AFC and AMH demonstrate significant predictive value for pregnancy outcomes in patients at risk of high ovarian reserve undergoing GnRH-antagonist protocols

AFC and AMH demonstrate significant predictive value for pregnancy outcomes in patients at risk of high ovarian reserve undergoing GnRH-antagonist protocols | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article AFC and AMH demonstrate significant predictive value for pregnancy outcomes in patients at risk of high ovarian reserve undergoing GnRH-antagonist protocols Yunzhu Lan, Shuang Liu, Jun zhang, Fang Wang, Shaowei Chen, Jian Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4813321/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective GnRH-antagonist protocols have garnered significant attention due to their potential to yield more favorable pregnancy outcomes. The association between clinical parameters of GnRH-antagonist protocols and pregnancy outcomes in fresh embryo transfer cycles is a major area of concern. Therefore, our study aimed to investigate the relationship between clinical parameters and pregnancy outcomes in GnRH-antagonist protocols. Methods Out of 2800 couples, we conducted a retrospective evaluation of 442 women, aged 22–40 years, who underwent embryo transfer in-vitro fertilization (IVF) with GnRH-antagonist protocols. Our focus was on the pregnancy outcomes in the fresh embryo transfer cycle of cleavage-stage. The participants were divided into pregnancy (n = 161) and non-pregnancy groups (n = 281), and their clinical parameters were compared to investigate which factors had an effect on pregnancy outcome using a binary logistic regression model. Results Using the Mann-Whitney test, it was determined that several factors were significantly different between the pregnant and non-pregnant groups. Specifically, anti-mullerian hormone (AMH) (p = 0.031 < 0.05), antral follicle count (AFC) (p = 0.000 < 0.05), number of oocytes retrieved (p = 0.002 < 0.05), Metaphase II (MIl) (p = 0.011 < 0.05), Two pronuclear (2PN) (p = 0.014 < 0.05), and endometrial thickness at transplantation (p = 0.045 < 0.05 ) were all found to be significantly greater in the pregnant group compared to the non-pregnant group. Furthermore, AFC (OR = 1.046, 95% confidence interval (CI):1.019–1.073, p = 0.000 < 0.05) and AMH (OR = 1.078 ,95% CI:1.013–1.013, p = 0.031 < 0.05 ) were positively associated with pregnancy outcome. It was also observed that AFC (AUC = 0.600, 95%CI:0.545–0.656,p = 0.002 < 0.05) and AMH (AUC = 0.562, 95%CI:0.507–0.616,p = 0.002 < 0.05) had weak predictive power for pregnancy outcome in GnRH-antagonist protocols, however, their predictive power was stronger when AFC was greater than 15 (AUC = 0.753, 95%C1:0.587–0.799,p = 0.002 < 0.05) and AMH levels were greater than 4.0 ng/mL in the group (AUC = 0.602, 95%C1:0.502–0.702, p = 0.033 < 0.05). Additionally, AFC was found to be more relevant and predictive of pregnancy outcome than AMH in GnRH-antagonist protocols. Conclusions : AFC and AMH levels have limited predictive value in predicting pregnancy outcomes with GnRH-antagonist protocols, but they demonstrate significant clinical utility when AFC exceeds 15 and AMH is above 4.0 ng/mL. This discovery holds significant predictive value for clinicians utilizing AFC and AMH to assess pregnancy outcomes in patients with high ovarian reserve undergoing GnRH-antagonistic cycles. GnRH-antagonist protocols Anti-mullerian hormone Antral follicle count Pregnancy Cleavage-stage embryos transfer Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Although numerous protocols have been developed for ovarian stimulation in assisted ART over the past two decades, the utilization of the GnRH-antagonist protocols represents a significant advancement in controlled ovarian stimulation (COS), not only is there a substantial reduction in the number of injections compared to traditional long agonist protocols, but there is also a notable decrease in the risk of OHSS without compromising pregnancy rates [ 1 ]. Therefore, GnRH-antagonist protocols are currently widely used in controlled ovarian hyperstimulation (COH). A large-scale research was conducted using data from 80 assisted reproduction centers in 35 representative cities in China. A total of 10 consecutively selected medical record cards were analyzed, along with statistics on the use of super-ovulation protocols (internal data from the research report of Aikunwei). The results revealed that the proportion of GnRH-agonist protocols in COS ovulation protocols declined from 62% in 2014 to 35% in 2021. In contrast, the proportion of GnRH-antagonist protocols in COS ovulation protocols increased from 6% in 2014 to 37% in 2021 [ 2 ]. This indicates a significant increase in the use of GnRH-antagonist protocols over time. GnRH-antagonist protocols are widely utilized, primarily due to the necessity of selecting an appropriate ovulation promotion protocol based on the patient's ovarian reserve function during diagnosis and treatment. Ovarian reserve function is categorized into three groups: normal ovarian reserve (NOR), high ovarian reserve (HOR), and diminished ovarian reserve (DOR) [ 3 ]. The GnRH-antagonist protocol is a commonly used method for ovulation induction in the NOR population, it is increasingly favored due to its short ovulation induction time, low incidence of ovarian hyperstimulation syndrome (OHSS), simplicity and convenience, faster cycle entry, minimal burden on patients in terms of treatment cost, and good compliance [4 ~ 6]. The HOR population is considered to be the most suitable for the application of GnRH-antagonist protocol for ovulation induction, in the HOR population and among polycystic ovary syndrome (PCOS) patients, ovulation induction using the GnRH-antagonist protocol, particularly with the application of GnRH-a "trigger", can significantly reduce the occurrence of OHSS [ 4 ]. Both GnRH-antagonist protocols and GnRH-agonist protocols are commonly preferred for ovulation promotion in the DOR population. The European Society of Human Reproduction and Embryology (ESHRE) 2019 edition of the guidelines states that there is no difference in the use of agonist or GnRH-antagonist protocol in the DOR population, based on safety and success rates [ 7 ]. However, the criteria for diagnosing ovarian reserve primarily consist of clinical parameters such as age, AMH, AFC and so on. For instance, the ranges of AMH in NOR, HOR, and DOR are 1 to 1.2 ng/mL, 4.0 ng/mL, < 0.5 to 1.1 ng/mL respectively; and the ranges of AFC are 15 respectively [ 3 ]. This means that all ranges of AMH can be treated with GnRH-antagonist protocol, hence, can it be considered that AMH serves as a feeble indicator for the GnRH-antagonist protocol? The same situation exists for age and AFC in the application of GnRH-antagonist protocol. In other words, clinical parameters such as AMH, AFC, and age remain inconclusive in predicting the outcome of GnRH-antagonist protocol. This raises concerns regarding the potential impact of widely GnRH-antagonist protocol use on pregnancy outcomes. The selection of an GnRH-antagonist protocol is primarily based on clinical parameters such as age, AMH, AFC, etc. However, there is a wide range of variation in these three types of clinical parameters that are applicable to the GnRH-antagonist protocol. Are there specific clinical parameters that have predictive value and provide guidance for the GnRH-antagonist protocol? In this retrospective analysis, we aim to explore potential differences and the value of common clinical parameters between two groups following embryo transfer with or without pregnancy in a fresh embryo transfer cycle of cleavage-stage in GnRH-antagonist protocol. Materials and methods We conducted an analysis of 2800 IVF-assisted conceptions at the Department of Human Assisted Technology of Southwest Medical University Hospital, China, between August 2020 and August 2022. This study has been approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University, with approval number KY2024238, Ethical approval date: June 7, 2024. The case data of the participants were retrospectively analyzed. We calculated the necessary sample size based on a "multistage random sampling survey." The inclusion criteria were as follows: 1) participants aged 20–40 years; 2) regular menstrual cycles (lasting 3–7 days, with a cycle length of 24 to 35 days); 3) use of a GnRH-antagonist protocol; 4) presence of both ovaries and no gonadotropin treatment for at least 6 months; 5) a body mass index (BMI) between 19 and 24kg/m 2 ; and 6) fresh stage embryo transfer. Exclusion criteria: 1) endometriosis and adenomyosis; 2) endometrial polyps, uterine adhesions, and congenital uterine dysplasia; 3) chromosomal karyotype abnormalities in either spouse; 4) patients with recurrent miscarriage. All participants were transferred with fresh cycle embryos at the cleavage stage using an GnRH-antagonist protocol. A total of 442 patients were included and divided into two groups: pregnancy (n = 161) and non-pregnancy (n = 281), based on whether they were pregnant or not. Controlled ovarian hyperstimulation The cycle initiation begins on day 2–4 of menstruation, with the initial dosage determined based on the patient's age, AFC, BMI, follicle-stimulating hormone (FSH), and AMH levels. The initiating drug used is recombinant FSH (75/450 U/strike, Gonafine, Merck, Germany). Once the primary follicle diameter reaches 12–14 mm and according to serum estradiol (E 2 ) and luteinizing hormone (LH) levels, a gonadotropin-releasing hormone antagonist (GnRH-ant) at a dosage of 0.25–0.5 mg/d is administered (Schizophrenia, Merck, Germany). When at least one follicle had a diameter of ≥ 18 mm, 250 ug of Eze (recombinant human chorionic gonadotropin injection, Merck, Germany) was administered and oocytes were retrieved at 36–38 h with vaginal ultrasound monitoring. Embryo transplantation Progesterone injection (10 mg/stem, Zhejiang Xianju) at a dosage of 60mg/d and Dydrogesterone tablets (10 mg/tablet, Solvay, Netherlands) at a dosage of 20 mg bid were administered on the day of oocyte retrieval. Following this, 1–2 good quality embryos were selected for transfer after recording endometrial thickness via ultrasound on the 3rd day post oocyte retrieval. Pregnancy outcome was determined by measuring blood β-HCG levels 14 days after transfer, which indicated either non-pregnancy or biochemical pregnancy. Clinical pregnancy was confirmed through vaginal ultrasound examination on day 28 to observe the presence of a gestational sac and visible fetal heartbeat. Embryo scoring The embryo scoring system assesses the quality of embryos according to cells, fragmentation and symmetry: cells are scored based on cell number and fragmentation classification (4 credits will be awarded for no fragmentation, 3 credits for less than 10% fragmentation, 2 credits for fragmentation between 10% and 25%, and 1 credit for fragmentation exceeding 25%) as well as ovoid homogeneity (symmetry score 1, asymmetry score 0). Observed indicators such as age, BMI, LH, FSH, AMH, Gn initiation dose (bottles), Gn days, total Gn dose (bottles), the number of retrieved oocytes, the number of MII, the number of 2PN, endometrial thickness at transplantation and clinical pregnancy outcome were recorded for patients in different groups. All steps can be seen in the table of contents diagram (refer to Fig. 1 ). Statistical Analysis SPSS 17.0 was used to conduct the statistical analysis. Prior to analysis, all data underwent normality testing. It was found that the data for Age, FSH, LH, AMH, AFC, total Gn dose (measured in bottles where one bottle equals 75 IU), initiation Gn dose (measured in IU), total days of Gn treatment, numbers of retrieved oocytes, numbers of oocytes in MII stage, numbers of cleavages, numbers of 2PN embryos, levels of E2 and Progesterone (P) on HCG day, as well as the endometrial thickness (measured in mm) at transplantation day were skewed. Therefore median and interquartile ranges were used to describe the data and a nonparametric