Publication:

Association of ovarian response with anogenital distance in patients undergoing ovarian stimulation for in vitro fertilization/intra cytoplasmic sperm injection: a prospective cohort study

Background The study investigates whether Anogenital Distance (AGD), a permanent marker of the prenatal hormonal environment, is associated with established ovarian reserve markers (FSH, AMH, AFC). Crucially, the aim is to determine if AGD can predict Ovarian Sensitivity Index (OSI) and overall ovarian response during controlled ovarian stimulation (COS) for IVF/ICSI.

Methods This was a prospective cohort study conducted at an Indian IVF  Reproductive and Biology Centre, located within the Department of Obstetrics and Gynaecology at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi (n=40), aiming to evaluate the association of the anogenital distance (AGD), measured using digital calipers, with ovarian response, specifically the ovarian sensitivity index (OSI), and clinical outcomes in infertile women undergoing their first IVF/ICSI cycle.

Results The study confirmed that age and AFC are inverse determinants of ovarian response, with low responders being older, having lower AFC, and requiring the highest gonadotropin dose. This resulted in highly significant differences (p<0.001) in oocyte yield, embryo formation, and ovarian sensitivity index (OSI), which peaked sharply in high responders (9.50\pm 2.87). Consequently, the clinical strategy varied significantly: Fresh ET dominated in Low/Normo groups, while 83.3% of high responders underwent frozen ET. Critically, the clinical pregnancy rate was highest in Normo Responders (42.8%), showing a statistically significant difference (P=0.03), while anogenital distance (AGD) showed no significant difference across the groups.

Conclusions This study confirmed that age and poor ovarian reserve (high FSH, low AFC, low OSI) significantly define low responders, leading to inferior IVF cycle productivity compared to normo and high responders. Although anogenital distance (AGD) itself wasn't significantly different between groups, it positively correlated with key ovarian markers (AFC, OSI), suggesting it is a promising but unproven biomarker for ovarian reserve.