The Relationship Between Serum Delta FSH Level and Ovarian Response in IVF/ICSI Cycles

Abstract

Background: When ovarian response to FSH stimulation for IVF/ICSI is unsatisfactory, the FSH dose is often adjusted in the treatment cycles, thereby assuming that hormone status and follicular development were insufficient for optimal stimulation. Objectives: To evaluate whether serum delta FSH levels between D6 of gonadotrophin use and basal serum FSH or between D6 of gonadotrophin use and D1 of gonadotrophin use predict ovarian response in IVF/ICSI cycles. Method: The participants of this retrospective study were chosen from the Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University between August 2015 and December 2017 (n = 3,109), and during the COS, each participant was given a fixed dose of rFSH in the first 6 days. Delta FSH1: The difference of serum FSH between D6 of gonadotrophin use and basal serum FSH. Delta FSH2: The difference of serum FSH between D6 of gonadotrophin use and D1 of gonadotrophin use. Logistic regression was used to analyze the association between delta FSH1 level and delta FSH2 level and ovarian response. Besides, we also use the tertile statistics to divide the groups. Results: Part I: Delta FSH1 levels (mean: 1.41 ± 3.46) in normal responders were higher than delta FSH1 levels (mean: 1.07 ± 23.89) in hyper responders (P = 0.0248). The tertile of delta FSH1 is dif ≤ 0, 0 < dif ≤ 2.25 and dif > 2.25. Compared with the hyper responder, the delta FSH1 (0 < dif ≤ 2.25 and dif > 2.25) in the normal responder has a higher ratio and is statistically significant. Part II: Delta FSH2 levels (mean: 4.90 ± 2.84) in normal responders were similar with delta FSH2 levels (mean: 4.74 ± 2.09) in hyper responders (P = 0.103). The tertile of delta FSH1 is dif ≤ 3.91, 3.91 < dif ≤ 5.69 and dif > 5.69. Compared with the hyper responders, the delta FSH2 (3.91 < dif ≤ 5.69 and dif > 5.69) in the normal responders has a higher ratio and is statistically significant. Conclusions: There is a weak relationship between ovarian response and serum delta FSH levels.

The relationship between serum FSH level and ovarian response during controlled ovarian stimulation

“…As shown, the markers standing for the ovarian response differed significantly between two groups. Superior responders had a significantly higher AMH compared to inappropriate responders [4.59 (3.05, 6.8) vs 2.19 (1.52, 3.53), p = 0.000], a significantly higher AFC [17 (14, 20) vs 12 (9,16), p = 0.000], but a significantly lower basal FSH [6.08 (5.27, 6.92) vs 6.78 (5.69, 7.70), p = 0.002]. There was no difference in serum FSH levels on the gonadotrophin starting day between two groups.…”

“…In this study, we identified that serum sFSH levels had significantly distinction between different ovarian responders undergoing the IVF/ICSI cycles in GnRH agonist cycles. A recent similar study [16] concluded that there was a weak relationship between ovarian response and serum delta FSH levels (the difference between serum FSH level on D6 of gonadotropin (Gn) use and basal serum FSH level) in the rFSH fixed dose treatment protocol. Because the study only focused on the comparison between the discrepancy of FSH level and ovarian response, it is difficult to directly compare these results to our study.…”

Development and validation of a live birth prediction model for expected poor ovarian response patients during IVF/ICSI

“…Estrogen levels in females would be reduced as the decline of ovarian reserve, resulting in an increase of FSH secretion. The elevated basal FSH (bFSH) level is associated with the declined ovarian reserve ( 33 ). Therefore, bFSH has been widely used in reproductive medicine to evaluate the ovarian reserve and its response.…”

A prediction model for high ovarian response in the GnRH antagonist protocol

“…After the age of 35, the number of follicles decreases sharply, probably due to the incidence of chromosomal defects increases, and the sensitivity of granulosa cells to gonadotropin decreases. Some studies suggested that serum FSH increases significantly when ovarian reserve is severely declined and fluctuates significantly during the menstrual cycle; therefore, FSH has no optimal sensitivity or specificity in predicting ovarian response ( 16 ). Our data indicated that FSH was associated with ovarian response, but it shouldn’t be single-used as the predictor due to its defects.…”