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. 2024 Aug 20;14(16):1811.
doi: 10.3390/diagnostics14161811.

The Predictive Accuracy of Anogenital Distance and Genital Tubercle Angle for First-Trimester Fetal Sex Determination

Abdulrahman M Alfuraih  1 , Bashaier Mansour Almajem  2 , Amal Abdullah Alsolai  3
Affiliations

The Predictive Accuracy of Anogenital Distance and Genital Tubercle Angle for First-Trimester Fetal Sex Determination

Abdulrahman M Alfuraih et al. Diagnostics (Basel). .

Abstract

Background: Early identification of fetal gender is crucial for managing gender-linked genetic disorders. This study aimed to evaluate the predictive performance of anogenital distance (AGD) and genital tubercle angle (GTA) for fetal sex determination during the first trimester.

Methods: A multicenter retrospective cohort study was conducted on 312 fetal cases between 11 and 13 + 6 weeks of gestation from two tertiary hospitals. AGD and GTA measurements were taken from midsagittal plane images using ultrasound, with intra- and inter-reader reproducibility assessed. Binomial logistic regression and ROC curve analysis were employed to determine the diagnostic performance and optimal cutoff points.

Results: AGD had a mean of 7.16 mm in male fetuses and 4.42 mm in female fetuses, with a sensitivity of 88.8%, specificity of 94.4%, and an area under the ROC curve (AUC) of 0.931 (95% CI: 0.899-0.962) using 5.74 mm as a cutoff point. For GTA, the mean was 35.90 degrees in males and 21.57 degrees in females, with a sensitivity of 92%, specificity of 84.7%, and an AUC of 0.932 (95% CI: 0.904-0.961) using 28.32 degrees as a cutoff point. The reproducibility results were excellent for AGD (intra-operator ICC = 0.938, inter-operator ICC = 0.871) and moderate for GTA (intra-operator ICC = 0.895, inter-operator ICC = 0.695).

Conclusions: The findings suggest that AGD and GTA are reliable markers for early fetal sex determination, with AGD showing higher reproducibility. The findings highlight the feasibility and accuracy of these non-invasive sonographic markers and their potential usefulness in guiding timely interventions and enhancing the management of gender-linked genetic conditions.

Keywords: anogenital distance; fetal gender determination; first-trimester ultrasound; genital tubercle angle; prenatal diagnosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Boxplots of the anogenital distance (a) and genital tubercle angle (b) measurement differences between male and female fetuses.
Figure 2
Figure 2
Examples of anogenital distance (a) and genital tubercle angle (b) measurements from a 12+4 week male fetus.
Figure 3
Figure 3
Receiver operating characteristic curves for anogenital distance (a) and genital tubercle angle (b) measurements.
See this image and copyright information in PMC

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