Basal fsh level is only predictive of the quantitative aspect of the ovarian response

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Published Jul 5, 2012
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Vol. 90 No. 7 (2012): Issue Jul 2012

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Selima Fourati
Ghaya Merdassi
Mohamed Khrouf
Hanene Elloumi
Anis Fadhlaoui
Imen Brahmi
Nadia Hammami
Sajiaa Ben Slima
Mounir Ben Meftah
Fethi Zhioua
Amel Zhioua

Abstract

Background: Determination FSH and LH at day 3 of the menstrual cycle predicts the response to stimulation.
Aim: To evaluate the value of FSH and LH measurements compared with women’s age in predicting qualitative and quantitative ovarian response to gonadotrophin stimulation.
Methods: 305 patients underwent at least one intra cytoplasmic sperm injection (ICSI) cycle. The levels of FSH and LH at day 3 were determined in an earlier cycle. A qood quantitative ovarian response was defined as ³3 oocytes retrieved and 3 embryos obtained. A good qualitative ovarian response was defined as a pourcentage of mature oocytes ³75% and immature ones²15% of the total number of oocytes retrieved with at least one top quality embryo obtained.
Results: Receiver operating characteristic (ROC) curves were generated for FSH, LH and female age. FSH is better than female age in predicting the number of oocytes retrieved (respectively ROCAUC=0.77, p=10-3 versus ROCAUC=0.73, p=10-3) and the number of embryos obtained (ROCAUC=0.69, p=10-3 versus ROCAUC=0.66, p=10-3). LH is non predictive. None of the three tested parameters was predictive of the fertilization and pregnancy rates. An FSH cutoff was calculated and a value of 7.8mUI/ml is associated with a sensitivity of 73% and a specificity of 70% for the prediction of ovarian response to controlled stimulation.
Conclusion: Basal FSH level predicts good quantitative rather than qualitative response. LH is non predictive. FSH and LH do not predict pregnancy rate. Patients having high FSH levels should not be excluded from IVF/ICSI treatment.

Keywords:

Ovarian stimulation, ovulation, micromanipulation, gonadotrophins, fertilization, pregnancy

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