test (Mann-Whitney test) was applied for analysis. A significance level of p < 0.05 was considered in this study. A binary logistic regression model was utilized to examine the impact of the aforementioned clinical parameters on pregnancy outcome. Additionally, ROC curves were employed to assess the predictive values of the clinical parameters associated with pregnancy outcome. Graph Prism software was used to generate pie charts, histograms, violin plots, and box plots. Statistical significance was indicated by a p < 0.05. Results The 442 patients included in the study were divided into two groups: the pregnancy group (n = 161) and the non-pregnancy group (n = 281), based on their pregnancy status (Fig. 2 ). The clinical parameters during ovulation in different groups were tested for normality. As the sample size was less than 2000, the Shapiro-Wilk test was used, indicating that the above variables were skewed. The median and quartiles were used to describe the degree of dispersion. A non-parametric test, the Mann-Whitney test, was utilized to compare various factors between the pregnancy and non-pregnancy groups. The results indicated that AMH (Fig. 4), AFC (Fig. 5), the numbers of retrieved oocytes, MII, and 2PN, as well as the data of endometrium at transplantation day (Fig. 3), were significantly greater in the pregnancy group than in the non-pregnancy group (p < 0.05). Conversely, age, total Gn dose, and Gn initiation dose were found to be significantly less in the pregnancy group compared to the non-pregnancy group (p < 0.05). However, no statistically significant differences were observed between the two groups for BMI, LH, FSH, total gonadotropin (bottles), or levels of E2 and P on HCG day (Table 1 ). A binary logistic regression model was employed to evaluate the impact of common parameters in the GnRH-antagonist protocol on pregnancy outcome. The findings revealed that age, total Gn dose (bottles), and initiation Gn dose (bottles) were inversely associated with pregnancy outcome (p < 0.05), whereas BMI, AMH, AFC, and the number of retrieved oocytes were positively linked to pregnancy outcome (p 0.05) (Table 2 ). The ROC curve was utilized to analyze the predictive value of age, BMI, AMH, AFC, initiation Gn dose, total Gn dose and the number of oocytes on the pregnancy outcome of the GnRH-antagonist protocol. AFC (AUC = 0.600, p < 0.05) and AMH (AUC = 0.562, p < 0.05) exhibited limited predictive power for pregnancy outcome in GnRH-antagonist protocols, despite demonstrating some predictive value. (Table 3 ; Fig. 6 for ROC curves of AMH and AFC). Categorizing ovarian reserve function into normal, high, and diminished groups revealed that the optimal predictive ability was found to be demonstrated when AMH levels were greater than 4.0 ng/mL in the group (AUC = 0.602, p < 0.05) and AFC was greater than 15 in the group (AUC = 0.753, p < 0.01), the strongest predictive ability was observed in the group with AFC greater than 15. (Table 4 ; Fig. 7 for ROC curves of AMH and AFC) Depicting the keywords of AMH and AFC in the IVF assisted conception process using VOS viewer. We conducted a search on the Web of Science for "AFC and IVF" and "AMH and IVF", resulting in 16525 items from the database (Last five years), with a search frequency of 15, showing 658 papers. The literature on "AFC/AMH" focused on topics such as "fertilization," "live birth," "prediction," "primary outcome," and "ovarian reserve." This suggests that AMH and AFC are closely related to ovarian reserve function and pregnancy outcome after in vitro fertilization ( Fig. 8 ). Table 1 The common clinical parameters of the pregnant and non-pregnant groups pregnancy group（n=161） non-pregnancy group（n=281） Z P Age(years) 30（27~34） 31（28~36） -2.274 0.023* BMI 22.66（20.11~24.82） 21.87（20.02~24.44） -1.723 0.085 LH (mIU/mL) 3.14（2.01~4.75） 3.13（2.25~4.35） -0.332 0.740 FSH(mIU/mL) 8.41（7.21~9.81） 8.47（7.00~10.36） -0.461 0.645 AMH (ng/mL) 2.25（1.46~4.48） 2.19（1.02~3.69） -2.157 0.031* AFC(pieces) 15（11~20.5） 12（9~17） -3.518 0.000** Total Gn dose(bottles) 32.00（21.00~37.17） 33.00（27.00~40.00） -2.688 0.007** Gn days 10（9~11） 10（9~11） -0.697 0.486 Initiation dose(bottles) 3.00（2.00~4.00） 3.33（3.00~4.00） -3.023 0.003** Number of retrieved oocytes(pieces) 9.00（6.00~12.00） 7.00（5.00~11.00） -3.089 0.002** Number of MII(pieces) 8.00（6.00~11.00） 7.00（4.50~10.00） -2.546 0.011* Number of 2PN(pieces) 5.00（4.00~7.00） 4,00（3.00~7.00） -2.447 0.014* E2 on HCG day(pg/L) 2174.71（1505.18~3000.00） 1951.97（1292.45~2751.51） -1.890 0.059 P in HCG day(ng/L) 0.700（0.48~1.05） 0.78（0.50~1.10） -0.904 0.366 endometrium at transplantation day(mm) 10.80（9.60~12.60） 10.50（9.10~12.18） -2.000 0.045* Table 2 Results for clinical parameters by Binary logistic regression model β OR 95%CI P Age (years) -0.049 0.952 0.916，0.99 0.013* BMI 0.065 1.067 1.009，1.128 0.022* LH (mIU/mL) -0.007 0.993 0.954，1.034 0.745 FSH (mIU/mL) -0.045 0.956 0.901，1.015 0.144 AMH (ng/mL) 0.075 1.078 1.013，1.148 0.018* AFC (pieces) 0.045 1.046 1.019，1.073 0.001** Total Gn dose (bottles) -0.024 0.976 0.958，0.995 0.013* Gn days -0.004 0.996 0.905，1.097 0.939 Initiation dose (bottles) -0.334 0.716 0.574，0.893 0.003** Number of retrieved oocytes (pieces) 0.053 1.055 1.01，1.101 0.016* Number of MII (pieces) 0.045 1.046 0.997，1.097 0.065 Number of 2PN (pieces) 0.047 1.048 0.991，1.109 0.103 E2 on HCG day (pg/L) 0 1 1，1 0.32 P in HCG day (ng/L) -0.047 0.954 0.64，1.424 0.819 endometrium at transplantation day(mm) 0.065 1.068 0.984，1.158 0.115 Table 3 Predictive value of clinical parameters on pregnancy outcome of GnRH-antagonist protocol AUC Sensitivity Specificity 95%CI P Age (years) 0.435 1 0.011 0.381,0.489 0.023* BMI 0.549 0.565 0.548 0.493,0.605 0.085 AMH (ng/mL) 0.562 0.845 0.31 0.507,0.616 0.031* AFC (pieces) 0.6 0.745 0.413 0.545,0.656 0.000** Initiation dose (bottles) 0.419 0.006 1 0.363,0.474 0.004** Total Gn dose (bottles) 0.423 0.019 0.993 0.367,0.479 0.007** Number of retrieved oocytes (pieces) 0.588 0.745 0.413 0.534,0.642 0.002** Table 4 Predictive value of age, AMH, and AFC segmentation on pregnancy outcome in GnRH-antagonist protocols AUC Sensitivity Specificity 95%CI P Age (years) , ≤ 29 0.567 0.341 0.672 0.465,0.668 0.197 30 to 35 0.511 0.693 0.344 0.418,0.605 0.816 ≥ 36 0.592 0.694 0.439 0.508,0.675 0.055 AMH (ng/mL) , 4.0 0.602 0.467 0.82 0.502,0.702 0.033* AFC (pieces) , ≤ 6 0.591 0.107 0.929 0.394,0.787 0.344 7 to 15 0.526 0.495 0.568 0.441,0.611 0.554 ≥15 0.753 0.63 0.667 0.587,0.799 0.002** Disscusion This retrospective study aimed to investigate the predictive value of clinical parameters in GnRH-antagonist protocols on pregnancy outcomes in the fresh embryo transfer cycle of cleavage-stage. This study demonstrated a positive association between AFC and AMH with pregnancy outcome. However, it was noted that in GnRH-antagonist protocols, AFC (AUC = 0.600) and AMH (AUC = 0.562) had weak predictive power for pregnancy outcome. Conversely, the predictive ability was stronger in the group with an AFC greater than 15 (AUC = 0.753), and AMH levels were greater than 4.0 ng/mL in the group (AUC = 0.602, p < 0.05). AFC and AMH have been utilized as biomarkers for estimating ovarian reserve and predicting ovarian response [ 8 , 9 ]. Given the widespread acceptance of AFC and AMH as predictors of ovarian response, it is reasonable to assume that they may be associated with IVF outcomes. Currently, numerous studies on AMH and AFC are focused on discussing its impact on clinical practice at various thresholds, as well as analyzing the effect of AFC on ART outcomes under different ovarian stimulation protocols. However, the role of AFC and AMH in predicting the pregnancy outcome of IVF remains inconclusive. Several studies have indicated that serum AFC and AMH can predict pregnancy outcomes, whether spontaneous or following assisted reproductive technology, such as the live birth rate and ongoing pregnancy rate [ 10 , 11 ]. On the other hand, some studies did not find a significant correlation between AFC and AMH and pregnancy outcomes in IVF cycles [12 ~ 14]. It is evident that each study opted for different ovulation protocols, resulting in varying outcomes. For instance, Goswami et al. [ 10 ] and Liao et al. [ 11 ] both suggested that AFC could predict pregnancy outcome, but Liao et al. utilized a standard long protocol while Goswami et al. used an GnRH-antagonist protocol. On the other hand, Sahmay et al. [ 12 ] and Peralta et al.[ 13 ] proposed that AFC was not predictive of pregnancy outcome, with Sahmay et al. using GnRH-agonist and Peralta et al. employing a GnRH-antagonist protocol. The discrepancy in the findings regarding AFC and AMH's impact on pregnancy outcomes may be attributed to the use of different ovulation protocols leading to divergent results, thus emphasizing the significance of highlighting the specific ovulation protocols employed in studies. Overall, it is crucial to consider how variations in ovulation protocols can influence research outcomes when examining the relationship between AFC or AMH and pregnancy success. The selection of the ovulation protocol should be based on the patient's fundamental condition (age, AMH, AFC), the patient's willingness and financial situation, as well as the physician's experience. The timing of Gn initiation should take into consideration the size and synchronization of the AFC, while the dose of Gn initiation is also determined based on the patient's age, AMH, AFC, and BMI [ 3 ]. Depending on the scope of use of the GnRH-antagonist protocol, it can be utilized in patients with varying ovarian responses, including those with normal, high, or diminished ovarian reserve function. Therefore, whether patients have normal ovarian reserve, high ovarian reserve, or diminished ovarian reserve, all of them can utilize the GnRH-antagonist protocol. This implies that the GnRH-antagonist protocol is applicable to any level of age, AMH, and AFC. This raises the question: are age, AMH, and AFC still relevant for assessing pregnancy outcomes when using the GnRH-antagonist protocol? GnRH-antagonist protocols have been shown to be equally effective as GnRH-agonist protocols, with the added benefits of being safer, simpler, and more patient-friendly. This makes them a favorable option for assisted reproductive technology procedures [ 15 ]. There has been a notable rise in the use of GnRH-antagonist protocols in clinical practice, as evidenced by internal data from the Elkhorn Weil study. This trend is also observed in our center, with a reported usage rate of 39% (442/1120). Based on our data, the level of AMH in the pregnant group (2.25 (1.46–4.48) vs. 2.19 (1.02–3.69), p = 0.031 < 0.05) was significantly higher compared to the non-pregnant group in the GnRH-antagonist protocol, suggesting a potential association between AMH levels and pregnancy outcomes in this protocol. Additionally, the AFC (15 (11-20.5) vs 12 (9–17), p = 0.002 < 0.05) was also observed to be significantly higher in the non-pregnant group, suggesting that AFC may play a role in pregnancy success within this protocol. It is possible that the higher AFC in the pregnant group indicates a more favorable ovarian reserve function, which is a positive factor for achieving a successful pregnancy. There was a significant age difference between the pregnant and non-pregnant groups (31 vs. 32 years, P = 0.023 < 0.05). In addition, age was negatively correlated with pregnancy outcome (OR = 0.952, CI:0.916–0.990, P = 0.013 < 0.05), suggesting that younger women were more likely to become pregnant in the GnRH-antagonist protocol. Nevertheless, we discovered that AMH (OR = 1.078, CI:1.013–1.013, P = 0.018 < 0.05) and AFC (OR = 1.046, CI: 1.019–1.073, P = 0.001 < 0.01) exhibited a positive correlation with pregnancy outcomes in the participants of the study. This finding is consistent with existing literature which recognizes AFC and AMH as reliable biomarkers for predicting clinical pregnancy outcomes [ 11 , 16 , 17 ]. We observed that in GnRH-antagonist protocols, both AFC (AUC = 0.600) and AMH (AUC = 0.562) demonstrated