The Value of Anti-MÃ¼llerian Hormone in Predicting Clinical Pregnancy After Intrauterine Insemination
OBJECTIVES/OBJECTIVE:To evaluate the utility of anti-MÃ¼llerian hormone (AMH) in predicting clinical pregnancy with intrauterine insemination (IUI) and compare it to other markers of quantitative ovarian reserve. METHODS:Retrospective cohort study of women undergoing natural and stimulated IUI cycles. All patients achieved a clinical pregnancy within three IUI cycles or completed three IUI cycles without pregnancy. Receiver operating curves were generated to determine the ability of AMH, antral follicle count, age, BMI, and day 3 FSH to predict clinical pregnancy with IUI. Characteristics of those with and without pregnancy were compared using Mann-Whitney U, chi-square, and Fisher exact tests. RESULTS:Of 209 women included, 49% achieved clinical pregnancy. Pregnant patients were more likely to have a higher AMH (2.76 vs. 1.55 ng/mL, PÂ = 0.0004). The area under the curve was 0.642 in predicting clinical pregnancy within three IUI cycles using AMH (0.608 if excluding polycystic ovarian syndrome patients); 0.639 using antral follicle count; 0.549 using age; 0.599 using day 3 FSH; and 0.639 using BMI. CONCLUSION/CONCLUSIONS:Although serum AMH appears significantly higher in women achieving clinical pregnancy, the predictive value of AMH alone was no better than that for other markers of quantitative ovarian reserve in a patient who clinically qualifies for IUI.
Comparing transabdominal and transvaginal ultrasound-guided follicular aspiration: A risk assessment formula
OBJECTIVE:We sought to identify patients at risk of incomplete transvaginal oocyte retrieval, develop a risk assessment formula to identify patients who would benefit from a transabdominal approach, and compare complication and pregnancy rates between these two approaches. MATERIALS AND METHODS/METHODS:In this retrospective case control study in a private in vitro fertilization center, 95 cases of women undergoing transabdominal follicular aspiration for oocyte retrieval (15 transabdominal only and 80 transabdominal and vaginal combined) were compared with 278 controls of women undergoing the transvaginal aspiration only. Transabdominal oocyte retrieval was performed when one or more ovaries could not be retrieved via the transvaginal approach. Main study outcomes included need for transabdominal retrieval, pregnancy rates, and complications. RESULTS:A risk assessment scoring system was developed as follows: difficulty seeing ovaries on ultrasound (+4), history of pelvic surgery (+3), and body mass index of 30 kg/m(2) or greater (+2). With a cutoff score of 4 or greater, the overall sensitivity is 75%, specificity is 80%, positive predictive value is 57%, and negative predictive value is 90%. No statistically significant differences were found for pregnancy rates or complications. CONCLUSION/CONCLUSIONS:The transabdominal approach is an alternative option that would increase the total number of oocytes retrieved with no statistical difference in complication or pregnancy rates. We also developed a scoring system that can serve as a useful screening tool for identifying women at increased risk of transabdominal oocyte retrieval.