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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.


Max FSH predicts cycle cancellations better than current FSH. a Number of completed and cancelled cycles with Max FSH and current FSH data, grouped by Max and current FSH elevation status. + indicates true and - indicates false. b Receiver operating characteristic (ROC) curve for model prediction of cycle cancellation using Max FSH (red), PMax FSH (blue), current FSH (black) or  hypothesis (grey). c Distribution of Max FSH, PMax FSH and current FSH in completed and cancelled cycles. IVF cycles were divided into the subset of completed and cancelled ones and the distribution of their respective Max FSH, PMax FSH and current FSH levels was plotted in red, blue and black, respectively. Completed cycles were plotted in solid lines and cancelled cycles in dashed lines. The Kolmogorov-Smirnov statistic between the distribution parameters for completed and cancelled cycles is noted to the right of each bracketed pair (see Methods for details)
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Fig2: Max FSH predicts cycle cancellations better than current FSH. a Number of completed and cancelled cycles with Max FSH and current FSH data, grouped by Max and current FSH elevation status. + indicates true and - indicates false. b Receiver operating characteristic (ROC) curve for model prediction of cycle cancellation using Max FSH (red), PMax FSH (blue), current FSH (black) or hypothesis (grey). c Distribution of Max FSH, PMax FSH and current FSH in completed and cancelled cycles. IVF cycles were divided into the subset of completed and cancelled ones and the distribution of their respective Max FSH, PMax FSH and current FSH levels was plotted in red, blue and black, respectively. Completed cycles were plotted in solid lines and cancelled cycles in dashed lines. The Kolmogorov-Smirnov statistic between the distribution parameters for completed and cancelled cycles is noted to the right of each bracketed pair (see Methods for details)

Mentions: A majority of patients underwent 1 or 2 cycles (57 % (n=5180) and 26 % (n=2402), respectively). Others underwent more cycles, up to a maximum of 13 (0.02 % (n=2)). Fourteen percent of cycles (n=2120) were cancelled prior to VOR (Fig. 1d, Table 2). Of these cancelled cycles, 85 % (n=1323 of 1554) were in patients with a normal current FSH (≤13 mIU/mL) and 64 % (n=1347 of 2120) were in patients with Max FSH ≤13 mIU/mL (i.e. who had never previously experienced an abnormal FSH). Together, 21 % of cancelled cycles were in patients whose FSH was normal at the time of the cycle but abnormal in the past (Fig. 2a).Fig. 2


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)

Max FSH predicts cycle cancellations better than current FSH. a Number of completed and cancelled cycles with Max FSH and current FSH data, grouped by Max and current FSH elevation status. + indicates true and - indicates false. b Receiver operating characteristic (ROC) curve for model prediction of cycle cancellation using Max FSH (red), PMax FSH (blue), current FSH (black) or  hypothesis (grey). c Distribution of Max FSH, PMax FSH and current FSH in completed and cancelled cycles. IVF cycles were divided into the subset of completed and cancelled ones and the distribution of their respective Max FSH, PMax FSH and current FSH levels was plotted in red, blue and black, respectively. Completed cycles were plotted in solid lines and cancelled cycles in dashed lines. The Kolmogorov-Smirnov statistic between the distribution parameters for completed and cancelled cycles is noted to the right of each bracketed pair (see Methods for details)
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Related In: Results  -  Collection

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Fig2: Max FSH predicts cycle cancellations better than current FSH. a Number of completed and cancelled cycles with Max FSH and current FSH data, grouped by Max and current FSH elevation status. + indicates true and - indicates false. b Receiver operating characteristic (ROC) curve for model prediction of cycle cancellation using Max FSH (red), PMax FSH (blue), current FSH (black) or hypothesis (grey). c Distribution of Max FSH, PMax FSH and current FSH in completed and cancelled cycles. IVF cycles were divided into the subset of completed and cancelled ones and the distribution of their respective Max FSH, PMax FSH and current FSH levels was plotted in red, blue and black, respectively. Completed cycles were plotted in solid lines and cancelled cycles in dashed lines. The Kolmogorov-Smirnov statistic between the distribution parameters for completed and cancelled cycles is noted to the right of each bracketed pair (see Methods for details)
Mentions: A majority of patients underwent 1 or 2 cycles (57 % (n=5180) and 26 % (n=2402), respectively). Others underwent more cycles, up to a maximum of 13 (0.02 % (n=2)). Fourteen percent of cycles (n=2120) were cancelled prior to VOR (Fig. 1d, Table 2). Of these cancelled cycles, 85 % (n=1323 of 1554) were in patients with a normal current FSH (≤13 mIU/mL) and 64 % (n=1347 of 2120) were in patients with Max FSH ≤13 mIU/mL (i.e. who had never previously experienced an abnormal FSH). Together, 21 % of cancelled cycles were in patients whose FSH was normal at the time of the cycle but abnormal in the past (Fig. 2a).Fig. 2

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.