Antral follicle count, anti-mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology?

BJOG. 2005 Oct;112(10):1384-90. doi: 10.1111/j.1471-0528.2005.00670.x.


Objective: The objective of this study was to evaluate the relationship between anti-mullerian hormone (AMH), inhibin B and antral follicle count (AFC) with ovarian response.

Design: Retrospective study.

Setting: Fertility unit.

Sample: AFC was recorded, and a serum sample obtained on day 3 from all patients undergoing in vitro fertilisation (IVF). Patients were given 300 IU/L recombinant follicle stimulating hormone (FSH; Gonal F). The following day blood samples were collected. METHODS Serum samples were assayed for FSH, AMH and inhibin B using commercial immunoassay kits and oestradiol using an in house assay.

Main outcome measures: Response to gonadotrophin stimulation and the number of eggs collected.

Results: AFC was negatively correlated to age (r=-0.426, P < 0.001). Delta inhibin B (levels of inhibin B on day 4 minus day 3) had the best association to the number of eggs collected (r= 0.533, P < 0.001) followed by basal AMH (r= 0.51, P < 0.001) and AFC (r= 0.505, P < 0.001). The number of eggs fertilised was significantly associated with basal AMH (r= 0.592, P < 0.001) and inhibin B (r= 0.548, P < 0.001). AMH with a cutoff of 0.2 ng/mL had the best sensitivity (87%) and specificity (64%) in predicting poor response. A cumulative score using basal FSH, basal AMH, delta E2 (levels of oestradiol on day 4 minus day 3), delta inhibin B, AFC and age gives the best predictive statistics to identify poor responders with 87% sensitivity and 80% specificity and a positive likelihood ratio of 4.36.

Conclusion: Delta inhibin B had the best positive association with the number of eggs collected and basal AMH is the single best predictor of poor response. AFC has a significant association with the number of eggs collected and is predictive of clinical pregnancy. It is evident that a single parameter is of limited value in predicting ovarian response. However, we have demonstrated a cumulative score using all the above markers could be useful in predicting poor response.

MeSH terms

  • Adult
  • Anti-Mullerian Hormone
  • Enzyme-Linked Immunosorbent Assay / methods
  • Female
  • Fertilization in Vitro*
  • Follicle Stimulating Hormone / metabolism
  • Glycoproteins / metabolism*
  • Humans
  • Inhibins / metabolism*
  • Observer Variation
  • Ovarian Follicle*
  • Ovulation Induction
  • Retrospective Studies
  • Sensitivity and Specificity
  • Testicular Hormones / metabolism*


  • Glycoproteins
  • Testicular Hormones
  • inhibin B
  • Inhibins
  • Anti-Mullerian Hormone
  • Follicle Stimulating Hormone