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Maximum basal FSH predicts reproductive outcome better than cycle-specific basal FSH levels: waiting for a "better" month conveys limited retrieval benefits.

Gingold JA, Lee JA, Whitehouse MC, Rodriguez-Purata J, Sandler B, Grunfeld L, Mukherjee T, Copperman AB - Reprod. Biol. Endocrinol. (2015)

Bottom Line: Elevated follicle stimulating hormone (FSH) is associated with poor vaginal oocyte retrieval (VOR) outcomes and cycle cancellations but intercycle variability in basal FSH reportedly does not predict ovarian response.Max FSH is the best FSH-based predictor of ovarian reserve.Retrieval benefits from waiting for a "better" month appear to exist but are limited.

View Article: PubMed Central - PubMed

Affiliation: Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor, New York, New York, 10022, USA. julian.gingold@mssm.edu.

ABSTRACT

Background: Elevated follicle stimulating hormone (FSH) is associated with poor vaginal oocyte retrieval (VOR) outcomes and cycle cancellations but intercycle variability in basal FSH reportedly does not predict ovarian response.

Methods: We conducted a retrospective cohort study of basal FSH (n = 15573 cycles) in couples (n = 9132) who initiated IVF cycle(s) with basal estradiol (E2) <100 pg/mL between 2002 and 2014 to reevaluate this hypothesis. The most recent (current) FSH, maximum FSH (Max FSH) and prior cycle maximum basal FSH (PMax FSH) were computed for each cycle. Metaphase II (MII) oocyte counts were modeled by age, stimulation type, prior peak E2 level, prior MII count, Max FSH, PMax FSH and current FSH. Antral follicle counts, pregnancy, clinical pregnancy and live birth rates were modeled as secondary outcomes.

Results: Max FSH level distinguished completed cycles from cancelled cycles better than PMax FSH or current FSH (AUC of 0.72, 0.71 and 0.61, respectively, p < 0.001). Fewer MIIs were retrieved (5.7 ± 3.8) in cycles with Max FSH >13 mIU/mL (n = 1475) than those with ≤13 mIU/mL (n = 11978) (11.6 ± 7.1) (p < 0.001). Max FSH was a better predictor of MII count than PMax FSH or current FSH after controlling for age, stimulation type, prior peak E2 level and prior MII count. Additional MIIs were retrieved on average in cycles with PMax FSH >13 mIU/mL (n = 1930) whose current FSH was ≤13 mIU/ml rather than >13 mIU/ml (p < 0.01) after controlling for age, cycle number and stimulation type. However, no improvement in pregnancy or live birth rate was detected.

Conclusions: Max FSH is the best FSH-based predictor of ovarian reserve. Retrieval benefits from waiting for a "better" month appear to exist but are limited.

No MeSH data available.


Patient Population Parameters. Histograms of patient a) age distribution and b) Max FSH distribution. Cycles with Max FSH >13 mIU/mL are shown in red. c) Quantiles of time since Max FSH measurement. d) Table of number of initiated and completed cycles
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Fig1: Patient Population Parameters. Histograms of patient a) age distribution and b) Max FSH distribution. Cycles with Max FSH >13 mIU/mL are shown in red. c) Quantiles of time since Max FSH measurement. d) Table of number of initiated and completed cycles

Mentions: A total of 9132 patients initiated 15573 IVF cycles between 2002 and 2014. Patients were 37.2 ±4.7 years old (yo) and had a Max FSH of 9.18 ±4.27 mIU/mL (Fig. 1a-b). Of the completed cycles (n=13453), 57.2 % (n=7698) were ICSI, 40.5 % (n=5448) were conventional insemination, and 2.3 % (n=307) were split ICSI and conventional insemination (Table 2, Additional file 1: Table S1). Of the patients with a complete intake history (n=6926), 50.6 % (n=3504) had a diagnosis of primary infertility, while 49.4 % (n=3422) had a diagnosis of secondary infertility (Table 2). The most common causes of infertility across these cycles were male-factor (19.8 %), diminished ovarian reserve (18.2 %), idiopathic (18.2 %) and tubal factor (12.1 %) (Table 2).Fig. 1


Maximum basal FSH predicts reproductive outcome better than cycle-specific basal FSH levels: waiting for a "better" month conveys limited retrieval benefits.

