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Anti-Mullerian hormone (AMH) and antral follicular count (AFC)

Anti-Mullerian hormone (AMH) and antral follicular count (AFC) are two potential markers of ovarian reserve. AMH produced by granulosa cells in ovarian follicles, and AFC, the number of small follicles measured by ultrasound during the early follicular phase, are thought to reflect ovarian reserve.
There seems to be a correlation between both AMH levels and AFC and the number of oocytes retrieved and the cancellation rates after controlled ovarian stimulation. There is still controversy regarding the usefulness of these markers to predict pregnancy and live birth rates. The purpose of this survey is to learn how often and in which manner these markers are being used, and what professionals think about the necessity of these tests.

Have the majority of patients visiting your IVF clinic already undergone endocrine function testing?
  • Yes
  • No
  • I do not know

 

Would you consider AMH testing a first- or second-line test?
  • First
  • Second
  • I do not know

 

Would you change your stimulation protocol based on AMH results?
  • Yes
  • No
  • I do not know

 

Do you consider AFC testing mandatory in your practice?
  • Yes
  • No
  • Welcome but not mandatory
  • I do not know

 

Do you routinely document the AFC in your patient’s charts?
  • Yes
  • No
  • I do not measure AFC

 

When do you measure the AFC?
  • During the early follicular phase
  • Any time in the cycle
  • I do not measure AFC on a routine basis

 

Would you change your stimulation protocol based on AFC results?
  • Yes
  • No
  • I do not know

 

What is your AFC cut-off level for poor responders?
  • Three follicles or less
  • Four to five follicles
  • Six to seven follicles
  • I do not measure AFC

 

What size of follicles (in mm) would you include in the AFC
  • Two to five mm in diameter only
  • Five to ten mm in diameter only
  • Two to ten mm in diameter
  • Other
  • I do not measure AFC

 

Do you consider FSH, LH, estradiol, progesterone and testosterone tests to be routine?
  • Yes
  • No
  • I do not know
  • Only some of these tests

 

Do you consider tests such as androstenedione, SHBG, free testosterone, prolactin and inhibin B essential?
  • Yes
  • No
  • I do not know
  • Only some of these tests

 

In your department, do you have a dedicated laboratory to run immunodiagnostic tests?
  • Yes
  • No
  • I do not know

 

Are you using an outsourced laboratory for IVF-related endocrine tests?
  • Yes
  • No
  • Only for some of the tests
  • I do not know

 

How relevant do you consider the use of AMH testing in you routine/practice?
  • Extremely relevant
  • Relevant
  • Not so relevant
  • Uninteresting

 

If the AMH test was available in your clinic at no cost, would you use it routinely?
  • Yes
  • No
  • I have not thought about this

 

If you had to choose one of the factors listed below, which would serve you best in assigning the starting gonadotropin dose?
  • Age
  • FSH
  • AFC
  • AMH

 

Would you like to have an automated AMH test?
  • Yes
  • No
  • It does not matter to me

 

How often do you, or would you test a patient’s AMH level?
  • Only once
  • Every 3-4 months
  • Twice a year
  • Once a year
  • Not at all

 

What are your center’s AMH test result turnaround requirements?
  • Within the same day
  • Is not important
  • I do not measure AMH

 

Which test do you think is best for evaluating ovarian reserve?
  • AMH
  • AFC
  • Basal hormone tests (FSH, LH, and E2)
  • None of the above

 

In your opinion, what is the best use of AMH?
  • To predict low ovarian reserve and response to stimulation
  • To predict high ovarian reserve and response to stimulation
  • To predict both low and high ovarian reserve and response to stimulation
  • To predict pregnancy and live birth rates
  • None of the above

 

In your opinion, which is the best predictor of hyper-response to ovarian induction?
  • Age
  • AFC
  • AMH
  • Other

 

What do you think is the best predictor of on-going pregnancy rate?
  • Age
  • FSH
  • AFC
  • AMH
  • Other

 

 

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