Is day 3 follicle stimulating hormone (fsh) useful in patients with normal antimullerian hormone (AMH) and antral follicle count (AFC)?

Abstract

Obtaining an early follicular phase serum FSH can be an inconvenience to patients, lead to increased costs and delay infertility treatments. The goal of this study was to determine the utility of the cycle day 3 FSH in patients with otherwise normal ovarian reserve tests. Retrospective cohort study. A review of patient's records who underwent IVF from 2012 to 2015 was performed. Subjects included in the study had AMH levels ≥1 ng/ml and AFC ≥10. Cycle day 3 serum FSH levels were categorized into three separate groups: high ≥10 IU/L, normal >5 IU/L and< 10 IU/L, and low ≤5 IU/L. Subjects with an elevated day 3 estradiol (≥80 ng/mL) obtained at the time of FSH and high responders (AMH ≥10 ng/ml and/or AFC ≥30) were excluded. Baseline demographics and IVF cycle parameters and outcomes were compared among the three groups using ANOVA and chi-square test where applicable. A total of 225 subjects were identified. The majority of the subjects (91%) utilized a GnRH antagonist cycle, and type of cycle utilized was not different based on FSH group (p=0.84). Those in the high group received a higher mean total dose of gonadotropins (3977 IU) compared to the normal (3335 IU) and low groups (3746 IU) (p=0.01). Comparison among the three groups is presented in table 1.Table 1Comparison of three FSH groupsHigh (n=36)Normal (n=170)Low (n=19)p valueAge33.3 ± 4.532.9 ± 4.631.2 ± 5.50.26BMI24 ± 426 ± 628 ± 70.06AMH2.6 ± 1.52.9 ± 1.63.2 ± 2.10.38AFC18 ± 519 ± 620 ± 50.19% started on 450 IU13 (36%)33 (19%)7 (37%)0.001*Peak estradiol (pg/ml)2270255323870.36No. of follicles recruited17 ± 1022 ± 925 ± 100.01*No. of oocytes retrieved15 ± 818 ± 921 ± 80.02*No. of 2PN embryos8 ± 410 ± 612 ± 50.04*Clinical pregnancy rate13/25 (52%)71/113 (63%)3/6 (50%)0.53Live birth rate10/25 (40%)53/113 (47%)2/6 (33%)0.69 Open table in a new tab An isolated elevated cycle day 3 FSH was associated with decreased follicular development and lower oocyte yield despite normal AMH and AFC. Although clinical pregnancy rate and live birth rate were not different statistically when looking at a single cycle, this may impact cumulative pregnancy rates and long term outcomes for these patients. Based on the findings from this study, we will continue to recommend a complete ovarian reserve evaluation to determine the of optimal initial gonadotropin dose and properly counsel patients on IVF outcomes.