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Hum. Reprod. Advance Access originally published online on June 3, 2009
Human Reproduction 2009 24(9):2124-2132; doi:10.1093/humrep/dep204
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The predictive value of the automated quantification of the number and size of small antral follicles in women undergoing ART

S. Deb1, M. Batcha, B.K. Campbell, K. Jayaprakasan, J.S. Clewes, J.F. Hopkisson, C. Sjoblom and N.J. Raine-Fenning

Division of Human Development, School of Clinical Sciences, University of Nottingham, Nottingham, UK

1 Correspondence address. Nottingham University Research and Treatment Unit in Reproduction (NURTURE), B Floor, East Block, Queen's Medical Centre, Derby Road, Nottingham, Nottinghamshire NG7 2UH, UK. Tel: +44-115-82-30700; Fax: +44-115-82-30651; E-mail: shilpa.deb{at}nottingham.ac.uk

BACKGROUND: Sono-automatic volume calculation (SonoAVC) automatically identifies and measures the dimensions of hypoechogenic areas within datasets acquired using three-dimensional ultrasound. The objective of this study was to evaluate the predictive value of automated antral follicle counts according to their relative sizes in women undergoing assisted reproduction treatment (ART).

METHODS: A total of 156 subjects aged ≤40 years with a baseline FSH ≤15 IU that undergo their first cycle of ART were prospectively recruited. SonoAVC was used to measure the datasets and record the number of antral follicles measuring ≤9 mm in diameter. These follicles were then grouped into subsets according to their relative sizes: ≤2.0, 2.1–4.0, 4.1–6.0, 6.1–8.0 and 8.1–9.0 mm. The primary outcome was viable pregnancy confirmed on ultrasound 5 weeks following embryo transfer.

RESULTS: A total of 142 subjects were included for analysis of primary end-point. Those subjects who conceived had significantly more antral follicles measuring ≤2 (P = 0.041) and 2.1–4.0 mm (P < 0.001) than those who had unsuccessful treatment. There were no significant differences between the groups in the number of antral follicles measuring 4.1–6.0 (P = 0.191), 6.1–8.0 (P = 0.203) and 8.1–9.0 mm (P = 0.601). Multiple logistic regression showed that antral follicles measuring 2.1–4.0 mm were an independent predictor of pregnancy [Exp(B) = 1.234, 95% CI = 1.092–1.491; P = 0.004; AUC = 0.693].

CONCLUSION: SonoAVC provides automated measures of antral follicle number and size. Using this technique, the number of antral follicles measuring 2.1–4.0 mm in diameter is an independent, significant predictor of pregnancy following in vitro fertilization treatment.

Key words: small antral follicles/three dimensional/assisted reproduction/treatment/measurement/ultrasound

Submitted on January 20, 2009; resubmitted on May 5, 2009; accepted on May 12, 2009.


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