Antral follicle count in clinical practice: analyzing clinical relevance

ObjectiveTo determine the clinical relevance of obtaining antral follicle counts (AFC) before ovarian stimulation in an IVF program.DesignRetrospective cohort study.SettingAn IVF program in a large academic teaching hospital.Patient(s)A total of 1,049 stimulated IVF cycles in 734 subjects between September 2003 and December 2007 selected from our program's database.Intervention(s)Basal antral follicles (AFCs) (3 mm–10 mm) were counted via ultrasound scan on cycle day 3 in luteal leuprolide acetate stimulations, or after at least 2 weeks of oral contraceptives in microdose leuprolide acetate stimulations. Patients were grouped according to basal AFC, and outcome parameters compared for AFC groups within each stimulation protocol.Main Outcome Measure(s)Oocytes retrieved, ovarian response, implantation rate, cancellations, pregnancy, pregnancy loss, and live births per cycle start.Result(s)Antral follicle count grouping is predictive of threefold change in ovarian response to gonadotropins and oocytes retrieved. Low AFC did predict a higher cancellation rate. Antral follicle count did not predict implantation rate, pregnancy rate, or live birth rate per cycle start.Conclusion(s)Antral follicle count may be helpful in determining stimulation protocol, as it is the most reliable determinant of oocytes retrieved per starting FSH dose. Antral follicle count predicts ovarian response, not embryo quality or pregnancy.