Age-specific FSH levels as a tool for appropriate patient counselling in assisted reproduction (original) (raw)
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Reproductive BioMedicine Online, 2006
The aim of this study was to determine the value of basal FSH as a predictor of assisted reproduction outcome in women >or=35 years undergoing ovarian stimulation with gonadotrophin-releasing hormone (GnRH) antagonist. A retrospective clinical study was carried out on 83 infertile women, 35-45 years old, divided into three groups according to their day 3 FSH concentration (group A = FSH <or=10 mIU/ml, group B = FSH >10 and <15 mIU/ml, group C = FSH >15 mIU/ml). Patients underwent ovarian stimulation with a GnRH-antagonist protocol. Group A women had significantly higher basal inhibin B concentrations (P < 0.001), lower cancellation rate (P < 0.001), required a significantly lower dosage of recombinant FSH (P < 0.0001) and had significantly higher oestradiol concentration under stimulation compared with the other groups (P < 0.0001). Oocyte and embryo numbers were comparable in all groups, although groups B and C had more low quality embryos compared with group A. The number of metaphase II oocytes and embryos was related to patients' ovarian reserve markers only in group C. Pregnancy and delivery rates were 35 and 22.5% in group A, 22.2 and 16.6% in group B and 5 and 0% in group C. It is concluded that a basal FSH cut-off of 10 mIU/ml seems predictive of ovarian reserve, while basal FSH cut-off of 15 mIU/ml seems predictive of pregnancy potential and probably of oocyte quality.
Journal of Assisted Reproduction and Genetics, 2000
Purpose : Chronological age, or biological age as indicated by elevated FSH levels, are related to ovarian reserve. This study addresses the likelihood of cancellation of IVF treatment due to a poor ovarian response utilising both basal serum FSH and woman's age. Methods : A prospective cohort of 536 infertile but ovulating women were studied in their first cycle of IVF treatment. Standardised methods of pituitary desensitisation and ovarian stimulation prior to IVF treatment were employed. Treatment cycles cancelled due to a poor ovarian response to gonadotrophins were studied. A series of logistic regression models were used to explore the probabilities of cancellation in relation to age and FSH. Results : Both age and basal serum FSH levels were independently associated with the risk of treatment cancellation. A low risk of treatment cancellation was observed in women under the age of 35 irrespective of serum FSH, however in older women the risk of treatment cancellation was most likely in women with a high FSH. Conclusions : In combination both age and FSH may serve as a valuable indicator of poor ovarian response leading to treatment cancellation. However, among older women FSH has particular importance, while less so in younger women with regular menstrual cycles.
Fertility and Sterility, 2007
To evaluate and compare IVF outcomes of patients within different age categories who had a normal basal FSH level with outcomes of patients with an elevated day 3 FSH level.Retrospective analysis.Large, private IVF center.We analyzed 2,708 patients. Of these, 2,477 had normal basal FSH levels, and 231 had elevated basal FSH levels (≥13.03 IU/L). Patients were segregated into various age groups.Follow-up.Outcomes of IVF overall, including cancellation rates, oocyte yield, and fertilization, implantation, and clinical pregnancy rates (PRs).Cancellation rates were significantly higher in patients with elevated day 3 FSH levels compared with patients with normal FSH levels in all age groups. A significantly lower oocyte yield was observed in patients with elevated basal FSH. Fertilization rates were not affected by FSH levels. A significant decrease in the number of embryos available for transfer in patients ≥38 with an elevated day 3 FSH level was found. Implantation and clinical PRs were lower in patients >40 years of age who had an elevated day 3 FSH level when compared to same age patients with a normal day 3 FSH level. Loss rates were not significantly different.Young women with an elevated basal FSH level should be counseled differently than older women, and should be given adequate counseling and granted the opportunity to undergo an IVF cycle.