limited predictive ability for pregnancy outcome, which is consistent with the findings of previous studies [ 12 , 13 ]. However, considering the specificity of the GnRH-antagonist protocol, which is suitable for normal, high, and diminished ovarian reserve, we conducted a segmented study of age, AMH, and AFC, the optimal predictive ability was found to be demonstrated when AMH levels were greater than 4.0 ng/mL in the group (AUC = 0.602, p = 0.032 < 0.05) and AFC was greater than 15 in the group (AUC = 0.753, p = 0.002 < 0.01), the strongest predictive ability was observed in the group with AFC greater than 15. However, AMH levels above 4.0 ng/mL and AFC counts above 15 can be considered as indicators of high ovarian reserve within the group [ 3 ]. In other words, AFC is considered the most reliable predictor of clinical outcomes for high ovarian reserve in GnRH-antagonist protocols. Previous research has observed that an increase in AFC was associated with a higher rate of live births across all examined data categories, with the highest number of live births occurring when the AFC exceeds 18 [ 11 ]. In this context, it is essential to focus on the guidelines for utilizing GnRH-antagonist protocols. The guidelines from the European Society of Human Reproduction and Embryology (ESHRE) on methods for preventing ovarian hyperstimulation syndrome (OHSS) emphasize that patients at high risk of OHSS should avoid the use of the GnRH-agonist ovulation protocol and instead consider using the GnRH-antagonist protocol [ 7 ]. Similarly, the Society of Reproductive Medicine, Chinese Medical Association (CSRM), has recommended GnRH-antagonist protocols as the most suitable method for promoting ovulation in the HOR population. For patients with polycystic ovary syndrome (PCOS) or those at high risk of OHSS, it is advised to induce ovulation using GnRH-antagonist protocols, such as the GnRH-a "trigger". This approach can significantly reduce the incidence of OHSS in both HOR and PCOS patients [ 3 ]. Based on our findings, it is evident that an AFC of greater than 15 is considered the most reliable predictor of pregnancy outcome in the GnRH-antagonist protocol. Furthermore, the consensus that AFC > 15 indicates a high ovarian reserve suggests that individuals with a high ovarian reserve are better suited for the GnRH-antagonist protocol. This may be attributed to the fact that the GnRH-ant protocol does not have a "flare-up" effect, rapidly inhibits endogenous LH release without pituitary desensitization, leading to a reduction in Gn dosage and shortened duration of administration, as demonstrated in the present study that both the total Gn dose and the starting dose of Gn were significantly lower in the pregnancy group compared to the non-pregnancy group (p 15 not only prevented HOSS occurrence but also resulted in a more favorable pro-ovulatory effect. Indeed, AFC values reported in literature are very variable, thus creating difficulties for clinicians in selecting cut of values based on evidence [18 ~ 20]. Our findings also reflect the situation that in the GnRH-antagonist protocol, AFC was unable to predict the ovarian normal and diminished reserve groups, but could predict the ovarian high reserve group. This could be attributed to the principle of action of the antagonist protocol and its wide applicability to patients with normal ovarian reserve, diminished ovarian reserve, and high ovarian reserve. Therefore, when studying the predictive value of AFC, it should be categorized and studied so as to avoid conflicting results. AFC refers to the number of follicles with a diameter of 2–10 mm visible on B-ultrasound on day 2–3 of the menstrual cycle. This method has the advantages of being non-invasive, inexpensive, and reproducible. We observed that AFC plays a stronger predictive role than AHM, possibly due to the fact that AFC is measured during each cycle, while AMH is typically only measured once a year [ 21 , 22 ]. Therefore, in comparison to AMH, AFC will capture more fluctuations in physiological ovarian function, which could indirectly be linked to a lack of reproducibility. Although AMH is a superior predictor of ovarian response to gonadotropin therapy compared to AFC [ 23 ], it should be noted that AMH levels remain relatively constant throughout the menstrual cycle. This characteristic makes it challenging to assess the impact of minor fluctuations in pregnancy outcomes. As a result, AFC provides a more accurate picture of the pregnancy outcome of the cycle. Some articles have observed that both AMH and AFC decrease with age, and the decline in both markers appears to be linear [ 19 ]. Serum AMH levels decrease by 5% per year, while AFC levels decrease by 4.0% per year [ 24 ]. Therefore, it is important to consider age when establishing a direct relationship between AMH and AFC or determining the cutoff. After conducting our analysis, we did observe a negative correlation between age and pregnancy outcome. However, it is important to note that the predictive value of age for pregnancy in the GnRH-antagonist protocol was not found to be statistically significant. The participants were categorized into three groups: those aged less than 29 years, those aged 30 to 35 years, and those older than 36 years, none of these groups showed a predictive value of age on pregnancy outcome (p > 0.05). While some researchers have suggested that the optimal threshold for clinical pregnancy in patients over 40 years of age in the GnRH-antagonist protocol was 41 years of age with an AFC > 3 (AUC = 0.698, p < 0.01), without analyzing the other ages [ 16 ]. There are several limitations to our study. First, the ovarian promotion protocol we used was the GnRH-antagonist protocol, which is not only capable of being performed in all ages, AMH and AFC, it also minimizes the interference of individual gonadotropin doses. Our findings suggest that an AFC > 15 in GnRH-antagonist protocols is significantly valuable for predicting clinical pregnancy outcomes. Different stimulation protocols operate on different principles of action, which may impact the clinical prognosis of AFC. Therefore, findings from one protocol cannot be generalized to other protocols, such as GnRH-antagonist protocols. Secondly, in addition, our clinical results were not comprehensive and the sample size was not large enough; we only analyzed clinical pregnancies, whereas pregnancy loss, live births, and cumulative live birth rates are factors that need to be taken into account in our further studies. In conclusion, our findings suggest that AFC and AMH have limited predictive value for pregnancy outcome in GnRH-antagonist protocols, however, the presence of the AMH > 4.0 ng/mL group and the AFC > 15 group was associated with a high predictive value for pregnancy outcome in the GnRH-antagonist protocol. Both the AMH > 4.0 ng/mL group and the AFC > 15 group can be considered as indicators of high ovarian reserve. Therefore, recognizing that the AFC > 15 group has significant predictive value for pregnancy outcomes with GnRH-antagonist protocols may aid in predicting a favorable prognosis and tailoring treatment strategies during pre-cycle clinical counseling of infertile patients with a high ovarian reserve.Additionally, this information provides valuable reference points for selecting appropriate ovarian stimulation protocols. Conclusions According to the wide applicability of the GnRH-antagonist protocols, we found that AMH and AFC had significant predictive value for pregnancy outcomes in patients at high risk for ovarian response. This discovery holds significant value for clinicians utilizing AFC and AMH to assess pregnancy outcomes in patients with high ovarian reserve undergoing GnRH-antagonistic cycles. Declarations Acknowledgements We thank the participants of the survey and all staff members involved in this study for their painstaking efforts in conducting the data collection.We are grateful to the Affiliated Hospital of Southwest Medical University for providing the data and to the women who provided the survey data.The authors wish to express their gratitude to the editors and anonymous reviewers who made supportive and insightful comments during the review process. Author contributions Yunzhu Lan and Shuang liu: Writing original draft, Software, Data curation. Jun Zhang and Fang Wang: interpreted the data, and read the entire manuscript critically. Shaowei Chen designed the study, directed and revised the manuscript, and approved the final manuscript. Jian Xu directed and revised the manuscript. All authors read and approved the final manuscript. Funding This research was supported by the Science and Technology Strategic Cooperation Projects of Suining First People's Hospital-Southwest Medical University (No#2022SNXNYD04) A conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Consent to publish The authors declare their consent to publish this article. Consent to participate The authors declare their consent to participate in this article. Ethics approval This study was approved by the ethics committee of the Affiliated Hospital of Southwest Medical University, Ethical approval number (No#KY2024238), Ethical approval date: June 7, 2024. Data Availability Statement The data sets utilized and/or analyzed in the present study can be provided by the corresponding author upon reasonable request. References Lambalk CB, Banga FR, Huirne JA, et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update. 2017;23(5):560-579. doi:10.1093/humupd/dmx017 Fang YY, Wu QJ, Zhang TN, et al. Assessment of the development of assisted reproductive technology in Liaoning province of China, from 2012 to 2016. BMC Health Serv Res. 2018;18(1):873. Published 2018 Nov 20. doi:10.1186/s12913-018-3585-9 Hu LL, Huang GN, Sun HX, et al. CSRM consensus on key indicators for quality control in ART clinical operation[J]. J Reprod Med, 2018, 27(9): 828-835. DOI:10.3969/j.issn.1004-3845.2018.09.002 Chinese Society of Reproductive Medicine (CSRM). Expert consensus on the use of gonadotropin-releasing hormone antagonist protocols in assisted reproduction[J]. Chin J Obstet Gynecol, 2015, 50(11): 805-809. DOI: 10.3760/cma.j.issn.0529-567x.2015.11.002 Toftager M, Bogstad J, Bryndorf T, et al. Risk of severe ovarian hyperstimulation syndrome in GnRH antagonist versus GnRH agonist protocol: RCT including 1050 first IVF/ICSI cycles[J]. Hum Reprod, 2016, 31(6): 1253-1264. DOI: 10.1093/humrep/dew051 Venetis CA, Storr A, Chua SJ, et al. What is the optimal GnRH antagonist protocol for ovarian stimulation during ART treatment? A systematic review and network meta-analysis. Hum Reprod Update. 2023;29(3):307-326. doi:10.1093/humupd/dmac040 Ovarian Stimulation TEGGO, Bosch E, Broer S, et al. ESHRE guideline: ovarian stimulation for IVF/ICSI[J]. Hum Reprod Open, 2020, 2020(2): hoaa009. DOI: 10.1093/hropen/hoaa009 Iliodromiti S, Anderson RA, Nelson SM. Technical and performance characteristics of anti-Müllerian hormone and antral follicle count as biomarkers of ovarian response. Hum Reprod Update. 2015;21(6):698-710. doi:10.1093/humupd/dmu062 La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update. 2014;20(1):124-140. doi:10.1093/humupd/dmt037 Goswami M, Nikolaou D. Is AMH Level, Independent of Age, a Predictor of Live Birth in IVF?. J Hum Reprod Sci. 2017;10(1):24-30. doi:10.4103/jhrs.JHRS_86_16 Liao S, Xiong J, Tu H, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds combined with female age, female cause of infertility, and ovarian response in a prospective cohort of 8269 women. Medicine (Baltimore). 2019;98(41):e17470. doi:10.1097/MD.0000000000017470 Sahmay S, Demirayak G, Guralp O, et al. Serum anti-müllerian hormone, follicle stimulating hormone and antral follicle count measurement cannot predict pregnancy rates in IVF/ICSI cycles. J Assist Reprod Genet. 2012;29(7):589-595. doi:10.1007/s10815-012-9754-6 Peralta S, Solernou R, Barral Y, et al. Antral follicle count measured at down-regulation as predictor of ovarian response and cumulative live birth: single center analysis including 2731 long agonist IVF cycles. Gynecol Endocrinol. 