F. Lamazou

Reproducibility and reliability of automated volumetric measurement of single preovulatory follicles using SonoAVC

OBJECTIVE To evaluate the reproducibility and the reliability of an innovative, computer-assisted approach for automatically measuring ovarian follicles. DESIGN Prospective, comparative study. SETTING Hospital Béclère, Clamart, France. PATIENT(S) Fifteen infertile women undergoing IVF-ET in monodominant follicle cycles. INTERVENTION(S) Just before oocyte retrieval, follicles were three-dimensionally reconstructed from transvaginal ultrasonographic images. Volumes were determined both manually by visual outlining of inner follicle borders (VOCAL) and automatically using SonoAVC. Each procedure was repeated three times. Follicular fluid volume indicated the actual follicle volume. MAIN OUTCOME MEASURE(S) Reproducibility and concordance of results were assessed by the intraclass correlation coefficient (ICC) and the limits of agreement method, respectively. RESULT(S) At any time, VOCAL (3.68, 2.41-8.29 mL; 3.73, 2.70-7.16 mL; 3.89, 2.96-7.83 mL; median, ranges, respectively) and SonoAVC (3.57, 2.41-8.19 mL; 3.71, 2.49-8.90 mL; 4.07, 3.12-8.16 mL, respectively) volume measurements failed to be statistically different from the corresponding actual follicle volume (3.60, 2.90-8.00 mL). Reproducibility (ICC, 95% confidence intervals) of repeated VOCAL (0.95, 0.87-0.98) and SonoAVC (0.97, 0.94-0.99) measurements as well as 95% limits of agreement between actual volumes and VOCAL (-0.48 to +0.80 mL) and SonoAVC (-0.61 to +0.99 mL) measurements were comparable. CONCLUSION(S) Automatic measurement of ovarian follicle volumes from three-dimensionally reconstructed ultrasound images (SonoAVC) is a rapid and simple technique, which reproducibility and reliability are comparable to the semimanual technique (VOCAL). It opens new perspectives for the accurate and objective assessment of ovarian function by ultrasound.

Reliability of automated volumetric measurement of multiple growing follicles in controlled ovarian hyperstimulation.

OBJECTIVE To evaluate the reliability of a computer-assisted approach for automatically measuring ovarian follicles during controlled ovarian hyperstimulation (COH). DESIGN Prospective, comparative study. SETTING Hospital Béclère, Clamart, France. PATIENT(S) Twenty-seven infertile IVF-ET candidates undergoing COH. INTERVENTION(S) Just before the oocyte retrieval, growing follicles (n=72) had their mean diameters measured and their volumes determined semimanually by virtual organ computer-aided analysis (VOCAL) and automatically by SonoAVC. Follicles were sorted in small (12-16 mm; n=35) and large (>16 mm; n=37) growing follicles. Measures were compared with the follicular fluid volume. MAIN OUTCOME MEASURE(S) Concordance of results using intraclass correlation coefficient and limits of agreement methods, respectively. RESULT(S) Overall, VOCAL (median: 3.42 mL; range: 0.98-9.68 mL) and SonoAVC (3.25 mL; 0.98-8.63 mL) measurements were equivalent to the corresponding actual follicle volume (3.20 mL; 0.80-10.20 mL). The intraclass correlation coefficient values between follicular fluid volume and mean diameter, VOCAL, and SonoAVC were 0.51, 0.95, and 0.98, respectively, for small follicles, and 0.80, 0.93, and 0.92, respectively, for large follicles. 95% limits of agreement between actual volume and VOCAL (-1.09 to +1.07 mL) and SonoAVC (-1.08 to +0.84 mL) measurements were comparable in both groups. CONCLUSION(S) Automated measurement of multiple follicular volumes using SonoAVC is a simple technique, which reliability is superior to usual diameter measurements and comparable to VOCAL. This technologic refinement invites us to switch toward volumetric monitoring of follicle growth during COH.

L’AMH sérique n’a pas de valeur prédictive en fécondation in vitro en cycle naturel modifié : analyse de 342 cycles

The objective is to compare the IVF procedures in modified natural cycle outcomes according to serum anti-Mullerian hormone (AMH) levels. We included in this retrospective study 342 patients undergoing their first IVF in modified natural cycle. Patients were regrouped in three groups according to their serum AMH level: group 1 was defined by patients with AMH level<0.97 ng/mL (<25th percentile), group 2, patients with AMH level between 0.97 ng/mL and 2.60 ng/mL (25-75th percentile), and group 3, patients with AMH level between 2.61 ng/mL and 6.99 ng/mL (>75th percentile). The main outcomes were cancellation rate, embryo transfer rate and clinical pregnancy rate, ongoing pregnancy rate and implantation rate. No difference has been observed on cancellation rate, embryo transfer rate, clinical pregnancy rate and implantation rate. The ongoing pregnancy rate per IVF cycle was respectively: 12.8±3.6% for AMH inferior to 0.97 ng/mL versus 12.5±2.5% for AMH between 0.97 to 2.60 ng/mL and 13.4±4.2% for AMH between 2.61 ng/mL and 6.99 ng/mL. In conclusion, IVF in modified natural cycles procedures should be considered as an option for patients with an altered ovarian reserve defined by a serum AMH inferior to 1 ng/mL. Serum AMH level seems a quantitative marker of the ovary but not a quality factor. Serum AMH level does not seem to be a prognostic factor for ongoing pregnancy rated in IVF modified cycles.

Place de l’échographie 2D-3D dans le bilan de l’infertilité

L’echographie occupe desormais une place incontournable dans le diagnostic et la prise en charge des infertilites feminines, ainsi que dans la mise en oeuvre des techniques de procreation medicalement assistee.