Antral follicle count measured at down-regulation as predictor of ovarian response and cumulative live birth: single center analysis including 2731 long agonist IVF cycles

Evaluate antral follicle count measured after pituitary suppression (AFCaps) with a GnRH agonist as predictor of ovarian response and cumulative live birth (CLB). This study is a large cohort analysis of retrospective data between January 2011 and September 2020 in a tertiary-care university hospital. All first initiated IVF/ICSI cycles in women under 43 years of age for whom AFCaps was registered in our database were included. To evaluate CLB rates (CLBRs), only finalized cycles were analyzed (at least one live birth and/or all embryos transferred), excluding PGT cycles and severe male factor requiring testicular sperm extraction. AFCaps showed a good predictive ability in predicting ovarian response to ovarian stimulation. Predicting poor response, AFCaps presented an area under the receiver-operating characteristic curve (AUCROC) of 0.85 (95% CI 0.83–0.87), for high response prediction, the AUCROC was 0.80 (95% confidence interval [CI] 0.77–0.83). Although AFCaps was statistically higher in patients who achieved at least one live birth (13.6 ± 6.05 vs. 9.79 ± 6.33) and CLBRs per started cycle significantly increase between AFCaps quartiles (15.9%, 36.2%, 45.1% and 52.9%) its ability to predict CLBR was modest, with an AUCROC of 0.67 (95% CI 0.65–0.69). Women undergoing their first IVF/ICSI cycle following a long agonist GnRH protocol can be counseled with AFCaps measurement about their probability of achieving poor/high response. Based on this marker physicians can personalize ovarian stimulation with the aim of optimizing ovarian response and minimizing its risks. However, AFCaps has failed to predict CLB per started IVF cycle as an isolated marker.本研究以促性腺激素释放激素激动剂（GnRH agonist）预处理后测得的垂体抑制后窦卵泡计数（antral follicle count measured after pituitary suppression, AFCaps）作为预测指标，评估其对卵巢反应性及累积活产（cumulative live birth, CLB）的预测价值。本研究为一项大型回顾性队列分析，数据来源于2011年1月至2020年9月某三级教学医院的临床病历资料。纳入对象为年龄43岁以下、首次启动体外受精/卵胞浆内单精子注射（in vitro fertilization/intracytoplasmic sperm injection, IVF/ICSI）周期且数据库中记录有AFCaps数据的女性患者。在评估累积活产率（cumulative live birth rates, CLBRs）时，仅纳入结局明确的周期（至少获得1次活产或已完成全部胚胎移植），排除植入前遗传学检测（preimplantation genetic testing, PGT）周期及需行睾丸精子提取术（testicular sperm extraction）的重度男性因素不育患者。AFCaps对卵巢刺激的卵巢反应性具有良好的预测效能：预测卵巢低反应时，受试者工作特征曲线下面积（area under the receiver-operating characteristic curve, AUCROC）为0.85（95%置信区间[CI] 0.83~0.87）；预测卵巢高反应时，AUCROC为0.80（95%置信区间[CI] 0.77~0.83）。尽管在至少获得1次活产的患者中，AFCaps水平显著更高（13.6±6.05 vs. 9.79±6.33），且每启动周期的CLBRs随AFCaps四分位数分组依次升高（15.9%、36.2%、45.1%及52.9%），但AFCaps作为单一指标预测CLB的效能仍较为有限，其AUCROC为0.67（95%置信区间[CI] 0.65~0.69）。对于采用长效GnRH激动剂方案启动首次IVF/ICSI周期的女性，可通过检测AFCaps为其提供卵巢低/高反应风险的临床咨询与指导。临床医师可基于该指标制定个体化卵巢刺激方案，以优化卵巢反应性并降低相关风险。然而，AFCaps作为单一指标，无法有效预测单次启动IVF周期后的累积活产结局。