2022;38(12):1079-1086. doi:10.1080/09513590.2022.2154339 Hamdine O, Eijkemans MJC, Lentjes EGW, et al. Antimüllerian hormone: prediction of cumulative live birth in gonadotropin-releasing hormone antagonist treatment for in vitro fertilization. Fertil Steril. 2015;104(4):891-898.e2. doi:10.1016/j.fertnstert.2015.06.030 Al-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2016;4(4):CD001750. Published 2016 Apr 29. doi:10.1002/14651858.CD001750.pub4 Lee Y, Kim TH, Park JK, et al. Predictive value of antral follicle count and serum anti-Müllerian hormone: Which is better for live birth prediction in patients aged over 40 with their first IVF treatment? Eur J Obstet Gynecol Reprod Biol. 2018;221:151-155. doi:10.1016/j.ejogrb.2017.12.047 Jayaprakasan K, Chan Y, Islam R, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril. 2012;98(3):657-663. doi:10.1016/j.fertnstert.2012.05.042 Zhang Y, Xu Y, Xue Q, et al. Discordance between antral follicle counts and anti-Müllerian hormone levels in women undergoing in vitro fertilization. Reprod Biol Endocrinol. 2019;17(1):51. Published 2019 Jul 4. doi:10.1186/s12958-019-0497-4 Arvis P, Rongières C, Pirrello O, Lehert P. Reliability of AMH and AFC measurements and their correlation: a large multicenter study. J Assist Reprod Genet. 2022;39(5):1045-1053. doi:10.1007/s10815-022-02449-5 Iliodromiti S, Kelsey TW, Wu O, Anderson RA, Nelson SM. The predictive accuracy of anti-Müllerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature. Hum Reprod Update. 2014;20(4):560-570. doi:10.1093/humupd/dmu003 La Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS; ESHRE Special Interest Group for Reproductive Endocrinology--AMH Round Table. Anti-Mullerian hormone (AMH): what do we still need to know?. Hum Reprod. 2009;24(9):2264-2275. doi:10.1093/humrep/dep210 Hsu A, Arny M, Knee AB, et al. Antral follicle count in clinical practice: analyzing clinical relevance. Fertil Steril. 2011;95(2):474-479. doi:10.1016/j.fertnstert.2010.03.023 Nelson SM, Klein BM, Arce JC. Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials. Fertil Steril. 2015;103(4):923-930.e1. doi:10.1016/j.fertnstert.2014.12.114 Bentzen JG, Forman JL, Johannsen TH, Pinborg A, Larsen EC, Andersen AN. Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive aging. J Clin Endocrinol Metab. 2013;98(4):1602-1611. doi:10.1210/jc.2012-1829 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4813321","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":333680094,"identity":"23de2aa4-c8c0-4c80-8832-6aaa737f888c","order_by":0,"name":"Yunzhu Lan","email":"","orcid":"","institution":"International Institutes of Medicine, Zhejiang University","correspondingAuthor":false,"prefix":"","firstName":"Yunzhu","middleName":"","lastName":"Lan","suffix":""},{"id":333680095,"identity":"f3da0b72-2859-4a50-85d5-e43221d4075d","order_by":1,"name":"Shuang Liu","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shuang","middleName":"","lastName":"Liu","suffix":""},{"id":333680096,"identity":"6e3f5600-2aee-4a41-a028-246323922133","order_by":2,"name":"Jun zhang","email":"","orcid":"","institution":"Institute of Cardiovascular Research Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"zhang","suffix":""},{"id":333680097,"identity":"5f59e366-d8a0-4226-a5d5-6d6610502822","order_by":3,"name":"Fang Wang","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Wang","suffix":""},{"id":333680098,"identity":"2f59ae0a-492e-4cf8-bb32-76128ab437a3","order_by":4,"name":"Shaowei Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYJCCAwk/JOSgbGaidDAe+NhjY0ySFuaDM9jSEhuI1sLff8bgMA/P4fT5M7LTJBgqrBMb2M8ewKtF4kYOUIvF4dwNN3K3STCcSU9s4MlLwKvFQIJ3A8iW3A3SQC2MbYcTGyR4DPBr4T8L1MJ2OF1+NkjLP2K0MORuAHk/geE2SEsDEVokbuR/AAWy4Yb7bzdbJBxLN27jycGvhb//WPIHYFTKy/ec3XjjQ421bD/7GfxaUEECELORoH4UjIJRMApGAQ4AAIp5SJcK2aqHAAAAAElFTkSuQmCC","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shaowei","middleName":"","lastName":"Chen","suffix":""},{"id":333680099,"identity":"f641d8d6-ff5a-469e-adf2-f30bacf4b524","order_by":5,"name":"Jian Xu","email":"","orcid":"","institution":"International Institutes of Medicine, Zhejiang University","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2024-07-27 13:38:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4813321/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4813321/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63805053,"identity":"be4d4d50-040b-47c0-bfc1-15f6276f9709","added_by":"auto","created_at":"2024-09-02 13:33:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":68677,"visible":true,"origin":"","legend":"\u003cp\u003eTable of Contents\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/6a26132f62c30de3e62fd43f.png"},{"id":63805054,"identity":"2c8d10aa-7de6-42de-a8f8-fc428330cdae","added_by":"auto","created_at":"2024-09-02 13:33:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":82836,"visible":true,"origin":"","legend":"\u003cp\u003ePie chart comparing the pregnancy and non-pregnancy groups\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/057f1427d86e2b2e27bce4cb.png"},{"id":63805052,"identity":"40bed784-1288-470d-a235-873fceaef6ef","added_by":"auto","created_at":"2024-09-02 13:33:45","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":110810,"visible":true,"origin":"","legend":"\u003cp\u003eDepicts a box plot of endometrial thickness at transplantation (mm).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/903bffaf6af0ab8aadf13882.png"},{"id":63807267,"identity":"12dd0282-40a6-47ef-a4d9-ad4035e8ae2d","added_by":"auto","created_at":"2024-09-02 13:41:46","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":51287,"visible":true,"origin":"","legend":"\u003cp\u003eHistogram of AMH levels.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/14e871d5aa803942862412d4.png"},{"id":63805055,"identity":"64ccfaa4-bbc3-4a9c-87d4-3929acce50d4","added_by":"auto","created_at":"2024-09-02 13:33:46","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":168690,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram of an AFC violin.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/63cb9d33ff14174a4c6aa20d.png"},{"id":63807265,"identity":"4794cfc1-0014-43b6-b68c-0bbc5dc517c9","added_by":"auto","created_at":"2024-09-02 13:41:46","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":180606,"visible":true,"origin":"","legend":"\u003cp\u003eROC of AMH and AFC\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/d1891a5f3317589c7317feee.png"},{"id":63805058,"identity":"83ee8185-13d8-48a5-9f6a-aa6fb9b8cb2f","added_by":"auto","created_at":"2024-09-02 13:33:46","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":188688,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve for AMH levels greater than 4.0 ng/mL and AFC greater than 15\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/e8af0914b1e76225666f97cb.png"},{"id":63805060,"identity":"7f7b62a4-600c-4909-b36a-6ddcef44cf28","added_by":"auto","created_at":"2024-09-02 13:33:46","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":108316,"visible":true,"origin":"","legend":"\u003cp\u003eVOS viewer analysis of AMH and AFC.\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/1fa6b6bd615e1eea9c2aed1b.png"},{"id":75770735,"identity":"99e71b1b-a43a-4d8f-9489-98844cedb8bf","added_by":"auto","created_at":"2025-02-08 05:39:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1730172,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4813321/v1/e3ec80fc-854d-4420-8f3f-ddb2fd51ec5a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"AFC and AMH demonstrate significant predictive value for pregnancy outcomes in patients at risk of high ovarian reserve undergoing GnRH-antagonist protocols","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAlthough numerous protocols have been developed for ovarian stimulation in assisted ART over the past two decades, the utilization of the GnRH-antagonist protocols represents a significant advancement in controlled ovarian stimulation (COS), not only is there a substantial reduction in the number of injections compared to traditional long agonist protocols, but there is also a notable decrease in the risk of OHSS without compromising pregnancy rates [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therefore, GnRH-antagonist protocols are currently widely used in controlled ovarian hyperstimulation (COH). A large-scale research was conducted using data from 80 assisted reproduction centers in 35 representative cities in China. A total of 10 consecutively selected medical record cards were analyzed, along with statistics on the use of super-ovulation protocols (internal data from the research report of Aikunwei). The results revealed that the proportion of GnRH-agonist protocols in COS ovulation protocols declined from 62% in 2014 to 35% in 2021. In contrast, the proportion of GnRH-antagonist protocols in COS ovulation protocols increased from 6% in 2014 to 37% in 2021 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This indicates a significant increase in the use of GnRH-antagonist protocols over time.\u003c/p\u003e \u003cp\u003eGnRH-antagonist protocols are widely utilized, primarily due to the necessity of selecting an appropriate ovulation promotion protocol based on the patient's ovarian reserve function during diagnosis and treatment. Ovarian reserve function is categorized into three groups: normal ovarian reserve (NOR), high ovarian reserve (HOR), and diminished ovarian reserve (DOR) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The GnRH-antagonist protocol is a commonly used method for ovulation induction in the NOR population, it is increasingly favored due to its short ovulation induction time, low incidence of ovarian hyperstimulation syndrome (OHSS), simplicity and convenience, faster cycle entry, minimal burden on patients in terms of treatment cost, and good compliance [4\u0026thinsp;~\u0026thinsp;6]. The HOR population is considered to be the most suitable for the application of GnRH-antagonist protocol for ovulation induction, in the HOR population and among polycystic ovary syndrome (PCOS) patients, ovulation induction using the GnRH-antagonist protocol, particularly with the application of GnRH-a \"trigger\", can significantly reduce the occurrence of OHSS [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Both GnRH-antagonist protocols and GnRH-agonist protocols are commonly preferred for ovulation promotion in the DOR population. The European Society of Human Reproduction and Embryology (ESHRE) 2019 edition of the guidelines states that there is no difference in the use of agonist or GnRH-antagonist protocol in the DOR population, based on safety and success rates [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the criteria for diagnosing ovarian reserve primarily consist of clinical parameters such as age, AMH, AFC and so on. For instance, the ranges of AMH in NOR, HOR, and DOR are 1 to 1.2 ng/mL, \u0026lt; 3.5 to 4.0 ng/mL, \u0026gt; 4.0 ng/mL, \u0026lt; 0.5 to 1.1 ng/mL respectively; and the ranges of AFC are \u0026lt;\u0026thinsp;6\u0026ndash;7, 7\u0026ndash;15, and \u0026gt;\u0026thinsp;15 respectively [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This means that all ranges of AMH can be treated with GnRH-antagonist protocol, hence, can it be considered that AMH serves as a feeble indicator for the GnRH-antagonist protocol? The same situation exists for age and AFC in the application of GnRH-antagonist protocol. In other words, clinical parameters such as AMH, AFC, and age remain inconclusive in predicting the outcome of GnRH-antagonist protocol. This raises concerns regarding the potential impact of widely GnRH-antagonist protocol use on pregnancy outcomes.\u003c/p\u003e \u003cp\u003eThe selection of an GnRH-antagonist protocol is primarily based on clinical parameters such as age, AMH, AFC, etc. However, there is a wide range of variation in these three types of clinical parameters that are applicable to the GnRH-antagonist protocol. Are there specific clinical parameters that have predictive value and provide guidance for the GnRH-antagonist protocol? In this retrospective analysis, we aim to explore potential differences and the value of common clinical parameters between two groups following embryo transfer with or without pregnancy in a fresh embryo transfer cycle of cleavage-stage in GnRH-antagonist protocol.