Basal Serum FSH Research Articles

Effects of anti-Müllerian hormone and follicle stimulating hormone levels on in vitro fertilization pregnancy rate

ObjectivesTo analyze the relationship between in vitro fertilization (IVF) pregnancy rate and basal serum hormone levels before patients begin an IVF course. Materials and methodsIn this retrospective study, we analyzed patients with anti-Müllerian hormone (AMH) data and IVF data from January 2009 to October 2012. Pregnancy rates were calculated by AMH and follicle stimulating hormone quartiles and analyzed using the independent samples t test. Furthermore, patients were divided into three groups by age. The Chi-square test was used to assess the association between the parameters and IVF pregnancy rates. ResultsFrom the 910 IVF treatment courses, 377 (41.4%) clinical pregnancies resulted. The pregnant and nonpregnant groups differed significantly in age and FSH and AMH levels. The pregnancy rate was 53.3% for patients aged <32 years and 22.1% for patients aged >38 years. The pregnancy rate was 53.4% for patients with FSH levels <5.6 mIU/mL and 25.8% for patients with FSH levels >8.9 mIU/mL. The pregnancy rate was 56.8% for patients with AMH levels >4.0 ng/mL and 20.0% for patients with AMH levels <1.1 ng/mL. Furthermore, among patients aged <40 years, AMH and FSH were significantly associated with pregnancy rate. Higher pregnancy rates were found among the groups with higher AMH levels than in groups with lower AMH levels. ConclusionFor patients aged <40 years, basal serum AMH level and FSH level affected the IVF pregnancy rate, and patients with higher AMH levels had better pregnancy rates.

Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis.

Does previous methotrexate (MTX) treatment for ectopic pregnancy (EP) have an effect on ovarian response in women receiving fertility treatment? MTX treatment for EP does not seem to affect subsequent fertility treatment. MTX is commonly used to treat EPs that are diagnosed early. Previous studies have reported conflicting results about its effect on subsequent fertility treatments. This systematic review and meta-analysis included a total of 329 patients who had participated in 7 observational studies. A search of the MEDLINE, EMBASE and PUBMED databases was conducted to identify studies about fertility treatments after MTX treatment for EP, published in English or French up to December 2013. Studies were eligible for inclusion only if they compared indicators of ovarian responsiveness during ART in the cycles before and after an injection of MTX for EP. The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the basal serum FSH level, duration of stimulation, total gonadotrophin dose and serum E2 level on the day of hCG triggering. The mean number of oocytes retrieved during the cycles before and after the MTX treatment did not differ significantly (P = 0.4). The comparisons before and after MTX treatment of the basal plasma FSH level, the duration of stimulation, the total gonadotrophin dose used for stimulation and the estradiol level on the day ovulation was triggered did not find any significant differences. The literature on this topic is sparse, with few studies and even fewer of high methodological quality. These results indicate that MTX to treat EP in infertile patients does not have any negative effect on their subsequent fertility treatment, but further studies should be performed before this result can be considered definitive. This work received support from the Department of Gynecology and Obstetrics, La Conception Hospital, Marseille, France. The authors have no competing interests to declare. N/A.

Prognostic models for high and low ovarian responses in controlled ovarian stimulation using a GnRH antagonist protocol.

