Study question: Is Antral Follicle Count collected at any time during the menstrual cycle (random AFC) reliable in predicting the number of collected mature oocytes? Summary answer: Random AFC is as reliable as serum AMH in predicting ovarian responsiveness to treatment. What is known already: In young women with cancer who are scheduled for chemotherapy, there is the need to provide prompt counseling on future fertility issues including a reliable estimate of the possible benefits of fertility preservation techniques. Unfortunately, hormonal assessments such as serum FSH or AMH take time to be available and FSH needs to be taken in a particular menstrual phase. AFC is conversely immediately available but its use is claimed to be reliable only if collected in the early follicular phase (day 3-5 of the cycle). Study design, size, duration: Retrospective case series of young women with malignancies undergoing ovarian hyperstimulation aimed at oocytes cryopreservation between July 2014 to December 2016. Random AFC and serum AMH was systematically recorded prior to initiate the therapy. All women received a standardized “random start” regimen of ovarian hyperstimulation. Participants/materials, setting, methods: Seventy-two women were ultimately included. The total number of retrieved mature oocytes was the primary outcome. A good response was defined as ≥ 10 retrieved mature oocytes. The predictive capacity of AFC was evaluated using receiver operating characteristic (ROC) curves. Main results and the role of chance: Indication to oocytes cryopreservation was breast cancer in 42 women (58%), lymphoma in 20 (28%) and other malignancies in the remaining 10 (14%). The mean ± SD age and AFC of the selected women was 31.4 ± 5.6 years and 18.7 ± 10.7, respectively. The median (interquartile range) serum AMH was 3.2 (1.3 - 4.2) ng/ml. Thirty-four women (47%) were in the follicular phase, 32 (45%) in the luteal phase and the remaining six (8%) were assuming oral contraceptives. Three cycles were cancelled for poor response. The mean ± SD number of mature oocytes retrieved in the remaining 69 women was 11.2 ± 7.7. Thirty-five women collected ≥10 oocytes (49% of the whole cohort). The c-statistics for the prediction of ≥10 mature oocytes using AFC and serum AMH were similar. Specifically, the area under the curve (AUC) was 0.76 (95%CI: 0.66-0.87; p<0.001) and 0.82 (95%CI: 0.72-0.92; p<0.001), respectively. Similarly, when considering the subgroup of women who were not assuming oral contraceptives and who were recruited after day 5 of the cycle (proper random start, n = 49), the AUC resulted 0.77 (95%CI: 0.64-0.89; p = 0.001) and 0.83 (95%CI: 0.72-0.95; p<0.001), respectively. Limitations, reasons for caution: Even if the accuracy of serum AMH and AFC resulted similar, larger series are required to rule out mild but potentially clinically relevant differences. Wider implications of the findings: Random AFC should be systematically performed prior to counsel women with malignancies. It is a simple assessment and can be obtained rapidly. Moreover, one may even question whether random AFC may become a standard also in women without malignancies who need ovarian reserve assessment. Trial registration number: not applicable.

Fertility preservation in women with malignancies: the accuracy of AFC collected randomly during the menstrual cycle in predicting the number of mature oocytes retrieved

Busnelli A;
2017-01-01

Abstract

Study question: Is Antral Follicle Count collected at any time during the menstrual cycle (random AFC) reliable in predicting the number of collected mature oocytes? Summary answer: Random AFC is as reliable as serum AMH in predicting ovarian responsiveness to treatment. What is known already: In young women with cancer who are scheduled for chemotherapy, there is the need to provide prompt counseling on future fertility issues including a reliable estimate of the possible benefits of fertility preservation techniques. Unfortunately, hormonal assessments such as serum FSH or AMH take time to be available and FSH needs to be taken in a particular menstrual phase. AFC is conversely immediately available but its use is claimed to be reliable only if collected in the early follicular phase (day 3-5 of the cycle). Study design, size, duration: Retrospective case series of young women with malignancies undergoing ovarian hyperstimulation aimed at oocytes cryopreservation between July 2014 to December 2016. Random AFC and serum AMH was systematically recorded prior to initiate the therapy. All women received a standardized “random start” regimen of ovarian hyperstimulation. Participants/materials, setting, methods: Seventy-two women were ultimately included. The total number of retrieved mature oocytes was the primary outcome. A good response was defined as ≥ 10 retrieved mature oocytes. The predictive capacity of AFC was evaluated using receiver operating characteristic (ROC) curves. Main results and the role of chance: Indication to oocytes cryopreservation was breast cancer in 42 women (58%), lymphoma in 20 (28%) and other malignancies in the remaining 10 (14%). The mean ± SD age and AFC of the selected women was 31.4 ± 5.6 years and 18.7 ± 10.7, respectively. The median (interquartile range) serum AMH was 3.2 (1.3 - 4.2) ng/ml. Thirty-four women (47%) were in the follicular phase, 32 (45%) in the luteal phase and the remaining six (8%) were assuming oral contraceptives. Three cycles were cancelled for poor response. The mean ± SD number of mature oocytes retrieved in the remaining 69 women was 11.2 ± 7.7. Thirty-five women collected ≥10 oocytes (49% of the whole cohort). The c-statistics for the prediction of ≥10 mature oocytes using AFC and serum AMH were similar. Specifically, the area under the curve (AUC) was 0.76 (95%CI: 0.66-0.87; p<0.001) and 0.82 (95%CI: 0.72-0.92; p<0.001), respectively. Similarly, when considering the subgroup of women who were not assuming oral contraceptives and who were recruited after day 5 of the cycle (proper random start, n = 49), the AUC resulted 0.77 (95%CI: 0.64-0.89; p = 0.001) and 0.83 (95%CI: 0.72-0.95; p<0.001), respectively. Limitations, reasons for caution: Even if the accuracy of serum AMH and AFC resulted similar, larger series are required to rule out mild but potentially clinically relevant differences. Wider implications of the findings: Random AFC should be systematically performed prior to counsel women with malignancies. It is a simple assessment and can be obtained rapidly. Moreover, one may even question whether random AFC may become a standard also in women without malignancies who need ovarian reserve assessment. Trial registration number: not applicable.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/73771
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