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

Abstract

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.

Methods: We studied 1,156 women (median age 35 years) undergoing the first IVF cycle. Baseline AFC and AMH level on the day before ovarian stimulation were analysed. The main outcome measure was cumulative live birth in the fresh plus all the frozen embryo transfers after the same stimulation cycle.

Results: Serum AMH was significantly correlated with AFC. Both AMH and AFC showed significant correlation with age and ovarian response in the stimulated cycle and total number of transferrable embryos. Baseline AFC and serum AMH were significantly higher in subjects attaining a live birth than those who did not in the fresh stimulated cycle, as well as those attaining cumulative live birth. There was a significant trend of higher cumulative live birth rate in women with higher AMH or AFC. However, logistic regression revealed that both AMH and AFC were not significant predictors of cumulative live birth after adjusting for age and number of embryos available for transfer. Considering only one single predictor, the areas under the ROC curves for AMH (0.646, 95% CI 0.616-0.675) and age (0.648, 95% CI 0.618-0.677) were slightly higher than that for AFC (0.617, 95% CI 0.587-0.647) in predicting cumulative live birth. However, a model combining AMH (with or without AFC) and age of the women only classified an addition of less than 2% of subjects correctly compared to the model with age alone.

Conclusion: Baseline AFC and serum AMH have only modest predictive performance on the occurrence of cumulative live birth, and may not give additional value on top of the women's age.

Figure 1. Receiver operator characteristic (ROC) curve analysis.

Panal (A) shows the ROC curves of antral follicle count (AFC), serum AMH concentration and age of the women in predicting live birth from the fresh stimulation cycle, while Panal (B) shows those in predicting cumulative live birth from fresh and all frozen embryo transfers after the same index stimulation cycle.

Figure 2. Cumulative live birth rate stratified according to serum AMH and antral follicle count (AFC).

Panal (A) shows the association between serum AMH level and cumulative live birth rate from the fresh plus all frozen embryo transfer cycles combined, whereas Panal (B) shows that between AFC and cumulative live birth rate. There was a significant trend of increase across the bars from the lower to the higher ends of AMH and antral follicle count (p<0.001 for both, χ² test for trend).