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Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial.

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  • Additional Information
    • Source:
      Publisher: John Wiley & Sons, Ltd Country of Publication: England NLM ID: 9108340 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1469-0705 (Electronic) Linking ISSN: 09607692 NLM ISO Abbreviation: Ultrasound Obstet Gynecol Subsets: In Process; MEDLINE
    • Publication Information:
      Publication: 2003- : Chichester, West Sussex, UK : John Wiley & Sons, Ltd.
      Original Publication: Carnforth, Lancs, UK ; Park Ridge, N.J., USA : Parthenon Pub., c1991-
    • Abstract:
      Objective: To compare the proportion of women achieving a desired ovarian response following ovarian stimulation when gonadotropin dosing was determined based on antral follicle count (AFC) vs serum anti-Müllerian hormone (AMH) level, in women undergoing in-vitro fertilization (IVF) using the gonadotropin-releasing hormone (GnRH) antagonist protocol.
      Methods: This was a randomized double-blind trial carried out in a university-affiliated assisted reproduction unit. A total of 200 women undergoing their first IVF cycle using the GnRH-antagonist protocol between April 2016 and February 2018 were randomized to determination of gonadotropin dosing based on either AFC or serum AMH level measured in the pretreatment cycle 1 month before the IVF cycle. Patients underwent IVF as per our center's standard protocol. The proportion of subjects achieving a desired ovarian response, defined as retrieval of six to 14 oocytes, was compared between the two study arms. Subgroup analysis of patients with baseline AFC > 5 and those with baseline AFC ≤ 5 was performed. Concordance in AFC and AMH categorization between the pretreatment cycle and the ovarian-stimulation cycle was assessed using Cohen's kappa (κ).
      Results: There was no significant difference in the proportion of patients achieving a desired ovarian response between the AFC (54%) and AMH (49%) groups (P = 0.479). The median number of oocytes retrieved was nine vs seven (P = 0.070), and the median follicular output rate was 0.54 vs 0.55 (P = 0.764) in the AFC and AMH groups, respectively. Similar findings were observed on subgroup analysis of subjects with AFC ≤ 5 and AFC > 5 at the start of ovarian stimulation (P > 0.05 for all comparisons). There was moderate concordance between AFC and AMH measured in the pretreatment cycle and the stimulation cycle (κ = 0.478 and 0.587, respectively).
      Conclusion: The proportion of women achieving a desired ovarian response following ovarian stimulation using the GnRH-antagonist protocol is similar when the gonadotropin-dosing algorithm used is based on AFC or serum AMH level. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
      (Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.)
    • References:
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      Genro VK, Grynberg M, Scheffer JB, Roux I, Frydman R, Fanchin R. Serum anti-Müllerian hormone levels are negatively related to Follicular Output RaTe (FORT) in normo-cycling women undergoing controlled ovarian hyperstimulation. Hum Reprod 2011; 26: 671-677.
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    • Grant Information:
      201309176223 The University of Hong Kong
    • Contributed Indexing:
      Keywords: IVF; anti-Müllerian hormone; antral follicle count; gonadotropin dosing; ovarian response
      Local Abstract: [Publisher, Spanish; Castilian] Comparación del recuento de folículos sinusales y el nivel de la hormona antimulleriana en el suero para la determinación de la dosis de gonadotrofina en la fecundación in vitro: ensayo aleatorizado OBJETIVO: Comparar la proporción de mujeres que logran una respuesta ovárica deseada tras la estimulación del ovario cuando se determinó la dosis de gonadotrofina en función del recuento de folículos sinusales (AFC, por sus siglas en inglés) frente al nivel de la hormona antimulleriana (HAM) en el suero, en mujeres que se sometieron a una fecundación in vitro (FIV) mediante el protocolo de antagonistas de la hormona liberadora de gonadotropina (GnRH, por sus siglas en inglés). MÉTODOS: Se trata de un ensayo aleatorizado doble ciego realizado en una unidad de reproducción asistida afiliada a una universidad. Un total de 200 mujeres que se sometieron a su primer ciclo de FIV y utilizaron el protocolo de antagonistas de la GnRH entre abril de 2016 y febrero de 2018 fueron asignadas al azar a la determinación de la dosis de gonadotrofina basada en el nivel de AFC o de HAM en suero, medidos en el ciclo de pretratamiento un mes antes del ciclo de FIV. Las pacientes se sometieron a una FIV según el protocolo estándar de nuestro centro. La proporción de mujeres que lograron una respuesta ovárica deseada, definida como