Ovarian Volume And Antral Follicle Count Versus Serum FSH Measurement in Assessment of Ovarian Reserve

BackgroundThe presence of a wide range of tests of ovarian reserve suggests that no single test provides a sufficiently accurate result.Many tests are used without reference to an evidence base.So far, individual studies conducted on these tests are too small to give precise estimates of prognostic accuracy.Objective: The current study was designed to compare ovarian volume& antral follicle count (A.F.C) & day 3 FSH level, with respect to their ability to predict ovarian response of infertile women to ovulation induction agents Material and Methods: This is a prospective observational study in which 52 infertile women who were attending the Obst & Gynae Dept,PMCH UDAIPUR, were recruited.Blood samples were collected on day 2/day 3 for assessment of Se.FSH and TVS were done for antral follicle count and ovarian volume.Induction of ovulation was done for three successive cycles.Clomiphene citrate 100 mg 1OD was given from day 2 to 6, and patients were followed up with serial USG measurements for the dominant follicles (> or = 18 mm).Patients with no dominant follicle in the 1st cycle were subjected to the 2nd and 3 rd cycle of clomiphene 100 mg 1OD from day 2 to day 6 with Inj HMG 150 IU given i.m. starting from day 8 and every alternate day until at least one leading follicle attained ≥18 mm.Results: In this study the results showed that AFC has a higher predictability for successful induction i.e. when AFC < 10; the success rate was 17.7%, while when AFC > 10; the success rate was 57.142% which shows high significant difference.The next predicting factor was ovarian volume, when < 3 ml; the chance of success was very poor (zero), while when volume is 3-9 ml; the success rate was 44.11% & when volume >9 ml; the success rate was 62.5%.While day 3 FSH had the lowest predictability, when S.FSH < 10 m IU /ml; the success rate was 41.26%, while when FSH > 10 m IU / ml; the success rate was 33.33% which does not make much significant difference. Conclusion:We concluded from our study that antral follicle count and ovarian volume are effective predictors of ovarian response being superior to complex and time consuming endocrine tests.