Transcript Comparision of AFC and AMH for assessment of ovarian reserve

Dr. Sonal Panchal, Dr. C.B.Nagori
Dr. Nagori’s Institute for Infertility and IVF,
Ahmedabad, India
Aim:
 This study aims to compare the efficacy of AFC & AMH, as
markers for ovarian reserve based on computation of
correlation between AFC and AMH.
Method:
 75 PCO patients + 75 non PCO patients undergoing IVF
(BMI : 22 – 26) .
 Baseline 3D US -AFC was done for all on day 3.
 AMH was measured in all on the same day.
 Primary end point was number of follicles > 12 mm on day
of hCG
 Final end point was ova retrieved on ovum pick up.
 Correlation of AFC and AMH was checked with both these
endpoints
 Correlation of AFC was also checked with AMH.
Table 1: Correlation of AFC & AMH with follicles >12mm on day
of hCG for Polycystic and nonPCO category of ovaries N= 75
Normal
ovaries
AFC
>12mm
Polycystic AFC
ovaries
>12mm
AFC
1.0
0.63
AFC
1.0
0.56
>12mm
0.63
1.0
> 12mm
0.56
1.0
AMH
>12mm
AMH
>12mm
AMH
1.0
0.47
AMH
1.0
0.42
>12mm
0.47
1.0
>12mm
0.42
1.0
Correlation between AFC and follicles of > 12mm diameter on the day of hCG
and AMH and follicle >12mm on the day of hCG, significant at .01 level at
0.283(99.9% as per Pearson’s correlation coefficient).
Table 2: Correlation of AFC and AMH with ova retrieved
on OPU for Polycystic & normal category of ovaries N= 75
Normal
ovaries
AFC
OPU
Polycystic AFC
ovaries
OPU
AFC
1.0
0.50
AFC
1.0
0.44
OPU
0.50
1.0
OPU
0.44
1.0
AMH
OPU
AMH
OPU
AMH
1.0
0.43
AMH
1.0
0.39
OPU
0.43
1.0
OPU
0.39
1.0
(correlation between AFC and AMH and ova retrieved on OPU for both the
types of ovaries. significant at 0.01 level)
Table 3: Z score for difference in correlation of AFC and AMH with number of
follicles larger than12mm for nonPCO and Polycystic Ovaries.
NonPCO Ovaries
AMH
AFC
Difference
>12mm
.63
.47
.16
Test of
Significance
Z Value
1.39*
Polycystic Ovaries
<12mm
.56
.42
.14
Test of
Significance
Z value
1.11*a
*Values for Level of Significance 0.0823 (one tailed) and 0.1645 (two tailed test)
* Values for Level of Significance 0.1335 (one tailed) and 0.267 (two tailed test)
Table 4: Z score for difference in correlation of AFC and AMH with ova retrieved
on OPU for Normal Ovaries and Polycystic Ovaries
NonPCO Ovaries
AMH
AFC
Difference
OPU
.50
.43
.07
Test of
Significance
Z Value
0.54*
Polycystic Ovaries
OPU
.44
.39
..05
*Values for Level of Significance 0.2946 (one tailed) and 0.5892 (two tailed test)
*Values for Level of Significance 0.3594 (one tailed) and 0.7188 (two tailed test)
Test of
Significance
Z value
0.36*a
Conclusion
 AFC & AMH both correlate with each other but have independent
significance for estimating follicles larger than 12 mm on the day of
hCG.
 Difference of correlation coefficient between AFC and AMH for ova
retrieved on OPU, is minimally significant in non PCO and is not
significant in PCO group .
 Z values for both nonpco & pco group are equal to or below the
tabulated one tailed significance value, for ova retrieved on OPU.
 Therefore for both groups, AFC alone may suffice as a test for
estimation of ovarian reserve.