Comparison of Ovarian volume and Antral follicle count with Endocrine tests for prediction of responsiveness in ovulation induction protocols


1 Radiology Department, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

2 Obstetrics and Gynecology Department, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran


Background: The aim of this study was to determine if the basal antral follicle number and ovarian volume contributes to the prediction of responsiveness in ovulation induction protocol and comparison of it with hormonal tests.
Materials and Methods: 52 irregularly-menstruating patients, aged 18-46 years, participated in this prospective study. All the patients underwent a transvaginal sonography to measure the basal ovarian volume and the basal antral follicles count (AFC). Clomiphene citrate challenge test was measured by summation of measurements of FSH on day 2 and 10. All the women received clomiphene citrate from day 2 to 6. Ovarian responsiveness was measured 1 week after termination of clomiphene citrate and was used as gold standard.
Results: Multiple regression analysis revealed that AFC was the only significant factor for ovarian responsiveness prediction. The area under the curve for AFC to discriminate responder ovaries was 0.66 (95% confidence interval, 0.87-0.99). The cutoff value for predicting ovarian responsiveness was 15.5.
Conclusion: AFC can contribute to the prediction of responsiveness in ovulation induction protocol better than ovarian volume and hormonal tests.


1. Kwee J, Schats R, McDonnell J, Schoemaker J, Lambalk CB. The clomiphene citrate challenge test versus the exogenous follicle-stimulating hormone ovarian reserve test as a single test for identification of low responders and hyperresponders to in vitro fertilization. Fertil Steril 2006;85:1714-22.  Back to cited text no. 1
2. Kwee J, Elting MW, Schats R, Bezemer PD, Lambalk CB, Schoemaker J. Comparison of endocrine tests with respect to their predictive value on the outcome of ovarian hyperstimulation in IVF treatment. Results of a prospective randomized study. Hum Reprod 2003;18:1422-7.  Back to cited text no. 2
3. Hendriks DJ, Broekmans FJ, Bancsi LF, de Jong FH, Looman CW, Te Velde ER. Repeated clomiphene citrate challenge testing in the prediction of outcome in IVF. a comparison with basal markers for ovarian reserve. Hum Reprod 2005;20:163-9.  Back to cited text no. 3
4. te Velde ER, Pearson PL. The variability of female reproductive ageing. Hum Reprod Update 2002;8:141-54.  Back to cited text no. 4
5. Pai MV, Kumari SS, Kumar P. Ovarian volume by transvaginal sonography in the prediction of ovarian response to induction of ovulation. The Journal of Obstetrics and Gynecology of India 2002;52:108-11.  Back to cited text no. 5
6. Kwee J, Elting ME, Schats R, McDonnell J, Lambalk CB. Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization. Reprod Biol Endocrinol 2007; 15;5:9.  Back to cited text no. 6
7. Decherney A, Nathan L. Current obstetric and gynecologic diagnosis and treatment. 2003:988.  Back to cited text no. 7
8. Parra J, Brocalero-Camacho A, Sancho J, Cervelló-Donderis A, Lacruz-Ballester L, Romero-Martínez A. Migrainous infarction and clomiphene citrate. Rev Neurol 2006;42:572-4.  Back to cited text no. 8
9. Parikh AR, Liskow BI. Manic delirium associated with clomiphene-induced ovulation. Psychosomatics 2007;48:65-6.  Back to cited text no. 9
10. Brinton LA, Lamb EJ, Moghissi KS, Scoccia B, Althuis MD, Mabie JE, et al. Ovarian cancer risk after the use of ovulation-stimulating drugs. Obstet Gynecol 2004;103:1194-203.  Back to cited text no. 10
11. Hannibal CG, Jensen A, Sharif H, Kjaer SK. Risk of thyroid cancer after exposure to fertility drugs: results from a large Danish cohort study. Hum Reprod 2008;239:451-6.  Back to cited text no. 11
12. Lee VY, Liu DT, Li CL, Hoi-Fan, Lam DS. Central retinal vein occlusion associated clomiphen-induced ovulation. Fertil Steril 2008;90:2011.e11-2.  Back to cited text no. 12
13. Panagopoulou E, Vedhara K, Gaintarzti C, Tarlatzis B. Emotionally expressive copying reduces pregnancy rate in patients undergoing In vitro Fertilization. Fertil Steril 2006;86:672-7.  Back to cited text no. 13
14. Peterson BD, Newton CR, Feingold T. Anxiety and sexual stress in men and women undergoing infertility treatment. Fertil Steril 2007;88:911-4.  Back to cited text no. 14
15. Finamore PS, Seifer DB, Ananth CV, Leiblum SR.Social concerns of women undergoing infertility treatment. Fertil Steril 2007;88:817-21.  Back to cited text no. 15
16. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update 2006;12:685-718.  Back to cited text no. 16
17. La Marca A, Argento C, Sighinolfi G, Grisendi V, Carbone M, D'Ippolito G, et al. Possibilities and limits of ovarian reserve testing in ART. Curr Pharm Biotechnol 2012;13:398-408.  Back to cited text no. 17
18. Erdem M, Erdem A, Guler I, Atmaca S. Role of antral follicle count in controlled ovarian hyperstimulation and intrauterine insemination cycles in patients with unexplained subfertility. Fertil Steril 2008;90:360-66.  Back to cited text no. 18
19. Jayaprakasan K, Hilwah N, Kendall NR, Hopkisson JF, Campbell BK, Johnson IR, et al. Does 3D ultrasound offer any advantage in the pretreatment assessment of ovarian reserve and prediction of outcome after assisted reproduction treatment? Hum Reprod 2007;22:1932-41.  Back to cited text no. 19
20. Lass A, Skull J, McVeigh E, Margara R, Winston RM. Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotropin for in-vitro fertilization can predict poor response. Hum Reprod 1997;12:294-7.  Back to cited text no. 20