Hormonal and functional biomarkers in ovarian response.

PURPOSE: Success rates of any artificial reproduction techniques depend on a correct protocol for ovarian stimulation. This can be decided only by proper assessment of ovarian reserve before commencing ovarian stimulation. This study has been conducted to investigate the role of hormonal and functional biomarkers in the prediction of ovarian response. METHODS: A total of 689 women between July 2012 and July 2013 undergoing IVF at Kocaeli University have been enrolled in the study. Patients have been categorized into three groups according to the number of oocytes retrieved: 0-3 oocytes (poor responders), 4-15 oocytes (normoresponders), and >16 oocytes (hyperresponders). Groups have been compared according to follicle-stimulating hormone (FSH), E2, luteinizing hormone (LH) levels, antral follicle counts, and E2 levels on hCG days. Furthermore, regression analysis has been performed with parameters such as age, FSH, LH, E2, anti-mullerian hormone (AMH) and antral follicle counts (AFC) that can affect the total number of oocytes retrieved and pregnancy rates and their interactions with each other have been investigated. RESULTS: FSH, age, hCG day LH level, cycle cancellation rate, total gonadotropin dose were significantly higher in the poor responder group, but in this group, AFC, AMH, hCG day E2 level, and the number of MII oocytes were significantly lower. Cut-off values of normal responders for FSH, AMH, and AFC were 8.43 area under curve [AUC: 0.541 (0.491-0.590)], 0.62 [AUC: 0.704 (0.638-0.764)], and 6 [AUC: 0.715 (0.667-0.760)], respectively. Cut-off values for the absolute poor response group (cycle cancellation) were 12.75 for FSH [AUC: 0.533 (0.49-0.57)], 0.23 for AMH [AUC: 0.678 (0.618-0.733)], and 6 for AFC [AUC: 0.576 (0.531-0.613)]. AMH and AFC were the best markers for the prediction of total oocyte count, independent of age, FSH, and LH levels. CONCLUSIONS: AMH and AFC were found to be the best ovarian reserve tests that can determine the total oocyte count retrieved, without any significant effects on pregnancy rates.