High follicle-stimulating hormone levels should not necessarily lead to the exclusion of subfertile patients from treatment

Abstract

Objective To determine ongoing pregnancy rates in subfertile patients with elevated FSH levels and regular cycles and to assess whether or not it is justified to exclude such patients from treatment on the basis of elevated FSH levels alone. Design Retrospective follow-up study. Setting Tertiary fertility center. Patient(s) One hundred twenty-two patients with normal FSH levels <10.0 IU/L, 126 with FSH between 10.0 and 15.0 IU/L, and 53 with FSH levels >15.0 IU/L, all having regular cycles and belonging to a general subfertility population. Intervention(s) Follow-up. Main outcome measure(s) Overall and treatment-independent and treatment-dependent ongoing pregnancy rates and time to ongoing pregnancy. Result(s) Overall ongoing pregnancy rates declined from 65% in the normal FSH group to 47%, and 28% in the respective elevated FSH groups. However, when adjusting for differences in age and whether or not treatment was applied, this declining trend became inconsistent for both treatment-independent and treatment-dependent ongoing pregnancy rates. Only when FSH levels exceeded 20 IU/L was a clear fall in ongoing pregnancy rate observed, independent of age. In a Cox regression analysis, FSH seemed significantly associated with the outcome time to overall ongoing pregnancy (odds ratio = 0.94, 95% confidence interval, 0.88–0.99), but after adjusting for age and being on treatment or not this significance disappeared (odds ratio = 0.97, 95% confidence interval, 0.91–1.01). Conclusion(s) The contribution of FSH in the initial evaluation of subfertile couples is restricted to counseling patients on the probability of having lower chances of conceiving. It does not seem justified to exclude patients with normal regular cycles from treatment on the basis of the FSH value alone.