2001
To examine the impact of low basal cycle day 3 serum LH levels or a high FSH:LH ratio on IVF results. Methods: A homogeneous group of patients was analyzed as identified by normal basal cycle of follicle stimulating hormone (FSH), Luteinizing hormone (LH), and estradiol (E 2) levels. High responders (high LH:FSH ratio) and low responders (high FSH or E 2 levels, and women ≥42 years of age) were excluded from analysis. Only cycles stimulated with a combination of a GnRHa (luteal suppression) and pure FSH were studied. Results: Patients with low basal LH levels (<3 mIU/mL) did not differ significantly from controls in terms of response to controlled ovarian hyperstimulation but there was a clear trend toward poorer implantation and clinical pregnancy rates. On the other hand, patients with a high FSH:LH ratio (>3) had significantly fewer mature oocytes aspirated, and lower implantation and clinical pregnancy rates than patients with gonadotropin ratio ≤3. These negative effects were evident in the presence of normal basal FSH levels and after adequate matching of female's age and number of embryos transferred. Conclusions: These studies highlight a negative impact of a basal cycle high FSH:LH ratio (and possibly low LH levels) on follicular development and oocyte quality in these patients subjected to pituitary down-regulation followed by pure FSH administration. A high FSH:LH ratio may be therefore used as an early biomarker of poor ovarian response.
Bangladesh Journal of Obstetrics & Gynaecology, 2016
Female age has consistently been shown to be the most important predictor of success in assisted reproductive technologies. There have been numerous reports in last twenty years showing the age-related effect on the results of IVF treatment in infertile couples. Templeton 1 in 1996 first demonstrated that the probability of live birth obtained through IVF treatment clearly decreases after the age of 35. Over the past two decades, a number of hormonal markers and imaging tests have been studied for their ability to predict outcome of IVF in terms of oocyte
Obstetrical Gynecological Survey, 2003
Objective: To investigate whether IVF outcome of patients older than 40 years of age with basal FSH levels less than 15 IU/L differs from that in patients 40 years of age or younger with basal FSH levels of 15 IU/L or greater. Design: Prospective observational study. Setting: Tertiary academic fertility center. Patient(s): Women 41 years of age or older with basal FSH levels less than 15 IU/L (n ϭ 50), and women 40 years of age or younger with elevated basal FSH levels (n ϭ 36) undergoing their first IVF cycle. Intervention(s): IVF treatment using a long suppression protocol with recombinant FSH at a fixed starting dose of 150 IU/L. Main Outcome Measure(s): Ovarian response, ongoing pregnancy rates, and implantation rates. Result(s): The high FSH group experienced more cycle cancellations due to absent follicular growth than did the high age group (31% vs. 8%). However, the high FSH group had better implantation rates per embryo (34% vs. 11%), higher ongoing rates per ET (40% vs.13%), and higher ongoing pregnancy rates per cycle (25% vs. 10%). In both groups, poor responders had lower pregnancy rates. Conclusion(s): The outcome of IVF differs between patients older than 40 years of age with normal FSH levels and relatively young patients with elevated FSH levels. This finding may have implications for the management of these patients.
Fertility and Sterility, 2002
BACKGROUND: Previous studies suggest that elevated basal FSH concentrations are related to aneuploid pregnancies. However, there have been no prospective studies evaluating the incidence of aneuploidies in relation to basal FSH concentrations. Since the majority of aneuploid conceptions end in early pregnancy loss or abortion of a recognized pregnancy, these determinants are appropriate intermediate end-points to study aneuploidy. METHODS: We performed a prospective study in 129 women without a history of subfertility pursuing a spontaneous pregnancy. Basal FSH concentrations were measured during three menstrual cycles. Urinary HCG levels were measured during menstruation for a maximum of six menstrual cycles, to detect early pregnancy loss. We estimated the effect of basal FSH concentrations on pregnancy outcome, taking into account possible confounders. RESULTS: We observed no signi®cant effect of basal FSH concentrations on the incidence of early pregnancy loss or abortion of clinically recognized pregnancies. CONCLUSIONS: We conclude that in a population of women without a history of subfertility, pursuing a spontaneous pregnancy, basal FSH concentrations are not related to the incidence of early pregnancy loss or abortions. This prospective study therefore fails to con®rm a relationship between signs of decreased ovarian reserve and aneuploid pregnancies.
