April 19, 2015
Not sure what got into me blogging last night. I was actually reading papers on the ability of AMH and AFC to predict IVF outcomes and got off thinking about how people really have to trust us medical professionals as we stick probes in places after only meeting them for minutes or, at most, hours. Let me explain. One of the most important pieces of information we need when treating infertility is egg count. We need to know whether a woman has a low, medium, or high egg count. There are a few ways to sort out egg count but the best two are Anti-Mullerian Hormone (AMH) and an ultrasound test called an Antral Follicle Count (AFC).
AMH is a blood test and it is highly accurate in predicting egg count, fertility, and response to fertility medications.
AFC is a test done by vaginal ultrasound where we count egg sacs (or follicles) that are getting ready to grow.
I had always had bias toward AFC for a few reasons: I do the test myself (ego), we are looking at the very follicles we want to stimulate with fertility drugs, and it doesn't cost the patient any money. So, historically I did AFCs on most if not all patients and not that many AMHs. Why didn't I do both? The only reason is that an AMH costs about $150. I hate, hate, hate the money part of medicine and I know $150 is a lot of money. So I've been trying to get around sending patients for AMHs by doing AFCs and resting on my belief it is superior to AMH.
I was wrong. Well, that's dramatic. I wasn't terribly wrong, but there is more and more evidence that an AMH is actually superior to an AFC in predicting response to fertility drugs, particularly during IVF.
The latest and most impressive study was published this month in Fertility & Sterility but to summarize, AMH was a better predictor of the number of eggs a woman will get during IVF treatment than AFC.
What does this mean? Going forward I will encourage most patients to have an AMH test done prior to treatment. However, I maintain the AFC still has value. The most information you have on a patient the better.
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