la recuperación de seis a 14 ovocitos, se comparó entre las dos ramas del estudio. Se realizó un análisis de subgrupos de las pacientes con AFC de base >5 y de aquellas con AFC de base ≤5. La concordancia en la categorización del AFC y la HAM entre el ciclo de pretratamiento y el ciclo de estimulación ovárica se evaluó utilizando la medida estadística kappa de Cohen (κ). RESULTADOS: No hubo diferencias significativas en la proporción de pacientes que lograron una respuesta ovárica deseada entre los grupos de AFC (54%) y HAM (49%) (P=0,479). La mediana del número de ovocitos recuperados fue de nueve frente a siete (P=0,070), y la mediana de la tasa de producción folicular fue de 0,54 frente a 0,55 (P=0,764) en los grupos AFC y HAM, respectivamente. Se observaron hallazgos similares en el análisis de subgrupos de pacientes con AFC ≤5 y AFC >5 al comienzo de la estimulación ovárica (P>0,05 para todas las comparaciones). Se observó una concordancia moderada entre el AFC y la HAM medidos en el ciclo de pretratamiento y el ciclo de estimulación (κ=0,478 y 0,587, respectivamente). CONCLUSIÓN: La proporción de mujeres que logran una respuesta ovárica deseada después de la estimulación ovárica utilizando el protocolo de antagonistas de la GnRH es similar cuando el algoritmo de dosificación de gonadotrofina utilizado se basa en el nivel del AFC o de la HAM en suero. [Publisher, Chinese] 窦性卵泡计数与血清抗苗勒氏激素水平比较测定体外受精中促性腺激素剂量:随机试验 目标: 比较分析在使用促性腺激素释放激素(GnRH)拮抗剂方案进行体外受精(IVF)的妇女中,根据窦性卵泡计数(AFC)对照血清抗苗勒氏激素(AMH)水平确定促性腺激素剂量时,卵巢刺激后出现预期卵巢反应的妇女比例。 方法: 这是一项在大学附属辅助生殖部门进行的随机双盲试验。在2016年4月至2018年2月期间,共有200名妇女通过GnRH拮抗剂进行了第一次体外受精。她们被随机分组,以便根据体外受精前1个月预处理周期测得的AFC或血清AMH水平测定促性腺激素剂量。患者根据本中心的标准试验方案接受了体外受精。试验中比较了两个研究组中出现所需卵巢反应--即形成6-14个卵母细胞--的受试者比例。对基线AFC>5和基线AFC≤5的患者进行了亚组分析。根据Cohen Kappa(k)系数,进行了预处理周期与卵巢刺激周期之间的AFC和AMH分类一致性评估。 结果: 就出现预期卵巢反应的患者比例而言,AFC(54%)组与AMH(49%)组之间并无明显的差别(P=0.479)。在AFC组和AMH组中,获卵中位数分别为9个和7个(P=0.070),卵泡输出率中位数分别为0.54和0.55(P=0.764)。卵巢刺激开始时针对AFC≤5和AFC>5的受试者的亚组分析中观察到类似的结果(每次比较都发现P>0.05)。预处理周期和刺激周期测得的AFC和AMH之间存在中度一致性(κ系数分别为0.478和0.587)。 结论: 根据AFC或血清AMH水平设计运用促性腺激素剂量算法时,通过GnRH拮抗剂方案刺激卵巢出现预期卵巢反应的妇女比例是相似的。.
    • Publication Date:
      Date Created: 20190721 Latest Revision: 20200302
    • Publication Date:
      20200827
    • Accession Number:
      10.1002/uog.20402
    • Accession Number:
      31325336
  • Citations
    • ABNT:
      LI, H. W. R. et al. Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, [s. l.], v. 55, n. 3, p. 303–309, 2020. DOI 10.1002/uog.20402. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=mdc&AN=31325336. Acesso em: 19 out. 2020.
    • AMA:
      Li HWR, Ko JKY, Lee VCY, et al. Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2020;55(3):303-309. doi:10.1002/uog.20402
    • APA:
      Li, H. W. R., Ko, J. K. Y., Lee, V. C. Y., Yung, S. S. F., Lau, E. Y. L., Yeung, W. S. B., Ho, P. C., & Ng, E. H. Y. (2020). Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial. Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 55(3), 303–309. https://doi.org/10.1002/uog.20402
    • Chicago/Turabian: Author-Date:
      Li, H W R, J K Y Ko, V C Y Lee, S S F Yung, E Y L Lau, W S B Yeung, P C Ho, and E H Y Ng. 2020. “Comparison of Antral Follicle Count and Serum Anti Müllerian Hormone Level for Determination of Gonadotropin Dosing in In-Vitro Fertilization: Randomized Trial.” Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 55 (3): 303–9. doi:10.1002/uog.20402.
    • Harvard:
      Li, H. W. R. et al. (2020) ‘Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial’, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 55(3), pp. 303–309. doi: 10.1002/uog.20402.
    • Harvard: Australian:
      Li, HWR, Ko, JKY, Lee, VCY, Yung, SSF, Lau, EYL, Yeung, WSB, Ho, PC & Ng, EHY 2020, ‘Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial’, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 55, no. 3, pp. 303–309, viewed 19 October 2020, .
    • MLA:
      Li, H. W. R., et al. “Comparison of Antral Follicle Count and Serum Anti Müllerian Hormone Level for Determination of Gonadotropin Dosing in In-Vitro Fertilization: Randomized Trial.” Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 55, no. 3, Mar. 2020, pp. 303–309. EBSCOhost, doi:10.1002/uog.20402.
    • Chicago/Turabian: Humanities:
      Li, H W R, J K Y Ko, V C Y Lee, S S F Yung, E Y L Lau, W S B Yeung, P C Ho, and E H Y Ng. “Comparison of Antral Follicle Count and Serum Anti Müllerian Hormone Level for Determination of Gonadotropin Dosing in In-Vitro Fertilization: Randomized Trial.” Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 55, no. 3 (March 2020): 303–9. doi:10.1002/uog.20402.
    • Vancouver/ICMJE:
      Li HWR, Ko JKY, Lee VCY, Yung SSF, Lau EYL, Yeung WSB, et al. Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology [Internet]. 2020 Mar [cited 2020 Oct 19];55(3):303–9. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=mdc&AN=31325336