Predicting ovarian response in women taking corifollitropin alfa

This study investigated using anti-Mullerian hormone (AMH; Elecsys) and antral follicle count (AFC) to predict the response to ovarian stimulation (OS) with corifollitropin alfa (CFA; Elonva). It found that these tests give good predictions of both high and low ovarian response.

OS uses medications, particularly gonadotropin hormones, to cause the ovaries to produce multiple mature follicles. When combined with in vitro fertilization (IVF), OS allows for the creation of multiple embryos in a single month. CFA is a long-acting engineered form of gonadotropin hormone.

However, not all women respond to OS in the same way. Women who have a low response to OS, meaning they produce few oocytes (eggs), will have more difficulty getting pregnant through IVF. In contrast, a high ovarian response puts women at risk of ovarian hyperstimulation syndrome (OHSS), or enlarged ovaries. OHSS can have serious complications, including the ovary twisting and losing blood supply (ovarian torsion). 

For women expected to have a high or low ovarian response, the dose of gonadotropins can be adjusted. The response to OS is related to ovarian reserve, or the number of oocytes available. There are two main tests of ovarian reserve: AMH and AFC. AFC uses ultrasound to count how many follicles have started to mature. However, a woman’s AFC can vary over different menstrual cycles. AMH is a hormone created by less mature follicles. It is not clear how accurate these tests are for predicting ovarian response to OS.

This study included 219 patients undergoing IVF. At the start of the cycle, they had the Elecsys test of AMH and an AFC ultrasound. All patients received OS with CFA. They received additional daily gonadotropin starting on day 8, dosed according to their estimated ovarian reserve. The number of oocytes was recorded after retrieval.

AMH and AFC were both effective at predicting low ovarian response. They were also both effective at predicting high ovarian response. Age alone was somewhat effective at predicting low and high ovarian response. The best predictions came from combining AMH, AFC, age, and follicle-stimulating hormone into one calculation. This calculation had highly effective predictions of both low and high ovarian response.

This study found that AMH and AFC are both effective at predicting ovarian response and that using more than one type of test can increase the accuracy of predictions.

The Elecsys AMH test used in this study is an automated test. It may have more standardized results than other types of AMH tests which are performed manually.