STUDY QUESTIONCan predictors of low and high ovarian responses be identified in patients undergoing controlled ovarian stimulation (COS) in a GnRH antagonist protocol?SUMMARY ANSWERCommon prognostic factors for high and low ovarian responses were female age, antral follicle count (AFC) and basal serum FSH and LH.WHAT IS KNOWN ALREADYPredictors of ovarian response have been identified in GnRH agonist protocols. With the introduction of GnRH antagonists to prevent premature LH rises during COS, and the gradual shift in use of long GnRH agonist to short GnRH antagonist protocols, there is a need for data on the predictability of ovarian response in GnRH antagonist cycles.STUDY DESIGN, SIZE, DURATIONA retrospective analysis of data from the Engage trial and validation with the Xpect trial. Prognostic models were constructed for high (>18 oocytes retrieved) and low (<6 oocytes retrieved) ovarian response. Model building was based on the recombinant FSH (rFSH) arm (n = 747) of the Engage trial. Multivariable logistic regression models were constructed in a stepwise fashion (P < 0.15 for entry). Validation based on calibration was performed in patients with equivalent treatment (n = 199) in the Xpect trial.PARTICIPANTS/MATERIALS, SETTING, METHODSInfertile women with an indication for COS prior to IVF. The Engage and Xpect trials included patients of similar ethnic origins from North America and Europe who had regular menstrual cycles. The main causes of infertility were male factor, tubal factor and endometriosis.MAIN RESULTS AND THE ROLE OF CHANCEIn the Engage trial, 18.3% of patients had a high and 12.7% had a low ovarian response. Age, AFC, serum FSH and serum LH at stimulation Day 1 were prognostic for both high and low ovarian responses. Higher AFC and LH were associated with an increased chance of high ovarian response. Older age and higher FSH correlated with an increased chance of low ovarian response. Region (North America/Europe) and BMI were prognostic for high ovarian response, and serum estradiol at stimulation Day 1 was associated with low ovarian response. The area under the receiver operating characteristic (ROC) curve (AUC) for the model for a high ovarian response was 0.82. Sensitivity and specificity were 0.82 and 0.73; positive and negative predictive values were 0.40 and 0.95, respectively. The AUC for the model for a low ovarian response was 0.80. Sensitivity and specificity were 0.77 and 0.73, respectively; positive and negative predictive values were 0.29 and 0.96, respectively. In Xpect, 19.1% of patients were high ovarian responders and 16.1% were low ovarian responders. The slope of the calibration line was 0.81 and 1.35 for high and low ovarian responses, respectively, both not statistically different from 1.0. In summary, common prognostic factors for high and low ovarian responses were female age, AFC and basal serum FSH and LH. Simple multivariable models are presented that are able to predict both a too low or too high ovarian response in patients treated with a GnRH antagonist protocol and daily rFSH.LIMITATIONS, REASONS FOR CAUTIONAnti-Müllerian hormone was not included in the prediction modelling.WIDER IMPLICATIONS OF THE FINDINGSThe findings will help with the identification of patients at risk of a too high or too low ovarian response and individualization of COS treatment.STUDY FUNDING/COMPETING INTERESTSFinancial support for this study and the editorial work was provided by Merck, Sharp & Dohme Corp. (MSD), a subsidiary of Merck & Co. Inc., Whitehouse Station, NJ, USA. F.J.B. received a grant from CVZ to his institution; P.J.M.V. and H.W. are employees of MSD, and B.M.J.L.M. was an employee of MSD at the time of development of this manuscript.TRIAL REGISTRATION NUMBERSNCT 00696800 and NCT00778999.

Achieving pregnancy in the previous fresh embryo transfer cycle is the most important variable affecting success of the following frozen-thawed embryo transfer (ET) cycle

Clinical parameters for predicting results in an IVF programme are: female age, ovarian reserve, infertility diagnosis, and embryo quality. The aim of this study is to asses if achieving pregnancy in a previous fresh ET impacts on the success rate of the following thawed ET cycle. Retrospective descriptive. One hundred and sixteen thawed-ET cycles performed between January 2012 and December 2012 were retrospectively evaluated. All patients had had a previous fresh ET, from which good quality surplus embryos had been cryopreserved. Some patients (Group A) had achieved clinical pregnancy in the fresh ET while others (Group B) did not. At the time of the fresh ET the patients were 21 to 39 years, basal FSH level ≤ 12 mIU/ml, and had at least 2 good quality embryos frozen after transferring two good quality embryos (≥8 equal sized blastomeres on day 3, ≤ 10% fragmentation). Both groups were comparable in terms of age, basal serum FSH, total gonadotropin dose, number of oocytes retrieved, fertilization rate, number and quality of both fresh (first ET) as well as frozen-thawed embryos. Group A patients had a 87.8% clinical pregnancy rate (CPR) vs. Group B who had a 20% CPR (p<0.5). Implantation rate (IR) was significantly higher in Group A vs. Group B: 38.8% vs. 31.7% respectively. Pregnancy loss and multiple pregnancy rates were comparable between groups. Patients with a previous pregnancy or miscarriage in a first fresh embryo cycle, doubles or triples the pregnancy rate of the next frozen embryo transfer when compared to those patients who did not get pregnant in the fresh cycle. Our data shows a surprisingly high chance of achieving pregnancy in this group of patients. This is an important factor to be considered when counseling our patients regarding the number of embryos to be transferred.