Human Reproduction, 2003
BACKGROUND: The aim was to identify independent predictors of ovarian response to recombinant (r)FSH through a multiple regression analysis. METHODS: Prospective study including 145`standard' patients treated with 150 IU/day of rFSH during their ®rst IVF/ICSI cycle. Down-regulation was achieved with long agonist protocol. The following were examined as possible predictive factors: age, body mass index, cycle length, smoking status and on day 2±5: total ovarian volume, total number of antral follicles (<10 mm), total Doppler score of the ovarian stromal blood¯ow, serum FSH, LH, estradiol, inhibin B, and testosterone. RESULTS: Total number of antral follicles, total Doppler score, serum FSH, LH, estradiol, inhibin B, smoking status and cycle length were independent predictors of the number of aspirated follicles. The number of oocytes was predicted by the total number of antral follicles, total Doppler score, serum testosterone and smoking status. In bivariate linear regression analyses ovarian volume was a highly signi®cant predictor of both the number of follicles (P < 0.001) and the number of oocytes (P < 0.001). CONCLUSIONS: Among 12 investigated possible predictive factors in`standard' patients, the total number of antral follicles and ovarian stromal blood¯ow assessed by total Power Doppler score are the two most signi®cant predictors of ovarian response. Suggestion for an rFSH dosage normogram is presented.
IVF performance of women who have fluctuating early follicular FSH levels
Journal of assisted reproduction and genetics, 2000
The aim was to evaluate whether women who have early follicular follicle-stimulating hormone (FSH) levels > 12 mIU/ml have reduced response to follicular stimulation for in vitro fertilization (IVF) in a following month, in spite of normal FSH levels. In a 3-year period from January 1996 to December 1998, 303 women aged 38 years and above and/or who had previously responded poorly to superovulation for IVF gave blood samples for FSH, luteinizing hormone (LH), and estradiol (E2) on day 2 of menstruation before commencing treatment. In 117 (38.6%) of these women, FSH levels were > 12 mIU/ml (range 12-114 mIU/ml). Sixty-six of these women gave a further 130 blood samples for FSH measurement in the following months. Seventy-eight (60.0%) of the tests showed raised FSH value > 12 mIU/ml. Thirty women whose repeat FSH levels were < 12 mIU/ml underwent 41 IVF cycles (group 1). Sixty-three other women, older than 38 and/or who had a poor response to superovulation previously and...
Human Reproduction, 2002
BACKGROUND: The study aim was to establish whether basal serum levels of FSH and estradiol are predictive of outcome in women undergoing treatment by in-vitro maturation (IVM) of immature oocytes. METHODS: Data were obtained from 123 unstimulated IVM cycles. Serum was taken between cycle days 2-4 for analysis. Patients received 10 000 IU of HCG 36 h before immature oocyte recovery that was performed between cycle days 9-14. IVM was performed and mature oocytes fertilized by ICSI, followed 2-3 days later by embryo transfer. Outcome measures included the number of immature oocytes retrieved, and the rates of oocyte maturation, fertilization, cleavage and pregnancy. RESULTS: A median (range) of 8 (0-36) immature oocytes was retrieved per patient. Oocyte maturation, fertilization, cleavage and pregnancy rates were 83, 76, 93 and 17.9% respectively. Serum FSH levels and the presence of polycystic ovary were significant independent predictors of the number of immature oocytes retrieved, whilst patient age and basal estradiol level were not. A basal serum estradiol level >100 pmol/l was associated with a significantly higher pregnancy rate (26 versus 11% for estradiol <100 pmol/l; P ⍧ 0.032). CONCLUSIONS: Measurement of basal serum levels of FSH and estradiol are useful in predicting the number of immature oocytes retrieved and the pregnancy rate in women undergoing unstimulated IVM treatment.