Relative influence of serum follicle stimulating hormone, age and other factors on ovarian response to gonadotrophin stimulation

Abstract

Objective To determine the relative value of the woman's age, basal follicle stimulating hormone (FSH), basal luteinising hormone (LH) and menstrual cycle pattern (all denned prior to treatment) in predicting the ovarian response to gonadotrophin stimulation for in vitro fertilisation. Design Open, descriptive cohort study. Patients One hundred and seventy‐one consecutive ovulatory women undergoing their first cycle of in vitro fertilisation with ovarian stimulation after pituitary desensitisation. Interventions Measurement of basal (early follicular phase) and down‐regulated concentrations of serum FSH and LH, and calculation of age at treatment and of median length of menstrual cycles and range of variation prior to treatment. Main outcome measures Duration and amount of gonadotrophin stimulation to achieve follicular maturity, number of mature follicles, peak serum oestradiol concentration and number of mature oocytes, were compared between banded values of variables studied. Results Increasing basal FSH concentrations were significantly associated with reducing oestradiol levels, numbers of mature follicles and oocyte yield even when the FSH levels were still within the normal range though above average (6 to 8.9 i.u./l). There were similar but weaker associations with FSH levels after down‐regulation. There were also significant differences between women over and under 40 years old in their oestradiol levels, numbers of follicles and of oocytes. Analysis of variance showed significant independent association of basal FSH with both oestradiol and numbers of oocytes, but not of age, menstrual pattern, or serum LH concentrations. Conclusion Serum FSH is more sensitive than the woman's age in determining her ovarian responsiveness to stimulation. LH concentrations and menstrual cycle patterns are unhelpful.

Dynamic measurements of serum inhibin B and estradiol: apredictive evaluation of ovarian response to gonadotrophin stimulation in the early stage of IVF treatment

“…The effects of age, basal FSH and estradiol concentrations have been well documented (Scott et al, 1989;Scott and Hofmann, 1995;Toner et al, 1991b;Cahill et al, 1994;Licciardi et al, 1995;Mukherjee et al, 1996;Kim et al, 1997). However, the most important aspect of diminished ovarian reserve and associated decline in reproductive potential is that its onset is highly variable (Mosher and Pratt, 1990;1991;Maroulis, 1991).…”

“…However, the most important aspect of diminished ovarian reserve and associated decline in reproductive potential is that its onset is highly variable (Mosher and Pratt, 1990;1991;Maroulis, 1991). This means that functional ovarian age as reflected by basal FSH and estradiol concentrations can be discordant with biological age (Scott et al, 1989;Scott and Hofmann, 1995;Toner et al, 1991b;Cahill et al, 1994). Patients who have normal FSH and estradiol levels or are younger than 35 years of age may still have a diminished ovarian reserve that leads to poor response to Gn stimulation (Farhi et al, 1997).…”

“…Traditional criteria used to predict ovarian response to Gn stimulation include the patient's age, baseline serum concentration of hormones such as follicle stimulating hormone (FSH), estradiol, FSH to luteinizing hormone (LH) ratio, and dynamic tests (such as the clomiphene citrate (CC) challenge test, the Gn-releasing hormone analogue (GnRHa) stimulation test, and the human menopausal Gn (HMG) stimulation test) (Navot et al, 1987;Scott et al, 1989;Scott and Hofmann, 1995;Toner et al, 1991a;Cahill et al, 1994;Licciardi et al, 1995;Mukherjee et al, 1996;Kim et al, 1997;Ravhon et al, 2000).…”

Anti-mullerian hormone and cumulative pregnancy outcome in in-vitro fertilization

“…Early follicular phase serum FSH has been widely used and is a better predictor of ovarian response than the women's age alone [2,3]. Subsequently, ultrasound assessment of the antral follicle count (AFC) has been found to be a better clinical predictor of ovarian response than FSH level [4,5].…”

Affordable ART for developing countries: a cost benefit comparison of low dose stimulation versus high dose GnRH antagonist protocol

“…Polycystic ovarian syndrome was concluded on the presence of a thickened capsule or necklace ring on ultrasound, hirsutism/acne and/or high serum testosterone. Normal ovarian reserve was based ultrasound measurements [13] and day three serum FSH and LH [14]. All subjects except two had FSH below 10 UI/L.…”