Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women

ObjectiveTo estimate the probability of live birth, adverse treatment outcome, and extremes of ovarian response at different antral follicle count (AFC) cutoff levels in a large prospective cohort of women undergoing IVF treatment.DesignProspective study.SettingUniversity-based assisted conception unit.Patient(s)A total of 1,012 consecutive subjects of all ages undergoing their first cycle of assisted reproductive techniques.Intervention(s)Transvaginal three-dimensional ultrasound assessment and venipuncture in the early follicular phase of the menstrual cycle.Main Outcome Measure(s)Live birth rate, poor ovarian response, and ovarian hyperstimulation syndrome (OHSS).Result(s)Analysis was performed in 1,012 subjects. Both age (r = 0.88) and AFC (r = 0.92) thresholds show significant linear relationship with the probability of live birth, but AFC demonstrates a stronger correlation. At AFC quartiles of 3-10, 11-15, 16-22, and ≥23, the mean live birth rates were 23%, 34%, 39%, and 44%, respectively. No live birth was observed in women with AFC <4. Antral follicle count was predictive of ovarian response, with a 67% likelihood of poor ovarian response for AFC ≤4. Although the risk of moderate or severe OHSS is 2.2% with AFC of ≤24, the risk increases to 8.6% at AFC of ≥24. The risk of OHSS increases further to 11% if there are signs and symptoms of polycystic ovary syndrome.Conclusion(s)Although age and AFC are significantly correlated with live birth, AFC demonstrates a stronger correlation. Antral follicle count thresholds are useful to predict live birth rates and risks of poor ovarian response and OHSS during IVF treatment.