Reproductive aging and variability in the ovarian antral follicle count: application in the clinical setting

Objective To determine the extent of intercycle and interobserver variability in antral follicle (AF) count and their impact on stimulation quality in IVF. Design Prospective evaluation of the impact on AF count of GnRH agonist down-regulation and interobserver variability. Retrospective evaluation of intercycle variability in AF count. Setting University ART clinic. Patient(s) Twenty subjects were used to evaluate the effect of GnRH agonist down-regulation upon AF count; six of whom were used to evaluate interobserver variability. Fifty patients experiencing two or three cycles of IVF within a 1-year interval. Intervention(s) Transvaginal ultrasound exams before and after down-regulation with a GnRH agonist. Videotaped day-3 transvaginal ultrasound exams. Main outcome measure(s) [1] Intercycle and interobserver variability in antral follicle count. [2] Oocytes retrieved, peak estradiol, gonadotropin dose, duration of stimulation and cancellation rates. Result(s) There is moderate intercycle and interobserver variability in AF counts. GnRH agonist down-regulation does not significantly change AF count. In infertility patients undergoing IVF, paired analysis between the low– and high–AF count cycles did not show a difference in quality of stimulation or cycle cancellation rates. Conclusion(s) Within an individual patient, higher AF count in a given cycle was not predictive of better stimulation compared with the case of a lower count cycle.