October 18th, 2018

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Combining Age, Antral Follicle Count, Anti-Müllerian Hormone, and Follicle-Stimulating Hormone Is More Accurate Than Individual Markers in Predicting Poor Ovarian Response
Authors:  Maurilio B. Palhares, Jr., M.D., Wellington P. Martins, M.D., Ph.D., Gustavo S. Romão, M.D., Ph.D., Rui A. Ferriani, M.D., Ph.D., and Paula A. Navarro, M.D., Ph.D.
  OBJECTIVE: To compare the predictive accuracy of a formula combining age, anti-Müllerian hormone (AMH), antral follicle count (AFC), and follicle-stimulating hormone (FSH) with those individual markers in predicting poor ovarian response (POR) in young, nonobese women undergoing their first IVF cycle.

STUDY DESIGN: Women aged <40 y, FSH <10 IU/L, BMI <30 kg/m² undergoing first IVF cycle. POR was defined as ≤3 oocytes retrieved or cycle cancellation. The predictive accuracy of each marker alone and the formula combining the 4 markers were determined by area under the receiver operating characteristic curve (AU-ROC). Additionally, we examined the cutoff values and false-positive rates (FPRs) for predicting POR at detection rates of 50% and 80%.

RESULTS: Of the 141 women we evaluated, 45 had POR. The AU-ROC of the combined parameters (0.82) was significantly higher than that for the individual parameters: age=0.67, AFC=0.74, AMH=0.75, and FSH=0.61. For a detection rate of 50%, the formula had FPR=10%, while the individual markers had FPR= 13–24%; for a detection rate of 80%, the formula had FPR=27%, while the individual markers had FPR= 42–72%.

CONCLUSION: Combining age, AMH, AFC, and FSH is significantly more accurate than those individual markers for the prediction of POR.
Keywords:  assisted reproductive techniques, in vitro fertilization, poor ovarian response, anti-Müllerian hormone, antral follicle count, follicle stimulating hormone
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