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

Objective: To 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. Design: Prospective study. Setting: University-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. (Fertil Steril (R) 2012; 98: 657-63. (C) 2012 by American Society for Reproductive Medicine.)