Regarding the prognostic significance of ovarian reserve testing, which single test has the best sensitivity and specificity for predicting poor ovarian response to controlled ovarian stimulation (COS)?

• A Day 3 serum FSH level
• B Antral follicle count (AFC) on transvaginal ultrasound
• C Serum anti-Müllerian hormone (AMH) ✓
• D Clomiphene citrate challenge test (CCCT)

Explanation

Serum anti-Müllerian hormone (AMH), secreted by small antral and pre-antral follicles, has the highest sensitivity and specificity among ovarian reserve tests for predicting poor ovarian response (POR) to gonadotrophin stimulation. AMH is cycle-independent (can be measured any day), does not fluctuate within cycle unlike FSH, and directly reflects the primordial follicle pool. AFC is equivalent to AMH in predictive value for many guidelines, but AMH is less operator-dependent. Day 3 FSH has poor sensitivity. CCCT is now largely obsolete.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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