Co relation of ovarian reserve parameters with response to clomiphene citrate

To correlate the ovarian reserve parameters like basal serum FSH, serum estradiol and antral follicle count, taken on day 3 of the cycle of response to clomiphene citrate induced cycle in infertile patients.

Optimal leading follicle size of hCG administration in modified natural-cycle IVF protocol of poor responder patient having retardation of follicle growth in later follicular phase

We examined what the optimal time and leading follicle size at the day of hCG administration for poor responder patients having retardation of follicle growth in later follicular phase may improve clinical outcomes by a modified natural cycle IVF protocols. A prospective clinical study. We evaluated total 52 cycles of 39 poor responder patients who were treated with modified natural cycle IVF protocol during 2009∼2012. All patients were increased serum basal FSH level (range 10∼23) and had at least twice IVF failure (range 2-5), developing in previous stimulated cycles < 4 follicles. It was monitored by measuring the follicle growth by TVS on day 7 of the cycle, and HP-hMG (Menopur) 150 IU and GnRH antagonist (0.25 mg/day) were administrated concomitantly from a diameter of leading follicle reached 12∼13 mm until the day of hCG trigger. We underwent the retardation of follicular growth on 14∼16 mm diameter (the same size on the next day, no growth). For this growth-retarded group (Group I), we were administrated r-hCG 250 μ the day (Group I, n=27). For another group (Group II) as no retardation of follicle growth, we triggered hCG until at least 1 follicles reached a mean diameter of 18 mm (Group II, n=35). No significant difference was observed in the percentage of metaphase I and II of retrieved oocyte (84.0% vs., 86.9%), fertilization rate (83.3% vs. 78.9%), cleavage rate (76.1% vs. 71.6%) and clinical pregnancy rate (25.9% vs. 22.8%). However, oocyte retrieval rate (74.0% vs. 62.8%, p<0.05) was significantly higher in Group I. Clinical pregnancy rate of follicle growth-retarded patients is not differed compared to that of patients having normal follicle growth. The follicle size is not important factor for pregnancy rate in the case of follicle retardation, and thus hCG administration should not be delayed for the poor responder patients having follicle growth retardation on late follicular phase.

A Modified Technique of Laparoscopic Ovarian Drilling for Polycystic Ovary Syndrome Using Harmonic Scalpel

Objective: To review our experience with a modified technique of laparoscopic ovarian drilling (LOD) using harmonic scalpel as a new energy modality and to compare its effect with electrocautery in managing Clomiphene resistant polycystic ovary syndrome as regard to ovulation rate, pregnancy rate, hormonal profile and ultrasonographic changes that reflect ovarian reserve and reproductive outcome. Patients and methods: Sixty patients presented by infertility due to PCOS were randomly allocated into two equal groups. Group I was subjected to laparoscopic ovarian drilling using electrocautery and Group II were subjected to laparoscopic ovarian drilling using harmonic scalpel. All patients were assessed twice (before the induction procedure and three months later, if pregnancy did not occur). Patients were assessed clinically (to determine menstrual regularity and body mass index), sonographically (to measure ovarian volume and antral follicle count at time of ovarian quiescence) and laboratory (to measure basal serum LH, FSH, LH/FSH ratio, total testosterone and estradiol). Also a 2nd look laparoscopy was performed in those patients who failed to conceive within six months of the initial laparoscopic procedure to assess the presence of adhesion and its type. Results: Laparoscopic ovarian drilling using harmonic scalpel improved menstrual pattern, ovulation rate, pregnancy rate, hormonal profile similar to electrocautery without a significant difference. However it was associated significantly with a minimal effect on ovarian volume, antral follicle count and post operative adhesion. Conclusions: We consider our LOD technique using harmonic scalpel as a new energy modality in managing Clomiphene resistant polycystic ovary syndrome practicable with less extensive destruction of the ovarian capsule and thereby of the ovarian reserve and with minimal incidence of post operative adhesion.

