engleski

The extent to which age, anti-Mullerian hormone (AMH) and antral follicle count (AFC) influence the initial gonadotrophin dose decision prior to the first GnRH antagonist IVF cycle

The success and complications of IVF treatment are highly determined by ovarian response to ovarian stimulation with exogenous gonadotropins. In the first IVF cycle, the optimization of ovarian response depends on clinician's decision on the initial gonadotropin dose (IGD) which is mainly based on different algorithms combining age, AMH and AFC. However, the extent to which these known predictors of ovarian response affect the IGD decision could vary considerably in different clinical settings. Thus, this study aimed to quantitatively assess the impact of age, AMH and AFC on IGD decision in our department. The clinical data on 572 patients undergoing the first ovarian stimulation cycle with gonadotropins in the GnRH antagonist protocol between 1.1.2011. and 31.12.2012. were selected for analysis. The associations of IGD with age, AMH and AFC were analyzed by univariate and multivariate regression. It was found that all three variables were determining factors in clinician's choice of IGD (R2= 0.345, P<0.001 ; R2= 0.374, P<0.001 ; R2= 0.467, P<0.001 for age, AMH and AFC, respectively). Moreover, all variables were identified to be independent contributors to the multivariate model which was able to explain 61.3% of the IGD variance (P<0.001). This study demonstrated that age, AMH and AFC had significant influence on the clinical decisions on individualized gonadotropin dose in the first GnRH antagonist IVF cycle in our department. Taken together, the information on these three parameters participated with 61.3% in making IGD decision. Although the individual and overall effect of these ovarian reserve markers on the IVF treatment strategy could differ from one clinical setting to another, here described method of quantification of their influence on clinician´s decision about the initial dose of gonadotropin could be applied universally.

AMH; AFC; gonadotropin dose; GnRH antagonist

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