Prognostic value of some ovarian reserve tests in poor responders

Background The objective of this study was to determine the prognostic value of the basal estradiol (E₂) and inhibin-B levels, the antral follicle count (AFC), and the clomiphene citrate challenge test (CCCT) of ovarian response in controlled ovarian hyperstimulation (COH), in an outcome with normal follicle-stimulating hormone (FSH) concentration in the early follicular phase of the menstrual cycle.Methods Fifty-two patients undergoing IVF treatment were included in the study. Blood samples were collected for assessment of basal E₂, FSH, and inhibin-B levels. Transvaginal ultrasound of an unstimulated cycle was performed to determine the mean antral follicle count (AFC). Serum FSH concentration was measured again on day 10 for CCCT performance.Results The mean values of womens age, and basal and day 10 FSH levels were significantly higher in cancelled cycles than in the control group, whereas basal inhibin-B and AFC were significantly higher in the latter. The mean basal E₂ concentration was similar in both groups. The results from the logistic regression analysis show that CCCT (cut-off point FSH >12.5 mIU/ml; AUC_ROC=0.90) was a better single predictor of poor ovarian response than AFC (AUC_ROC=0.85) and inhibin-B (AUC_ROC=0.79) with a correct prediction for CCCT (86.5%), antral follicle count (84.6%), and for inhibin-B (82.7%).Conclusions In women with normal basal FSH level, the determination of E₂ has no prognostic value for the outcome of poor responders. However, CCCT, AFC, and inhibin-B tests, when applied separately, produce good prognostic values. CCCT is the best single predictor of poor ovarian response, followed by antral follicle count and basal inhibin-B values. In spite of that, CCCT does not add significantly to the simpler AFC ultrasound test in the prediction of poor ovarian response.