Fabregues F, et al. - Researchers evaluated if the length of the anogenital distance (AGD) was a biomarker of ovarian reserve and response to controlled ovarian stimulation (COS). Findings suggested an association of shorter AGD with presence of poor ovarian response.

Methods

• Experts conducted a prospective cohort study of 437 women treated with IVF/ICSI conducted in a tertiary-care university hospital between January and December 2016.
• All the women included in this study had undergone their first COS for IVF/ICSI and reached criteria for oocyte retrieval.
• They divided the patients into three groups based on the number of oocytes obtained: poor responders (≤3 oocytes) (n = 50), normoresponders (4–15 oocytes) (n = 332) and high responders (>15 oocytes) (n = 55).
• Before retrieval, they recorded the following patient data: age, body mass index (BMI), ovarian reserve markers (anti-Müllerian hormone [AMH], antral follicle count [AFC] and follicular stimulation hormone [FSH]), cause of infertility, total doses of gonadotropins used and ovarian sensitivity index (OSI).
• Researchers excluded the patients with previous pregnancies, polycystic ovary syndrome (PCOS), endometriosis and previous ovarian or genital surgery.
• In all patients under sedation on the day of retrieval and before proceeding to oocyte pick-up, anthropometric biomarkers of AGDAC (anus-clitoris) and AGDAF (anus-fourchette) were measured.
• In order to examine the association between both AGD and ovarian reserve markers, the total units of gonadotropins used, the number of oocytes obtained and the OSI, multiple linear regression analyses were used.
• They used logistic regression to predict poor response in COS for IVF/ICSI, while accounting for confounders such as age and BMI.

Results

• As per data, baseline FSH, AMH, AFC and age were significantly different among the three groups of ovarian response, as were the units of gonadotropin used, and the ovarian sensitivity index (OSI) (P< 0.001).
• Findings suggested a positive correlation of both AGDAC and AGDAF measurements with AMH levels (r = 0.38 and r = 0.21;P< 0.05), AFC (r=0.41 and r=0.20;P < 0.05), the OSI (r=0.24 and r=0.19;P < 0.05) and the number of oocytes retrieved (r=0.29 and r=0.28, respectively;P < 0.05).
• Conversely, both AGD measurements and the doses of gonadotropins used (r= –0.19 and r=–0.15;P < 0.05) were negatively associated.
• For prediction of poor response of AGDAC, the area under the curve (AUC) was 0.70 (95% CI 0.66, 0.75), which was comparable to the classic ovarian reserve markers, such as AFC and AMH.
• A significantly worse predictive capacity for poor ovarian response was demonstrated by AGDAF (AUC 0.60 [95% CI 0.55, 0.60]) than AMH and AFC.