Anti–Müllerian hormone and antral follicle count predict ovarian response in women less than 45 years following GnRH antagonist multiple–dose protocol

Objective: To speculate which of the following parameters: antral follicle count (AFC), anti-Müllerian hormone (AMH), follicle- stimulating hormone (FSH) and age can be used as a predictor of ovarian response to gonadotropin-releasing hormone (GnRH) antagonist stimulation multiple-dose protocol in women under 45 years, and to determine the cutoff value of these parameters and their correlations for predicting low and high ovarian response. Methods: This prospective study included 462 women with the mean age of (29.3±6.5) years. All women were subjected to the GnRH antagonist stimulation multiple-dose protocol. On the second day of the menstrual cycle, ultrasonography was conducted to determine AFC in both ovaries. Peripheral blood samples were collected to evaluate the level of estradiol, FSH, luteinizing hormone, prolactin, thyroid-stimulating hormone, and AMH. The women were divided into three groups: low response (AHH<1 ng/mL, n=173), normal response (AMH=1.0-3.5 ng/mL, n=175), and high response (AMH >3.5 ng/mL, n=114). Results: A significant decrease was found in the age and FSH level in the high response group compared to other groups (P<0.001). Conversely, a significant increase was shown in AMH, estradiol on human chorionic gonadotropin (hCG) day, AFC, mature oocytes, fertilized oocytes, and embryos transferred in the high response group compared to the other two groups (P<0.001). The receiver operating characteristic (ROC) curves demonstrated that AFC and AMH had the highest accuracy, followed by basal FSH level and age in the prediction of low ovarian reserves (P<0.001) with cutoff values of ≤4.50 and ≤0.95 for AFC and AMH, respectively. Moreover, the ROC analysis showed that AFC had the highest accuracy, followed by AMH level and age in the prediction of high ovarian reserves with a cutoff value of ≥14.50, ≥3.63, and ≤27.50 years, respectively (P<0.01). A significant decrease was observed in women′s age, estradiol level, and oocyte fertilization rate in pregnant women compared to non-pregnant women (P<0.001). Additionally, significant negative correlations were found between the AFC, the number of mature oocytes, fertilized oocytes, embryos transferred, and the age of pregnant women (P<0.001). Conclusions: AFC and AMH predict low and high ovarian response to GnRH antagonist stimulation multiple-dose protocol in women under 45 years.