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eWe conducted an analysis of 2800 IVF-assisted conceptions at the Department of Human Assisted Technology of Southwest Medical University Hospital, China, between August 2020 and August 2022. This study has been approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University, with approval number KY2024238, Ethical approval date: June 7, 2024. The case data of the participants were retrospectively analyzed. We calculated the necessary sample size based on a \"multistage random sampling survey.\" The inclusion criteria were as follows: 1) participants aged 20\u0026ndash;40 years; 2) regular menstrual cycles (lasting 3\u0026ndash;7 days, with a cycle length of 24 to 35 days); 3) use of a GnRH-antagonist protocol; 4) presence of both ovaries and no gonadotropin treatment for at least 6 months; 5) a body mass index (BMI) between 19 and 24kg/m\u003csup\u003e2\u003c/sup\u003e; and 6) fresh stage embryo transfer. Exclusion criteria: 1) endometriosis and adenomyosis; 2) endometrial polyps, uterine adhesions, and congenital uterine dysplasia; 3) chromosomal karyotype abnormalities in either spouse; 4) patients with recurrent miscarriage. All participants were transferred with fresh cycle embryos at the cleavage stage using an GnRH-antagonist protocol. A total of 442 patients were included and divided into two groups: pregnancy (n\u0026thinsp;=\u0026thinsp;161) and non-pregnancy (n\u0026thinsp;=\u0026thinsp;281), based on whether they were pregnant or not.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eControlled ovarian hyperstimulation\u003c/h2\u003e \u003cp\u003eThe cycle initiation begins on day 2\u0026ndash;4 of menstruation, with the initial dosage determined based on the patient's age, AFC, BMI, follicle-stimulating hormone (FSH), and AMH levels. The initiating drug used is recombinant FSH (75/450 U/strike, Gonafine, Merck, Germany). Once the primary follicle diameter reaches 12\u0026ndash;14 mm and according to serum estradiol (E\u003csub\u003e2\u003c/sub\u003e) and luteinizing hormone (LH) levels, a gonadotropin-releasing hormone antagonist (GnRH-ant) at a dosage of 0.25\u0026ndash;0.5 mg/d is administered (Schizophrenia, Merck, Germany). When at least one follicle had a diameter of \u0026ge;\u0026thinsp;18 mm, 250 ug of Eze (recombinant human chorionic gonadotropin injection, Merck, Germany) was administered and oocytes were retrieved at 36\u0026ndash;38 h with vaginal ultrasound monitoring.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEmbryo transplantation\u003c/h2\u003e \u003cp\u003eProgesterone injection (10 mg/stem, Zhejiang Xianju) at a dosage of 60mg/d and Dydrogesterone tablets (10 mg/tablet, Solvay, Netherlands) at a dosage of 20 mg bid were administered on the day of oocyte retrieval. Following this, 1\u0026ndash;2 good quality embryos were selected for transfer after recording endometrial thickness via ultrasound on the 3rd day post oocyte retrieval. Pregnancy outcome was determined by measuring blood β-HCG levels 14 days after transfer, which indicated either non-pregnancy or biochemical pregnancy. Clinical pregnancy was confirmed through vaginal ultrasound examination on day 28 to observe the presence of a gestational sac and visible fetal heartbeat.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEmbryo scoring\u003c/h2\u003e \u003cp\u003eThe embryo scoring system assesses the quality of embryos according to cells, fragmentation and symmetry: cells are scored based on cell number and fragmentation classification (4 credits will be awarded for no fragmentation, 3 credits for less than 10% fragmentation, 2 credits for fragmentation between 10% and 25%, and 1 credit for fragmentation exceeding 25%) as well as ovoid homogeneity (symmetry score 1, asymmetry score 0). Observed indicators such as age, BMI, LH, FSH, AMH, Gn initiation dose (bottles), Gn days, total Gn dose (bottles), the number of retrieved oocytes, the number of MII, the number of 2PN, endometrial thickness at transplantation and clinical pregnancy outcome were recorded for patients in different groups. All steps can be seen in the table of contents diagram (refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eSPSS 17.0 was used to conduct the statistical analysis. Prior to analysis, all data underwent normality testing. It was found that the data for Age, FSH, LH, AMH, AFC, total Gn dose (measured in bottles where one bottle equals 75 IU), initiation Gn dose (measured in IU), total days of Gn treatment, numbers of retrieved oocytes, numbers of oocytes in MII stage, numbers of cleavages, numbers of 2PN embryos, levels of E2 and Progesterone (P) on HCG day, as well as the endometrial thickness (measured in mm) at transplantation day were skewed. Therefore median and interquartile ranges were used to describe the data and a nonparametric test (Mann-Whitney test) was applied for analysis. A significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered in this study. A binary logistic regression model was utilized to examine the impact of the aforementioned clinical parameters on pregnancy outcome. Additionally, ROC curves were employed to assess the predictive values of the clinical parameters associated with pregnancy outcome. Graph Prism software was used to generate pie charts, histograms, violin plots, and box plots. Statistical significance was indicated by a p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe 442 patients included in the study were divided into two groups: the pregnancy group (n\u0026thinsp;=\u0026thinsp;161) and the non-pregnancy group (n\u0026thinsp;=\u0026thinsp;281), based on their pregnancy status (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The clinical parameters during ovulation in different groups were tested for normality. As the sample size was less than 2000, the Shapiro-Wilk test was used, indicating that the above variables were skewed. The median and quartiles were used to describe the degree of dispersion. A non-parametric test, the Mann-Whitney test, was utilized to compare various factors between the pregnancy and non-pregnancy groups. The results indicated that AMH (Fig. 4), AFC (Fig. 5), the numbers of retrieved oocytes, MII, and 2PN, as well as the data of endometrium at transplantation day (Fig. 3), were significantly greater in the pregnancy group than in the non-pregnancy group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Conversely, age, total Gn dose, and Gn initiation dose were found to be significantly less in the pregnancy group compared to the non-pregnancy group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no statistically significant differences were observed between the two groups for BMI, LH, FSH, total gonadotropin (bottles), or levels of E2 and P on HCG day (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA binary logistic regression model was employed to evaluate the impact of common parameters in the GnRH-antagonist protocol on pregnancy outcome. The findings revealed that age, total Gn dose (bottles), and initiation Gn dose (bottles) were inversely associated with pregnancy outcome (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas BMI, AMH, AFC, and the number of retrieved oocytes were positively linked to pregnancy outcome (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). LH, FSH, Gn days, the number of MII and 2PN, the levels of E2 and P on HCG day, as well as endometrial thickness at transplantation showed no significant effect on pregnancy outcome (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe ROC curve was utilized to analyze the predictive value of age, BMI, AMH, AFC, initiation Gn dose, total Gn dose and the number of oocytes on the pregnancy outcome of the GnRH-antagonist protocol. AFC (AUC\u0026thinsp;=\u0026thinsp;0.600, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and AMH (AUC\u0026thinsp;=\u0026thinsp;0.562, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) exhibited limited predictive power for pregnancy outcome in GnRH-antagonist protocols, despite demonstrating some predictive value. (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e; Fig. 6 for ROC curves of AMH and AFC). Categorizing ovarian reserve function into normal, high, and diminished groups revealed that the optimal predictive ability was found to be demonstrated when AMH levels were greater than 4.0 ng/mL in the group (AUC\u0026thinsp;=\u0026thinsp;0.602, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and AFC was greater than 15 in the group (AUC\u0026thinsp;=\u0026thinsp;0.753, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), the strongest predictive ability was observed in the group with AFC greater than 15. (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e; Fig.\u0026nbsp;7 for ROC curves of AMH and AFC)\u003c/p\u003e\n\u003cp\u003eDepicting the keywords of AMH and AFC in the IVF assisted conception process using VOS viewer. We conducted a search on the Web of Science for \u0026quot;AFC and IVF\u0026quot; and \u0026quot;AMH and IVF\u0026quot;, resulting in 16525 items from the database (Last five years), with a search frequency of 15, showing 658 papers. The literature on \u0026quot;AFC/AMH\u0026quot; focused on topics such as \u0026quot;fertilization,\u0026quot; \u0026quot;live birth,\u0026quot; \u0026quot;prediction,\u0026quot; \u0026quot;primary outcome,\u0026quot; and \u0026quot;ovarian reserve.\u0026quot; This suggests that AMH and AFC are closely related to ovarian reserve function and pregnancy outcome after in vitro fertilization ( Fig. \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e The common clinical parameters of the pregnant and non-pregnant groups\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003epregnancy group（n=161）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003enon-pregnancy group（n=281）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e30（27~34）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e31（28~36）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-2.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.023*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e22.66（20.11~24.82）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e21.87（20.02~24.44）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-1.723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eLH\u0026nbsp;(mIU/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e3.14（2.01~4.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e3.13（2.25~4.35）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eFSH(mIU/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e8.41（7.21~9.81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e8.47（7.00~10.36）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eAMH\u0026nbsp;(ng/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e2.25（1.46~4.48）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e2.19（1.02~3.69）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-2.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.031*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eAFC(pieces)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e15（11~20.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e12（9~17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-3.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eTotal Gn dose(bottles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e32.00（21.00~37.17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e33.00（27.00~40.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-2.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.007**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eGn days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e10（9~11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e10（9~11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-0.