Serum anti-Müllerian hormone and basal serum FSH as predictors of poor ovarian response in assisted conception cycles

The aim of the study was to correlate serum AMH and serum FSH levels with ovarian response to stimulation in IVF–ICSI cycles. This was a prospective observational study conducted in a private assisted conception unit. One hundred and two patients were selected on their first IVF cycle. Basal serum FSH and serum AMH were measured one month before the stimulation cycle. A fixed dose GnRH antagonist protocol was used in all cycles transferring a maximum of three day-3 cleavage stage embryos. We defined poor ovarian response as retrieval of fewer than four mature oocytes in cycles requiring ⩾ 3000 IU of gonadotropins for stimulation or cycle cancellation due to poor response. The correlation between different parameters was expressed as a Spearman’s correlation coefficient. The clinical value of AMH and FSH as predictors of poor ovarian response as well as predictors of pregnancy was evaluated by constructing relevant receiver operator characteristics curves (ROC curves). Of these 102 cycles, 28 fitted our definition of poor response while the remaining 74 cycles all produced an adequate response to stimulation. There was a statistically significant difference between the adequate responders group and poor responders group regarding their mean age (31.5 versus 39.6, p < 0.001), the mean value of AMH (2.84 ng/ml versus 0.9 ng/ml, p < 0.0001) as well as the mean value of basal FSH (7.6 IU/ml versus 9.7 IU/ml, p < 0.0001). Serum AMH level had a positive correlation while serum FSH had a negative correlation with the number of oocytes collected while only serum AMH had a significant positive correlation with the occurrence of pregnancy. ROC curve analysis of our results showed that serum AMH with an optimal cut-off value of 1.2 ng/ml is a reliable predictor of poor ovarian response with an area under the ROC curve of 90.4%. Serum basal FSH with an optimal cut-off value of 8.9 IU/ml was of lower value than AMH as a predictor of poor ovarian response with an area under the ROC curve of 81.9%. However, neither serum AMH nor basal serum FSH was found to able to reliably predict the occurrence of pregnancy with an area under the ROC curve of 59.4% and 58.6% respectively. Our results show that serum AMH level is more reliable than basal serum FSH as a predictor of poor ovarian response to stimulation with a cut-off value of 1.2 ng/ml shown to predict poor ovarian response with a sensitivity of 91.7%.

Anti-Müllerian Hormone Serum Values and Ovarian Reserve: Can It Predict a Decrease in Fertility after Ovarian Stimulation by ART Cycles?

BackgroundA variety of indicators of potentially successful ovarian stimulation cycles are available, including biomarkers such as anti-Mullerian hormone. The aim of our study was to confirm the usefulness of serum anti-Mullerian hormone assay in predicting ovarian response and reproductive outcome in women eligible for ART cycles.MaterialsForty-six women undergoing ART cycles at the Centre for Reproductive Medicine in Parma were recruited from March-to-June 2010. Inclusion criteria: age<42 years; body-mass-index = 20–25; regular menstrual cycles; basal serum FSH concentration <12 IU/L and basal serum estradiol concentration <70 pg/mL. The couples included in our study reported a variety of primary infertility causes. All women underwent FSH stimulation and pituitary suppression (GnRH-agonist/GnRH-antagonist protocols). Women were considered poor-responders if thay had ≤3 oocytes; normal-responders 4–9 oocytes and high-responders ≥10 oocytes. Serum samples for the AMH assays were obtained on the first and last days of stimulation. A P value ≤0.05 was considered statistically significant.ResultFSH levels increased significantly when AMH levels decreased. The total dose of r-FSH administered to induce ovulation was not correlated to AMH. The number of follicles on the hCG, serum estradiol levels on the hCG-day, and the number of retrieved oocytes were significantly correlated to AMH. The number of fertilized oocytes was significantly correlated to the AMH levels. No significant correlation was found between obtained embryos or transferred embryos and AMH. Basal serum AMH levels were significantly higher than those measured on the hCG-day, which appeared significantly reduced. There was a significant correlation between AMH in normal responders and AMH in both high and poor responders.ConclusionsOur data confirm the clinical usefulness of AMH in ART-cycles to customize treatment protocols and suggest the necessity of verifying an eventual permanent decrease in AMH levels after IVF.

Changes of endocrine and ultrasound markers as ovarian aging in modifying the Stages of Reproductive Aging Workshop (STRAW) staging system with subclassification of mid reproductive age stage

