Role of antral follicle count in controlled ovarian hyperstimulation and intrauterine insemination cycles in patients with unexplained subfertility

Objective To determine the predictive value of basal antral follicle count (AFC) as a marker for pregnancy, live birth rate, and ovarian response in COH and intrauterine insemination (IUI) cycles in couples with unexplained subfertility. Design Prospective analysis. Setting University-based infertility clinic. Patient(s) One hundred forty-five women who were treated during 283 COH and IUI cycles with recombinant FSH. Intervention(s) Basal AFC by transvaginal ultrasonography and basal hormone levels were determined on the 3rd day of the treatment cycles. Main Outcome Measure(s) Clinical pregnancy and live birth rate with regard to AFC. Result(s) Antral follicle count significantly correlated negatively with age and total dosage of gonadotropin and correlated positively with number of developing follicles on the day of hCG. Patients with pregnant cycles and live births had significantly more AFC, as compared with nonpregnant cycles. Multiple regression analysis revealed that AFC was the only factor to predict both clinical pregnancy and live birth. The area under the curve for AFC to discriminate clinical pregnancy and live birth, respectively, was 0.77 (95% confidence interval, 0.62–0.79) and 0.718 (95% confidence interval, 0.63–0.82). The cutoff value for AFC for predicting clinical pregnancy and live birth was 7.5 in both cases. Conclusion(s) Lower AFC on basal transvaginal ultrasonography is associated with lower clinical pregnancy and live birth rates in unexplained subfertile couples who are treated with COH and IUI. These data are comparable with those for IVF–intracytoplasmic sperm injection cycles.