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eInitiation dose(bottles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e3.00（2.00~4.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e3.33（3.00~4.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-3.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.003**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of retrieved\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eoocytes(pieces)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e9.00（6.00~12.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e7.00（5.00~11.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-3.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of MII(pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e8.00（6.00~11.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e7.00（4.50~10.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-2.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of 2PN(pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e5.00（4.00~7.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e4,00（3.00~7.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-2.447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.014*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eE2 on HCG day(pg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e2174.71（1505.18~3000.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e1951.97（1292.45~2751.51）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-1.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eP in HCG day(ng/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e0.700（0.48~1.05）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e0.78（0.50~1.10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-0.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eendometrium at transplantation day(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e10.80（9.60~12.60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e10.50（9.10~12.18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\" valign=\"top\" style=\"width: 8.0909%;\"\u003e\n \u003cp\u003e-2.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\" valign=\"top\" style=\"width: 9.2289%;\"\u003e\n \u003cp\u003e0.045*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Results for clinical parameters by Binary logistic regression model\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"bottom\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"bottom\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e-0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.916，0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.013*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e1.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e1.009，1.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.022*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eLH (mIU/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e-0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.954，1.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eFSH (mIU/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.901，1.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eAMH (ng/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e1.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e1.013，1.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eAFC (pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e1.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e1.019，1.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eTotal Gn dose (bottles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e-0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.958，0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.013*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eGn days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.905，1.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eInitiation dose (bottles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e-0.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.574，0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.003**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of retrieved oocytes (pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.01，1.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.016*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of MII (pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e1.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.997，1.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of 2PN (pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e1.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.991，1.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eE2 on HCG day (pg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e1，1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eP in HCG day (ng/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e-0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\" valign=\"top\"\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\" valign=\"top\"\u003e\n \u003cp\u003e0.64，1.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\" valign=\"top\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.76493256262042%\" valign=\"top\"\u003e\n \u003cp\u003eendometrium at transplantation day(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.33140655105973%\"\u003e\n \u003cp\u003e1.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.497109826589597%\"\u003e\n \u003cp\u003e0.984，1.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.533718689788053%\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Predictive value of clinical parameters on pregnancy outcome of GnRH-antagonist protocol\u003c/div\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"bottom\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"bottom\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"top\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"top\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"top\"\u003e\n \u003cp\u003e0.381,0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"top\"\u003e\n \u003cp\u003e0.023*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"top\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"top\"\u003e\n \u003cp\u003e0.493,0.605\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"top\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003eAMH (ng/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"top\"\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.845\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"top\"\u003e\n \u003cp\u003e0.507,0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"top\"\u003e\n \u003cp\u003e0.031*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003eAFC (pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"top\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"top\"\u003e\n \u003cp\u003e0.545,0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"top\"\u003e\n \u003cp\u003e0.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003eInitiation dose (bottles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"top\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"top\"\u003e\n \u003cp\u003e0.363,0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"top\"\u003e\n \u003cp\u003e0.004**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003eTotal Gn dose (bottles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"top\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"top\"\u003e\n \u003cp\u003e0.367,0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"top\"\u003e\n \u003cp\u003e0.007**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of retrieved oocytes (pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.534,0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Predictive value of age, AMH, and AFC segmentation on pregnancy outcome in GnRH-antagonist protocols \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92894280762565%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.691507798960139%\" valign=\"bottom\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.103986135181977%\" valign=\"bottom\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAge\u0026nbsp;(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026le; 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.465,0.668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e30 to 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.418,0.605\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.816\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026ge; 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.508,0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAMH\u0026nbsp;(ng/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.428,0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.2 to 4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.483,0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt; 4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.502,0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.033*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAFC\u0026nbsp;(pieces)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026le; 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.394,0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7 to 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.441,0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026ge;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.587,0.799\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Disscusion","content":"\u003cp\u003eThis retrospective study aimed to investigate the predictive value of clinical parameters in GnRH-antagonist protocols on pregnancy outcomes in the fresh embryo transfer cycle of cleavage-stage. This study demonstrated a positive association between AFC and AMH with pregnancy outcome. However, it was noted that in GnRH-antagonist protocols, AFC (AUC\u0026thinsp;=\u0026thinsp;0.600) and AMH (AUC\u0026thinsp;=\u0026thinsp;0.562) had weak predictive power for pregnancy outcome. Conversely, the predictive ability was stronger in the group with an AFC greater than 15 (AUC\u0026thinsp;=\u0026thinsp;0.753), and AMH levels were greater than 4.0 ng/mL in the group (AUC\u0026thinsp;=\u0026thinsp;0.602, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eAFC and AMH have been utilized as biomarkers for estimating ovarian reserve and predicting ovarian response [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Given the widespread acceptance of AFC and AMH as predictors of ovarian response, it is reasonable to assume that they may be associated with IVF outcomes. Currently, numerous studies on AMH and AFC are focused on discussing its impact on clinical practice at various thresholds, as well as analyzing the effect of AFC on ART outcomes under different ovarian stimulation protocols. However, the role of AFC and AMH in predicting the pregnancy outcome of IVF remains inconclusive. Several studies have indicated that serum AFC and AMH can predict pregnancy outcomes, whether spontaneous or following assisted reproductive technology, such as the live birth rate and ongoing pregnancy rate [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. On the other hand, some studies did not find a significant correlation between AFC and AMH and pregnancy outcomes in IVF cycles [12\u0026thinsp;~\u0026thinsp;14]. It is evident that each study opted for different ovulation protocols, resulting in varying outcomes. For instance, Goswami et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and Liao et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] both suggested that AFC could predict pregnancy outcome, but Liao et al. utilized a standard long protocol while Goswami et al. used an GnRH-antagonist protocol. On the other hand, Sahmay et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and Peralta et al.