Objective: To demonstrate the changes of ovarian aging markers across the Stages of Reproductive Aging Workshop (STRAW) stages and modify it with subclassification of mid reproductive age stage (MR). Design: Healthy females were classified according to the STRAW system. Serum basal FSH, LH, E2, and anti-Müllerian hormone (AMH) were detected, FSH/LH ratio calculated, and antral follicle counts (AFCs) determined in follicular phase. Results: Progression through the whole STRAW stages under MR stage subdivided is associated with elevations in FSH, LH, FSH/LH ratio and decreases in E2, AMH and AFCs (p < 0.001). Both serum AMH and AFCs decreased early (after 25 years) and significantly (p < 0.01) with chronological age in MR stage. 0.982 ng/ml AMH and 3 antral follicles (low level of MR 25–30 years) were set as cutoffs to distinguish MR stage into early mid reproductive age (EMR) and late mid reproductive age (LMR) stages. The women in EMR stage compared with LMR could retrieve more oocytes in IVF treatment (p < 0.05) and has a higher pregnancy chance (57.9%) though not significant. Conclusion(s): The early and marked fall in serum AMH levels and AFCs suggest fine markers to further categorize and define the MR stage, demonstrating disparate reproductive aging period with reduced ovarian reserve in young age across the STRAW stages.

Examining the relationship between ovarian reserve, as measured by basal FSH levels, and the risk of poor obstetric outcome in singleton IVF gestations

The higher prevalence of preterm birth (PTB) and low birthweight (LBW) following infertility treatment may relate to the treatment itself or indicate that subfertility predisposes to a higher risk. Our aim was to examine whether basal FSH levels are related to the risk for PTB and LBW among pregnancies resulting from IVF. We studied a retrospective cohort in the 2008 National Society for Assisted Reproductive Technology Database, including all women who underwent a fresh non-donor IVF cycle resulting in a singleton live birth having a recorded basal serum FSH value (n = 14 262). The FSH value used was either the maximum basal or clomiphene-stimulated serum level. Log binomial models were created to assess the associations between FSH and PTB (<37 weeks), and between FSH and LBW (<2500 g), adjusting for maternal age, ethnicity, gravidity/parity, history of PTB, smoking, BMI and infant gender. Data for 14 086 patients were analyzed. FSH levels were inversely related to the risk of PTB and LBW. Women in the highest quartile of FSH levels (≥ 9 mIU/ml) had the longest adjusted mean gestational age (271.2 days), the lowest adjusted relative risk (RR) of PTB [0.87, 95% confidence interval (CI): 0.76-1.01], the highest adjusted mean birthweight (3249 g) and the lowest adjusted RR of LBW (0.89, 95% CI: 0.73-1.04). The inverse relationship between maximal basal FSH levels and the risk for PTB and LBW in singleton IVF gestations suggests that diminished ovarian reserve is not the primary mediator of the increased prevalence of PTB and LBW in IVF pregnancies.

Diminished ovarian reserve is not independently associated with clinical reproductive loss in pregnancies achieved by assisted reproductive technologies (ART)

