Prospective analysis of ovarian reserve markers as determinant in response to controlled ovarian stimulation in women undergoing IVF cycles in low resource setting in India

The objective of this study was to determine whether ovarian reserve markers can predict ovarian response in women undergoing their first cycle of assisted reproduction. This prospective observational study included 292 infertile patients undergoing their first IVF trial in the Assisted Reproductive Unit in a tertiary care hospital. Day 2 follicle stimulating hormone (FSH), Inhibin B, anti-Mullerian hormone (AMH), antral follicle count (AFC) and ovarian volume was measured before commencement of controlled ovarian hyperstimulation. The main outcome measures were oocytes retrieved and this was correlated with ovarian reserve markers. The mean age was 31.8 (+/- 4.4) years and mean duration of infertility 8.2 (+/- 3.9) years. The correlation between oocytes retrieved and age, day 2 FSH, Inhibin B, AMH, AFC and volume of the ovary was calculated. A negative correlation was found with age (r = -0.22, p < 0.001) and day 2 FSH (r = -0.35, p < 0.001). A positive correlation was seen with AMH (r = 0.15, p = 0.022), AFC (r = 0.48, p < 0.05) and volume (r = 0.17, p = 0.009). In the bivariate analysis, 1 year increase in age was found to decrease the oocytes retrieved count by 0.37 with a significant p value. The independent significant factors found in multiple linear regression analysis were day 2 FSH and AFC. The present study concludes that day 2 FSH and AFC are promising biomarkers for ovarian reserve in predicting ovarian response to gonadotropin stimulation in IVF patients.