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] proposed that AFC was not predictive of pregnancy outcome, with Sahmay et al. using GnRH-agonist and Peralta et al. employing a GnRH-antagonist protocol. The discrepancy in the findings regarding AFC and AMH's impact on pregnancy outcomes may be attributed to the use of different ovulation protocols leading to divergent results, thus emphasizing the significance of highlighting the specific ovulation protocols employed in studies. Overall, it is crucial to consider how variations in ovulation protocols can influence research outcomes when examining the relationship between AFC or AMH and pregnancy success.\u003c/p\u003e \u003cp\u003eThe selection of the ovulation protocol should be based on the patient's fundamental condition (age, AMH, AFC), the patient's willingness and financial situation, as well as the physician's experience. The timing of Gn initiation should take into consideration the size and synchronization of the AFC, while the dose of Gn initiation is also determined based on the patient's age, AMH, AFC, and BMI [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Depending on the scope of use of the GnRH-antagonist protocol, it can be utilized in patients with varying ovarian responses, including those with normal, high, or diminished ovarian reserve function. Therefore, whether patients have normal ovarian reserve, high ovarian reserve, or diminished ovarian reserve, all of them can utilize the GnRH-antagonist protocol. This implies that the GnRH-antagonist protocol is applicable to any level of age, AMH, and AFC. This raises the question: are age, AMH, and AFC still relevant for assessing pregnancy outcomes when using the GnRH-antagonist protocol?\u003c/p\u003e \u003cp\u003eGnRH-antagonist protocols have been shown to be equally effective as GnRH-agonist protocols, with the added benefits of being safer, simpler, and more patient-friendly. This makes them a favorable option for assisted reproductive technology procedures [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. There has been a notable rise in the use of GnRH-antagonist protocols in clinical practice, as evidenced by internal data from the Elkhorn Weil study. This trend is also observed in our center, with a reported usage rate of 39% (442/1120). Based on our data, the level of AMH in the pregnant group (2.25 (1.46\u0026ndash;4.48) vs. 2.19 (1.02\u0026ndash;3.69), p\u0026thinsp;=\u0026thinsp;0.031\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was significantly higher compared to the non-pregnant group in the GnRH-antagonist protocol, suggesting a potential association between AMH levels and pregnancy outcomes in this protocol. Additionally, the AFC (15 (11-20.5) vs 12 (9\u0026ndash;17), p\u0026thinsp;=\u0026thinsp;0.002\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was also observed to be significantly higher in the non-pregnant group, suggesting that AFC may play a role in pregnancy success within this protocol. It is possible that the higher AFC in the pregnant group indicates a more favorable ovarian reserve function, which is a positive factor for achieving a successful pregnancy. There was a significant age difference between the pregnant and non-pregnant groups (31 vs. 32 years, P\u0026thinsp;=\u0026thinsp;0.023\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition, age was negatively correlated with pregnancy outcome (OR\u0026thinsp;=\u0026thinsp;0.952, CI:0.916\u0026ndash;0.990, P\u0026thinsp;=\u0026thinsp;0.013\u0026thinsp;\u0026lt;\u0026thinsp;0.05), suggesting that younger women were more likely to become pregnant in the GnRH-antagonist protocol. Nevertheless, we discovered that AMH (OR\u0026thinsp;=\u0026thinsp;1.078, CI:1.013\u0026ndash;1.013, P\u0026thinsp;=\u0026thinsp;0.018\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and AFC (OR\u0026thinsp;=\u0026thinsp;1.046, CI: 1.019\u0026ndash;1.073, P\u0026thinsp;=\u0026thinsp;0.001\u0026thinsp;\u0026lt;\u0026thinsp;0.01) exhibited a positive correlation with pregnancy outcomes in the participants of the study. This finding is consistent with existing literature which recognizes AFC and AMH as reliable biomarkers for predicting clinical pregnancy outcomes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe observed that in GnRH-antagonist protocols, both AFC (AUC\u0026thinsp;=\u0026thinsp;0.600) and AMH (AUC\u0026thinsp;=\u0026thinsp;0.562) demonstrated limited predictive ability for pregnancy outcome, which is consistent with the findings of previous studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, considering the specificity of the GnRH-antagonist protocol, which is suitable for normal, high, and diminished ovarian reserve, we conducted a segmented study of age, AMH, and AFC, the optimal predictive ability was found to be demonstrated when AMH levels were greater than 4.0 ng/mL in the group (AUC\u0026thinsp;=\u0026thinsp;0.602, p\u0026thinsp;=\u0026thinsp;0.032\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and AFC was greater than 15 in the group (AUC\u0026thinsp;=\u0026thinsp;0.753, p\u0026thinsp;=\u0026thinsp;0.002\u0026thinsp;\u0026lt;\u0026thinsp;0.01), the strongest predictive ability was observed in the group with AFC greater than 15. However, AMH levels above 4.0 ng/mL and AFC counts above 15 can be considered as indicators of high ovarian reserve within the group [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In other words, AFC is considered the most reliable predictor of clinical outcomes for high ovarian reserve in GnRH-antagonist protocols. Previous research has observed that an increase in AFC was associated with a higher rate of live births across all examined data categories, with the highest number of live births occurring when the AFC exceeds 18 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In this context, it is essential to focus on the guidelines for utilizing GnRH-antagonist protocols. The guidelines from the European Society of Human Reproduction and Embryology (ESHRE) on methods for preventing ovarian hyperstimulation syndrome (OHSS) emphasize that patients at high risk of OHSS should avoid the use of the GnRH-agonist ovulation protocol and instead consider using the GnRH-antagonist protocol [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Similarly, the Society of Reproductive Medicine, Chinese Medical Association (CSRM), has recommended GnRH-antagonist protocols as the most suitable method for promoting ovulation in the HOR population. For patients with polycystic ovary syndrome (PCOS) or those at high risk of OHSS, it is advised to induce ovulation using GnRH-antagonist protocols, such as the GnRH-a \"trigger\". This approach can significantly reduce the incidence of OHSS in both HOR and PCOS patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on our findings, it is evident that an AFC of greater than 15 is considered the most reliable predictor of pregnancy outcome in the GnRH-antagonist protocol. Furthermore, the consensus that AFC\u0026thinsp;\u0026gt;\u0026thinsp;15 indicates a high ovarian reserve suggests that individuals with a high ovarian reserve are better suited for the GnRH-antagonist protocol. This may be attributed to the fact that the GnRH-ant protocol does not have a \"flare-up\" effect, rapidly inhibits endogenous LH release without pituitary desensitization, leading to a reduction in Gn dosage and shortened duration of administration, as demonstrated in the present study that both the total Gn dose and the starting dose of Gn were significantly lower in the pregnancy group compared to the non-pregnancy group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Therefore, utilizing the GnRH-antagonist protocol for cases with AFC\u0026thinsp;\u0026gt;\u0026thinsp;15 not only prevented HOSS occurrence but also resulted in a more favorable pro-ovulatory effect.\u003c/p\u003e \u003cp\u003eIndeed, AFC values reported in literature are very variable, thus creating difficulties for clinicians in selecting cut of values based on evidence [18\u0026thinsp;~\u0026thinsp;20]. Our findings also reflect the situation that in the GnRH-antagonist protocol, AFC was unable to predict the ovarian normal and diminished reserve groups, but could predict the ovarian high reserve group. This could be attributed to the principle of action of the antagonist protocol and its wide applicability to patients with normal ovarian reserve, diminished ovarian reserve, and high ovarian reserve. Therefore, when studying the predictive value of AFC, it should be categorized and studied so as to avoid conflicting results.\u003c/p\u003e \u003cp\u003eAFC refers to the number of follicles with a diameter of 2\u0026ndash;10 mm visible on B-ultrasound on day 2\u0026ndash;3 of the menstrual cycle. This method has the advantages of being non-invasive, inexpensive, and reproducible. We observed that AFC plays a stronger predictive role than AHM, possibly due to the fact that AFC is measured during each cycle, while AMH is typically only measured once a year [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, in comparison to AMH, AFC will capture more fluctuations in physiological ovarian function, which could indirectly be linked to a lack of reproducibility. Although AMH is a superior predictor of ovarian response to gonadotropin therapy compared to AFC [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], it should be noted that AMH levels remain relatively constant throughout the menstrual cycle. This characteristic makes it challenging to assess the impact of minor fluctuations in pregnancy outcomes. As a result, AFC provides a more accurate picture of the pregnancy outcome of the cycle.\u003c/p\u003e \u003cp\u003eSome articles have observed that both AMH and AFC decrease with age, and the decline in both markers appears to be linear [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Serum AMH levels decrease by 5% per year, while AFC levels decrease by 4.0% per year [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, it is important to consider age when establishing a direct relationship between AMH and AFC or determining the cutoff. After conducting our analysis, we did observe a negative correlation between age and pregnancy outcome. However, it is important to note that the predictive value of age for pregnancy in the GnRH-antagonist protocol was not found to be statistically significant. The participants were categorized into three groups: those aged less than 29 years, those aged 30 to 35 years, and those older than 36 years, none of these groups showed a predictive value of age on pregnancy outcome (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). While some researchers have suggested that the optimal threshold for clinical pregnancy in patients over 40 years of age in the GnRH-antagonist protocol was 41 years of age with an AFC\u0026thinsp;\u0026gt;\u0026thinsp;3 (AUC\u0026thinsp;=\u0026thinsp;0.698, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), without analyzing the other ages [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are several limitations to our study. First, the ovarian promotion protocol we used was the GnRH-antagonist protocol, which is not only capable of being performed in all ages, AMH and AFC, it also minimizes the interference of individual gonadotropin doses. Our findings suggest that an AFC\u0026thinsp;\u0026gt;\u0026thinsp;15 in GnRH-antagonist protocols is significantly valuable for predicting clinical pregnancy outcomes. Different stimulation protocols operate on different principles of action, which may impact the clinical prognosis of AFC. Therefore, findings from one protocol cannot be generalized to other protocols, such as GnRH-antagonist protocols. Secondly, in addition, our clinical results were not comprehensive and the sample size was not large enough; we only analyzed clinical pregnancies, whereas pregnancy loss, live births, and cumulative live birth rates are factors that need to be taken into account in our further studies.