ObjectivePrior studies have suggested that women with diminished ovarian reserve (DOR) are at higher risk for reproductive loss, independent of age. These studies, however, did not distinguish very early losses from losses after clinical detection of an intrauterine pregnancy (IUP). Here we examined the rate of reproductive loss after sonographic identification of an IUP in a cohort of women with DOR compared to women with normal ovarian reserve undergoing ART.DesignRetrospective cohort.Materials and MethodsThe study cohort consisted of all fresh autologous ART cycles that resulted in a first singleton clinical IUP (sonographic identification of a single gestational sac at approximately 6-7 weeks gestational age) from Jan-Dec 2009 at a single fertility practice, verified by chart review. DOR was defined by basal serum FSH ≥14 IU/L. Patients were excluded if no FSH level was measured within one year of the cycle analyzed or if the patient had only one ovary. Patients were grouped by FSH <8, 8-13.9, or ≥14 IU/L.ResultsTabled 1FSH (IU/L)<88-13.9≥14# OF SUBJECTS60522125AGE (YEARS)33.535.035.6CLINICAL PREGNANCY LOSS24.3%28%28.% Open table in a new tab ConclusionAfter adjusting for age, there was no relationship between basal serum FSH concentration and pregnancy loss greater than 6-7 weeks gestational age in women achieving IUP through ART. The higher pregnancy loss rates previously reported in women with DOR may be due to loss prior to 6-7 weeks gestational age. ObjectivePrior studies have suggested that women with diminished ovarian reserve (DOR) are at higher risk for reproductive loss, independent of age. These studies, however, did not distinguish very early losses from losses after clinical detection of an intrauterine pregnancy (IUP). Here we examined the rate of reproductive loss after sonographic identification of an IUP in a cohort of women with DOR compared to women with normal ovarian reserve undergoing ART. Prior studies have suggested that women with diminished ovarian reserve (DOR) are at higher risk for reproductive loss, independent of age. These studies, however, did not distinguish very early losses from losses after clinical detection of an intrauterine pregnancy (IUP). Here we examined the rate of reproductive loss after sonographic identification of an IUP in a cohort of women with DOR compared to women with normal ovarian reserve undergoing ART. DesignRetrospective cohort. Retrospective cohort. Materials and MethodsThe study cohort consisted of all fresh autologous ART cycles that resulted in a first singleton clinical IUP (sonographic identification of a single gestational sac at approximately 6-7 weeks gestational age) from Jan-Dec 2009 at a single fertility practice, verified by chart review. DOR was defined by basal serum FSH ≥14 IU/L. Patients were excluded if no FSH level was measured within one year of the cycle analyzed or if the patient had only one ovary. Patients were grouped by FSH <8, 8-13.9, or ≥14 IU/L. The study cohort consisted of all fresh autologous ART cycles that resulted in a first singleton clinical IUP (sonographic identification of a single gestational sac at approximately 6-7 weeks gestational age) from Jan-Dec 2009 at a single fertility practice, verified by chart review. DOR was defined by basal serum FSH ≥14 IU/L. Patients were excluded if no FSH level was measured within one year of the cycle analyzed or if the patient had only one ovary. Patients were grouped by FSH <8, 8-13.9, or ≥14 IU/L. ResultsTabled 1FSH (IU/L)<88-13.9≥14# OF SUBJECTS60522125AGE (YEARS)33.535.035.6CLINICAL PREGNANCY LOSS24.3%28%28.% Open table in a new tab ConclusionAfter adjusting for age, there was no relationship between basal serum FSH concentration and pregnancy loss greater than 6-7 weeks gestational age in women achieving IUP through ART. The higher pregnancy loss rates previously reported in women with DOR may be due to loss prior to 6-7 weeks gestational age. After adjusting for age, there was no relationship between basal serum FSH concentration and pregnancy loss greater than 6-7 weeks gestational age in women achieving IUP through ART. The higher pregnancy loss rates previously reported in women with DOR may be due to loss prior to 6-7 weeks gestational age.

Basal serum testosterone predict ovarian response and in vitro fertilization outcome in women with diminished ovarian reserve

Diminished ovarian reserve predicts disappointing pregnancy chances. Little data have concerned predictor for in vitro fertilization (IVF) outcome in women with diminished ovarian reserve. To investigate the association of basal testosterone (T) levels with ovarian response and in vitro fertilization (IVF) outcome in women with diminished ovarian reserve. Retrospective cohort study. We reviewed data of patients underwent their first IVF cycle, without polycystic ovary syndrome (PCOS) or endometriosis, from 2009-2010. Diminished ovarian reserve was defined as basal FSH value >10IU/L or FSH:LH ratio >3. The association of basal FSH, LH, E2, T levels with ovarian response and IVF outcome were analyzed with SPSS statistical package. We reviewed 1598 IVF cycles. Complete clinical data of 223 women with diminished ovarian reserve were analyzed. The mean age of patients was 34.51 ± 5.12 years old. Antral follicle count (AFC) was 6.59 ± 3.66. Levels of basal serum FSH, LH, E2 and T were10.55 ± 3.90IU/L, 3.57 ± 1.88 IU/L, 0.15 ± 0.10 nmol/L and 1.37 ± 0.61 nmol/L. The average total dose of gonadotropins was 2666.13 ± 960.33IU. The numbers of large follicles (>14 mm) on HCG day, oocyte retrieved and high-quality embryo were 6.20 ± 2.94, 7.76 ± 3.97 and 1.34 ± 1.37. Endometrial thickness on hCG day was 1.02 ± 0.25cm. The pregnancy rate was 29.60%. Basal T was correlated with the numbers of large follicles on HCG day (r = 0.132, P=0.049), numbers of oocyte retrieved (r = 0.144, P=0.031), two pronuclei (r = 0.137, P=0.041). On the other hand, significantly negative correlations were observed between basal T and basal FSH (r = -0.16,P=0.017), total dose of gonadotropins (r = -0.154, P=0.02). A testosterone level of 1.12nmol/L was shown to predict pregnancy outcome with a sensitivity of 83.3% and specificity of 42.3%, P=0.039. In women with diminished ovarian reserve, basal T was a predictor for ovarian response and IVF outcome.

