engleski

Clinical implications of the discordances between anti-Müllerian hormone (AMH) and antral follicle count (AFC)

BACKGROUND: AMH and AFC strongly correlate with each other. Nevertheless, discordances between these ovarian reserve tests are sometimes encountered during infertility evaluation. OBJECTIVE: To investigate cases with possible clinical implications of AMH-AFC discordances. MATERIALS AND METHODS: Based on AFC, the subjects were divided into three groups: L-AFC (AFC<7, N=59), I-AFC (AFC=7-20, N=173) and H-AFC (AFC>20, N=198). The predicted AMH values (pAMH) were calculated according to regression equation Log(AMHp)= -0.2577 + 1.2534 Log(AFC), R2=0.698. The pAMH for AFC=7 and AFC=20 were used as cut- offs for subject division according to obtained AMH values: L-AMH (AMH<6.31 pmol/L, N=71), I-AMH (AMH=6.31-23.59 pmol/L ; N=176) and H-AMH (AMH>23.59 pmol/L ; N=183). Cases were considered „as predicted“ if found in AMH and AFC groups with an equal prefix. Overcounted and undercounted cases were those with AMH lower and higher than predicted according to AFC, respectively. RESULTS: The proportion of "as predicted" cases was similar among the AFC groups. Intermediate and high AFC groups had similar proportions of overcounted cases (16.2 vs 18.7%, P=0.621). A significant difference in the proportion of undercounted cases was observed between the low and the intermediate AFC group (27.1 vs 12.7%, P=0.017). CONCLUSION: Patients with discordances between AMH and AFC represent an additional clinical challenge. Undercounted cases in low AFC group and overcounted cases in intermediate AFC group may not have the same prognosis compared to their „as predicted“ counterparts. Additionaly, AFC undercounting in intermediate group could mask the risk of ovarian hyperstimulation syndrome in these patients. Further research aiming at the associations of ovarian response and AMH and AFC in discordant cases could help in decision-making and better counselling of these patients.

anti-Müllerian hormone; antral follicle count

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