\u003c/p\u003e \u003cp\u003eIn conclusion, our findings suggest that AFC and AMH have limited predictive value for pregnancy outcome in GnRH-antagonist protocols, however, the presence of the AMH\u0026thinsp;\u0026gt;\u0026thinsp;4.0 ng/mL group and the AFC\u0026thinsp;\u0026gt;\u0026thinsp;15 group was associated with a high predictive value for pregnancy outcome in the GnRH-antagonist protocol. Both the AMH\u0026thinsp;\u0026gt;\u0026thinsp;4.0 ng/mL group and the AFC\u0026thinsp;\u0026gt;\u0026thinsp;15 group can be considered as indicators of high ovarian reserve. Therefore, recognizing that the AFC\u0026thinsp;\u0026gt;\u0026thinsp;15 group has significant predictive value for pregnancy outcomes with GnRH-antagonist protocols may aid in predicting a favorable prognosis and tailoring treatment strategies during pre-cycle clinical counseling of infertile patients with a high ovarian reserve.Additionally, this information provides valuable reference points for selecting appropriate ovarian stimulation protocols.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAccording to the wide applicability of the GnRH-antagonist protocols, we found that AMH and AFC had significant predictive value for pregnancy outcomes in patients at high risk for ovarian response. This discovery holds significant value for clinicians utilizing AFC and AMH to assess pregnancy outcomes in patients with high ovarian reserve undergoing GnRH-antagonistic cycles.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the participants of the survey and all staff members involved in this study for their painstaking efforts in conducting the data collection.We are grateful to the Affiliated Hospital of Southwest Medical University for providing the data and to the women who provided the survey data.The authors wish to express their gratitude to the editors and anonymous reviewers who made supportive and insightful comments during the review process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYunzhu Lan and Shuang liu: Writing original draft, Software, Data curation. Jun Zhang and Fang Wang: interpreted the data, and read the entire manuscript critically. Shaowei Chen designed the study, directed and revised the manuscript, and approved the final manuscript. Jian Xu directed and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Science and Technology Strategic Cooperation Projects of Suining First People\u0026apos;s Hospital-Southwest Medical University (No#2022SNXNYD04)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA conflict of interest statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare their consent to publish this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare their consent to participate in this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of the Affiliated Hospital of Southwest Medical University, Ethical approval number (No#KY2024238), Ethical approval date: June 7, 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets utilized and/or analyzed in the present study can be provided by the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLambalk CB, Banga FR, Huirne JA, et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update. 2017;23(5):560-579. doi:10.1093/humupd/dmx017\u003c/li\u003e\n\u003cli\u003eFang YY, Wu QJ, Zhang TN, et al. Assessment of the development of assisted reproductive technology in Liaoning province of China, from 2012 to 2016. BMC Health Serv Res. 2018;18(1):873. Published 2018 Nov 20. doi:10.1186/s12913-018-3585-9\u003c/li\u003e\n\u003cli\u003eHu LL, Huang GN, Sun HX, et al. CSRM consensus on key indicators for quality control in ART clinical operation[J]. J Reprod Med, 2018, 27(9): 828-835. DOI:10.3969/j.issn.1004-3845.2018.09.002\u003c/li\u003e\n\u003cli\u003eChinese Society of Reproductive Medicine (CSRM). Expert consensus on the use of gonadotropin-releasing hormone antagonist protocols in assisted reproduction[J]. Chin J Obstet Gynecol, 2015, 50(11): 805-809. 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Medicine (Baltimore). 2019;98(41):e17470. doi:10.1097/MD.0000000000017470\u003c/li\u003e\n\u003cli\u003eSahmay S, Demirayak G, Guralp O, et al. Serum anti-m\u0026uuml;llerian hormone, follicle stimulating hormone and antral follicle count measurement cannot predict pregnancy rates in IVF/ICSI cycles. J Assist Reprod Genet. 2012;29(7):589-595. doi:10.1007/s10815-012-9754-6\u003c/li\u003e\n\u003cli\u003ePeralta S, Solernou R, Barral Y, et al. Antral follicle count measured at down-regulation as predictor of ovarian response and cumulative live birth: single center analysis including 2731 long agonist IVF cycles. Gynecol Endocrinol. 2022;38(12):1079-1086. doi:10.1080/09513590.2022.2154339\u003c/li\u003e\n\u003cli\u003eHamdine O, Eijkemans MJC, Lentjes EGW, et al. Antim\u0026uuml;llerian hormone: prediction of cumulative live birth in gonadotropin-releasing hormone antagonist treatment for in vitro fertilization. Fertil Steril. 2015;104(4):891-898.e2. doi:10.1016/j.fertnstert.2015.06.030\u003c/li\u003e\n\u003cli\u003eAl-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2016;4(4):CD001750. Published 2016 Apr 29. doi:10.1002/14651858.CD001750.pub4 \u003c/li\u003e\n\u003cli\u003eLee Y, Kim TH, Park JK, et al. Predictive value of antral follicle count and serum anti-M\u0026uuml;llerian hormone: Which is better for live birth prediction in patients aged over 40 with their first IVF treatment? Eur J Obstet Gynecol Reprod Biol. 2018;221:151-155. doi:10.1016/j.ejogrb.2017.12.047\u003c/li\u003e\n\u003cli\u003eJayaprakasan K, Chan Y, Islam R, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril. 2012;98(3):657-663. doi:10.1016/j.fertnstert.2012.05.042\u003c/li\u003e\n\u003cli\u003eZhang Y, Xu Y, Xue Q, et al. Discordance between antral follicle counts and anti-M\u0026uuml;llerian hormone levels in women undergoing in vitro fertilization. Reprod Biol Endocrinol. 2019;17(1):51. Published 2019 Jul 4. doi:10.1186/s12958-019-0497-4\u003c/li\u003e\n\u003cli\u003eArvis P, Rongi\u0026egrave;res C, Pirrello O, Lehert P. Reliability of AMH and AFC measurements and their correlation: a large multicenter study. J Assist Reprod Genet. 2022;39(5):1045-1053. doi:10.1007/s10815-022-02449-5 \u003c/li\u003e\n\u003cli\u003eIliodromiti S, Kelsey TW, Wu O, Anderson RA, Nelson SM. The predictive accuracy of anti-M\u0026uuml;llerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature. Hum Reprod Update. 2014;20(4):560-570. doi:10.1093/humupd/dmu003\u003c/li\u003e\n\u003cli\u003eLa Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS; ESHRE Special Interest Group for Reproductive Endocrinology--AMH Round Table. Anti-Mullerian hormone (AMH): what do we still need to know?. Hum Reprod. 2009;24(9):2264-2275. doi:10.1093/humrep/dep210\u003c/li\u003e\n\u003cli\u003eHsu A, Arny M, Knee AB, et al. Antral follicle count in clinical practice: analyzing clinical relevance. Fertil Steril. 2011;95(2):474-479. doi:10.1016/j.fertnstert.2010.03.023\u003c/li\u003e\n\u003cli\u003eNelson SM, Klein BM, Arce JC. Comparison of antim\u0026uuml;llerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials. Fertil Steril. 2015;103(4):923-930.e1. doi:10.1016/j.fertnstert.2014.12.114\u003c/li\u003e\n\u003cli\u003eBentzen JG, Forman JL, Johannsen TH, Pinborg A, Larsen EC, Andersen AN. Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive aging. J Clin Endocrinol Metab. 2013;98(4):1602-1611. doi:10.1210/jc.2012-1829 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"GnRH-antagonist protocols, Anti-mullerian hormone, Antral follicle count Pregnancy, Cleavage-stage embryos transfer","lastPublishedDoi":"10.21203/rs.3.rs-4813321/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4813321/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eObjective\u003c/b\u003e GnRH-antagonist protocols have garnered significant attention due to their potential to yield more favorable pregnancy outcomes. The association between clinical parameters of GnRH-antagonist protocols and pregnancy outcomes in fresh embryo transfer cycles is a major area of concern. Therefore, our study aimed to investigate the relationship between clinical parameters and pregnancy outcomes in GnRH-antagonist protocols.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e Out of 2800 couples, we conducted a retrospective evaluation of 442 women, aged 22\u0026ndash;40 years, who underwent embryo transfer in-vitro fertilization (IVF) with GnRH-antagonist protocols. Our focus was on the pregnancy outcomes in the fresh embryo transfer cycle of cleavage-stage. The participants were divided into pregnancy (n\u0026thinsp;=\u0026thinsp;161) and non-pregnancy groups (n\u0026thinsp;=\u0026thinsp;281), and their clinical parameters were compared to investigate which factors had an effect on pregnancy outcome using a binary logistic regression model.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e Using the Mann-Whitney test, it was determined that several factors were significantly different between the pregnant and non-pregnant groups. Specifically, anti-mullerian hormone (AMH) (p\u0026thinsp;=\u0026thinsp;0.031\u0026thinsp;\u0026lt;\u0026thinsp;0.05), antral follicle count (AFC) (p\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05), number of oocytes retrieved (p\u0026thinsp;=\u0026thinsp;0.002\u0026thinsp;\u0026lt;\u0026thinsp;0.05), Metaphase II (MIl) (p\u0026thinsp;=\u0026thinsp;0.011\u0026thinsp;\u0026lt;\u0026thinsp;0.05), Two pronuclear (2PN) (p\u0026thinsp;=\u0026thinsp;0.014\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and endometrial thickness at transplantation (p\u0026thinsp;=\u0026thinsp;0.045\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ) were all found to be significantly greater in the pregnant group compared to the non-pregnant group. Furthermore, AFC (OR\u0026thinsp;=\u0026thinsp;1.046, 95% confidence interval (CI):1.019\u0026ndash;1.073, p\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and AMH (OR\u0026thinsp;=\u0026thinsp;1.078 ,95% CI:1.013\u0026ndash;1.013, p\u0026thinsp;=\u0026thinsp;0.031\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ) were positively associated with pregnancy outcome. It was also observed that AFC (AUC\u0026thinsp;=\u0026thinsp;0.600, 95%CI:0.545\u0026ndash;0.656,p\u0026thinsp;=\u0026thinsp;0.002\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and AMH (AUC\u0026thinsp;=\u0026thinsp;0.562, 95%CI:0.507\u0026ndash;0.616,p\u0026thinsp;=\u0026thinsp;0.002\u0026thinsp;\u0026lt;\u0026thinsp;0.05) had weak predictive power for pregnancy outcome in GnRH-antagonist protocols, however, their predictive power was stronger when AFC was greater than 15 (AUC\u0026thinsp;=\u0026thinsp;0.753, 95%C1:0.587\u0026ndash;0.799,p\u0026thinsp;=\u0026thinsp;0.002\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and AMH levels were greater than 4.0 ng/mL in the group (AUC\u0026thinsp;=\u0026thinsp;0.602, 95%C1:0.502\u0026ndash;0.702, p\u0026thinsp;=\u0026thinsp;0.033\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, AFC was found to be more relevant and predictive of pregnancy outcome than AMH in GnRH-antagonist protocols.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e: AFC and AMH levels have limited predictive value in predicting pregnancy outcomes with GnRH-antagonist protocols, but they demonstrate significant clinical utility when AFC exceeds 15 and AMH is above 4.0 ng/mL. This discovery holds significant predictive value for clinicians utilizing AFC and AMH to assess pregnancy outcomes in patients with high ovarian reserve undergoing GnRH-antagonistic cycles.\u003c/p\u003e","manuscriptTitle":"AFC and AMH demonstrate significant predictive value for pregnancy outcomes in patients at risk of high ovarian reserve undergoing GnRH-antagonist protocols","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-02 13:33:41","doi":"10.21203/rs.3.rs-4813321/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5a7ee184-c2a0-4b70-80c1-259c8da748ec","owner":[],"postedDate":"September 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-08T05:23:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-02 13:33:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4813321","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4813321","identity":"rs-4813321","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}