Controlled ovarian hyperstimulation for low responders in in vitro fertilization/intracytoplasmic sperm injection: a low-dose flare protocol

In this retrospective study of 652 anticipated low response women, the overall clinical outcomes (live birth rate and clinical pregnancy rate [PR]) of low-dose flare (LDF) protocol appeared lower than those of conventional down-regulation (DR) (LDF: 15.1% vs. DR: 20.6% and LDF: 10.3% vs. DR: 17.4%, respectively). The findings that LDF protocol improved the clinical outcome in older women, or when LDF followed an unsuccessful IVF/intracytoplasmic sperm injection (ICSI) cycle with DR (LDF: 19.4% vs. DR: 9.76% and LDF: 13.9% vs. DR: 4.2% respectively), need further evaluation through randomized trials.

IVF treatment should not be postponed for patients with high basal FSH concentrations

This study determined the influence of inter-cycle variation of basal FSH concentrations on IVF treatment results, in patients with a history of high basal FSH. Patients underwent at least two IVF cycles, one with basal serum FSH ⩾10IU/l and the other at least 3IU/l lower (interval between cycles being <1year when the second cycle had the elevated FSH). A subanalysis was performed in patients with exceptionally large differences in values (⩾16IU/l and ⩽12IU/l). IVF outcomes were compared according to basal FSH concentrations in two consecutive cycles. Seventy-six patients met the inclusion criteria. Mean basal serum FSH were 15.0±3.6IU/l in the 'high FSH' group (range 12-24IU/l) and 9.0±3.0IU/l in the 'low FSH' group (range 5-14IU/l). Patient age, oestradiol at HCG administration, number of collected oocytes, fertilization and clinical pregnancy rates were similar for all cycles compared. Analysis of the subgroup with exceptionally large differences of basal FSH concentration yielded similar results. Neither high nor low basal serum FSH values were associated with IVF outcome in patients with reduced ovarian reserve and previously determined high basal FSH concentrations. Ovarian stimulation need not be delayed until FSH declines.

A nonspecific disturbance of the gonadostat in women with transsexualism and isolated hypergonadotropism in the male-to-female disturbance of gender identity.

Principal parameters of gonadostat function were determined in 15 female-to-male (F-M) and 7 male-to-female (M-F) transsexual patients (T), all homosexuals. The data were compared with normal heterosexual controls of the respective sex. Anamnesis revealed prolongation of the menstrual cycles in F-M patients, mainly in those taking previously medication with depot-testosterone. However, also in patients with no previous medication the basal body temperature chart revealed anovulatory cycles (all 4 examined patients). In 8 of 9 patients (82.2%) with no previous medication an elevation of serum testosterone was found (63-600 ng/dl). No disturbances in gonadal functions were found in M-F group (semen analysis), serum testosterone was normal (328-710 ng/dl) except 1 case with reduced testosterone level (200 ng/ml). Both women and men with transsexualism revealed significantly higher mean basal serum concentration of LH in comparisons to controls (F-M: 23.14 +/- 16.16 vs 7.56 +/- 4.23; M-F 15.30 +/- 6.49 vs 5.75 +/- 3.66). No changes in basal serum FSH concentration were present. GnRH test (100 micrograms i.v.) revealed decreased evocability of LH in woman with T and exaggerated LH response in men with T. FSH hyperresponse to GnRH was nonsignificant in F-M and significant in M-F T. It is concluded that F-M transsexualism is associated with nonspecific disturbances of gonadostat since hypergonadotropism coexists with the signs of impaired gonadal function. In M-F T and isolated hypergonadotropism coexisted with specific, increased sensitivity of the pituitary to GnRH.

Effects of serotonin antagonists in sexually impotent men.

Thirty-one men affected with sexual impotence were studied. Since sexual function in the male seems to be controlled by both dopaminergic stimulatory and serotoninergic inhibitory mechanisms, the patients were treated with serotonin antagonists. In basal conditions mean serum LH, FSH, PRL and testosterone did not significantly differ from those found in normal subjects; no significant variations, except for PRL reduction, were observed after treatment. Both methysergide, in association with bromocriptine or mesterolone, and metergoline, either alone or in association with mesterolone, were ineffective in significantly improving sexual activity.

