrasound imaging. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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three dimensional ultrasound improves the interobserver reliability of Antral Follicle counts and facilitates increased clinical work flow
Ultrasound in Obstetrics & Gynecology, 2008Co-Authors: K Jayaprakasan, B K Campbell, J S Clewes, I R Johnson, N RainefenningAbstract:Objectives To compare the interobserver reliability of Antral Follicle counts made using real-time two-dimensional (2D) ultrasound with offline counts made from stored three-dimensional (3D) data and to assess the time required for such counts. Methods Two observers conducted transvaginal ultrasound examinations in 45 subfertile women in the early follicular phase of the menstrual cycle. Antral Follicles were counted using real-time 2D ultrasound and the time taken was recorded. A 3D volume was then acquired from each ovary and stored for subsequent offline analysis using the multiplanar view. The time taken for each step was recorded and the total time was calculated. Intraclass correlation coefficients (ICC) and limits of agreement were used to assess reliability. Results There was no difference in the mean Antral Follicle counts using real-time 2D (16.51 ± 11.51) and 3D (16.33 ± 12.13) ultrasound. According to ICCs, there was a significantly higher interobserver reliability for counts made using 3D (mean, 0.992; 95% CI, 0.986–0.996) compared with real-time 2D (mean, 0.961; 95% CI, 0.940–0.977) (P < 0.01) ultrasound. 3D ultrasound was also associated with narrower limits of agreement (−2.7 to + 3.1) than was 2D ultrasound (−6.9 to + 6.4). Whilst the total time taken was significantly longer for the 3D technique (239.3 ± 71.4 s vs. 103.1 ± 28.6 s, P < 0.001), the time required for the actual ultrasound examination was significantly less (46.4 ± 7.4 s vs. 103.1 ± 28.6 s, P < 0.001). Conclusions 3D ultrasound significantly improves the interobserver reliability of Antral Follicle counts. While this is at the expense of time overall, the duration of the actual ultrasound examination and patient exposure is significantly reduced using 3D compared with real-time 2D ultrasound. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.