High Intercycle Variability of Day 3 FSH Levels is Useful for Predicting Ovarian Responses But Not Pregnancy Outcomes in IVF

Abstract

OBJECTIVE: To determine if intercycle variability in day 3 FSH (D3FSH) levels is useful in predicting IVF outcomes. DESIGN: Retrospective analysis of patients undergoing IVF from January 2004 to March 2005 in a large private practice setting. MATERIALS AND METHODS: A total of 2504 fresh, nondonor IVF cycles were available for analysis. This group encompassed a broad spectrum of patients representing typical infertility patients presenting for assisted reproduction. The patients ranged in age from 21-44 and underwent controlled ovarian hyperstimulation by standard midluteal phase GnRH agonist down regulation or GnRH antagonist protocol using recombinant FSH or FSH in combination with HMG. Adjustments were made based on individual responses, and when two or more follicles had attained a minimum mean diameter of 19-20mm, follicular triggering was achieved with hCG and oocyte retrieval was performed 36 hours later. Standard laboratory protocols were followed, including intracytoplasmic sperm injection, assisted hatching for cleavage embryos and extended culture for blastocyst transfer, as clinically appropriate. Ultrasound guided embryo transfer was performed, and all patients received luteal progesterone support. Serum hCG levels were measured 15 days after retrieval, and a clinical pregnancy was defined as the presence of a gestational sac on ultrasound. An estimate of normal intercycle D3FSH variability was derived by regressing standard deviations of replicate measurements against mean FSH in patients 35 years old with D3FSH 10. Patients were placed in the high variability category when their calculated standard deviation was significantly higher than normal. Comparisons were made between patients with normal and high D3FSH variability as well as patients with a single treatment cycle. Continuous and categorical data were analyzed by ANOVA and Chi Square tests, respectively. A value of P 0.05 was considered to be statistically significant. Results are expressed as mean SD. RESULTS: Patients with replicate cycles were older. Relative to patients with normal variability, patients with high D3FSH variability had significantly diminished ovarian responses, with fewer retrieved and mature oocytes but similar fertilization, pregnancy and clinical pregnancy rates. All patients with replicate cycles had significantly lower pregnancy outcomes than patients with single cycles.