Gingold JA, Lee JA, Whitehouse MC, Rodriguez-Purata J, Sandler B, Grunfeld L, Mukherjee T, Copperman AB - Reprod. Biol. Endocrinol. (2015)

Patient Population Parameters. Histograms of patient a) age distribution and b) Max FSH distribution. Cycles with Max FSH >13 mIU/mL are shown in red. c) Quantiles of time since Max FSH measurement. d) Table of number of initiated and completed cycles
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536597&req=5

Fig1: Patient Population Parameters. Histograms of patient a) age distribution and b) Max FSH distribution. Cycles with Max FSH >13 mIU/mL are shown in red. c) Quantiles of time since Max FSH measurement. d) Table of number of initiated and completed cycles
Mentions: A total of 9132 patients initiated 15573 IVF cycles between 2002 and 2014. Patients were 37.2 ±4.7 years old (yo) and had a Max FSH of 9.18 ±4.27 mIU/mL (Fig. 1a-b). Of the completed cycles (n=13453), 57.2 % (n=7698) were ICSI, 40.5 % (n=5448) were conventional insemination, and 2.3 % (n=307) were split ICSI and conventional insemination (Table 2, Additional file 1: Table S1). Of the patients with a complete intake history (n=6926), 50.6 % (n=3504) had a diagnosis of primary infertility, while 49.4 % (n=3422) had a diagnosis of secondary infertility (Table 2). The most common causes of infertility across these cycles were male-factor (19.8 %), diminished ovarian reserve (18.2 %), idiopathic (18.2 %) and tubal factor (12.1 %) (Table 2).Fig. 1

Bottom Line: Elevated follicle stimulating hormone (FSH) is associated with poor vaginal oocyte retrieval (VOR) outcomes and cycle cancellations but intercycle variability in basal FSH reportedly does not predict ovarian response.Max FSH is the best FSH-based predictor of ovarian reserve.Retrieval benefits from waiting for a "better" month appear to exist but are limited.

View Article: PubMed Central - PubMed

Affiliation: Reproductive Medicine Associates of New York, 635 Madison Ave 10th Floor, New York, New York, 10022, USA. julian.gingold@mssm.edu.

ABSTRACT

Background: Elevated follicle stimulating hormone (FSH) is associated with poor vaginal oocyte retrieval (VOR) outcomes and cycle cancellations but intercycle variability in basal FSH reportedly does not predict ovarian response.

Methods: We conducted a retrospective cohort study of basal FSH (n = 15573 cycles) in couples (n = 9132) who initiated IVF cycle(s) with basal estradiol (E2) <100 pg/mL between 2002 and 2014 to reevaluate this hypothesis. The most recent (current) FSH, maximum FSH (Max FSH) and prior cycle maximum basal FSH (PMax FSH) were computed for each cycle. Metaphase II (MII) oocyte counts were modeled by age, stimulation type, prior peak E2 level, prior MII count, Max FSH, PMax FSH and current FSH. Antral follicle counts, pregnancy, clinical pregnancy and live birth rates were modeled as secondary outcomes.

Results: Max FSH level distinguished completed cycles from cancelled cycles better than PMax FSH or current FSH (AUC of 0.72, 0.71 and 0.61, respectively, p < 0.001). Fewer MIIs were retrieved (5.7 ± 3.8) in cycles with Max FSH >13 mIU/mL (n = 1475) than those with ≤13 mIU/mL (n = 11978) (11.6 ± 7.1) (p < 0.001). Max FSH was a better predictor of MII count than PMax FSH or current FSH after controlling for age, stimulation type, prior peak E2 level and prior MII count. Additional MIIs were retrieved on average in cycles with PMax FSH >13 mIU/mL (n = 1930) whose current FSH was ≤13 mIU/ml rather than >13 mIU/ml (p < 0.01) after controlling for age, cycle number and stimulation type. However, no improvement in pregnancy or live birth rate was detected.

Conclusions: Max FSH is the best FSH-based predictor of ovarian reserve. Retrieval benefits from waiting for a "better" month appear to exist but are limited.

No MeSH data available.