The correlation between basal serum follicle-stimulating hormone levels before embryo cryopreservation and the clinical outcome of frozen embryo transfers

To evaluate the correlation between basal serum FSH level before the fresh IVF/intracytoplasmic sperm injection (ICSI) cycle and the clinical outcome of the subsequent frozen embryo replacement cycles. Retrospective observational study. University tertiary referral center, London, United Kingdom. Five hundred four consecutive frozen embryo transfer (FET) cycles where serum FSH levels were obtained, on days 1-4 of the cycle before the fresh IVF +/- ICSI cycles. Frozen-thawed embryo transfer. Clinical pregnancy (CP) and live birth (LB). Basal serum FSH in 127 women (25.2%) who had a CP was significantly lower compared with that in women who did not have a CP. Multivariate regression analysis showed significant correlation between basal serum FSH levels and clinical pregnancy and a low significance to LB, but there was no statistical significant differences between women who had a CP and those who did not with regard to age, treatment protocol (natural or hormone treatment cycle), or the freeze-thaw interval. The LB rate was higher in natural cycles (n = 71; 21.2%) than in hormone treatment cycles (n = 28; 16.7%). Conceiving in the fresh cycle had a positive influence on the FET outcome. Basal serum FSH level before fresh IVF/ICSI cycle is inversely correlated to a CP outcome in FET cycles. A trend was present between FSH levels and LB, but this failed to reach statistical significance.

Significance of endometrial thickness to evaluate endometrial receptivity for embryos in natural cycle

OBJECTIVE: To confirm endometrial receptivity by evaluating the relationship between endometrial thickness on the day of human chorionic gonadotropin (hCG) administration and clinical outcome in natural cycle frozen embryo transfer (FET) without artificial endometrial preparation. DESIGN: Retrospective study. MATERIALS AND METHODS: 181 cycles from 150 patients who underwent single FET at our clinic between January 2005 and January 2008 were studied. Rapid freezing protocol (Vitrification) was performed on all embryos and those were rapidly thawed, and a single good quality blastocyst-stage embryo with grade greater than 3 without assisted hatching technique was transferred in a natural cycle. Endometrial thickness was measured by transvaginal ultrasound on the day of hCG administration. The cycles were divided into 5 groups of A (<8mm, n=25), B (8-9mm, n=64), C (10-11mm, n=55), D (12-13mm, n=28) and E (≥14mm, n=9) according to endometrial thickness, and clinical pregnancy and miscarriage rates were compared between the groups. RESULTS: There were no significant differences between the groups in age, basal serum FSH level, endometrial echo pattern (triple-line or not triple-line) and rates of luteal phase supports. Endometrial thickness on the day of hCG administration ranged from 5.8mm to 17.9mm. The clinical pregnancy rates among the 5groups were A-24.0% (6/25), B-35.9% (23/64), C-41.8% (23/55), D-57.1% (16/28) and E-33.3% (3/9), respectively. The miscarriage rates were A-0% (0/6), B-8.7% (2/23), C-13.0% (3/23), D-18.8% (3/16) and E-0.0% (0/3), respectively. The clinical pregnancy rates increased as the endometrium thickened (<14mm) and significantly higher rates were achieved in groups C and D compared with those in group A (p<0.05). There were no statistically significant differences in the miscarriage rates between the groups. CONCLUSIONS: Endometrial thickness is an important indicator to evaluate endometrial receptivity for an embryo. The clinical pregnancy rates increase gradually in proportion to endometrial thickness in natural cycle FET. The miscarriage rates do not appear to be related to endometrial thickness. However, this study is not able to establish a threshold of endometrial thickness indicative of unlikely pregnancies in natural cycle.

Basal follicle-stimulating hormone as a predictor of fetal aneuploidy

To determine whether an elevated basal FSH concentration is an independent predictor of fetal aneuploidy, as measured in spontaneous abortions (SAB). Retrospective study. Academic reproductive endocrinology and infertility center. All women with karyotypes of chorionic villi isolated from first trimester spontaneous miscarriages at the time of dilation and curettage from 1999 to 2006. The highest basal serum FSH level in the year preceding dilation and curettage was recorded. Monitoring of early pregnancy. Fetal karyotype. A total of 177 spontaneous miscarriages with karyotypes (70 euploid and 107 aneuploid) were identified, of which 53% were conceived by IVF. The aneuploid cohort consisted of trisomic (87%), teraploid (9.3%), and monosomic (3.7%) gestations. Using logistic regression analysis, basal FSH was not found to be independently predictive of an aneuploid gestation in our data set. Our data do not support the hypothesis that an elevated basal FSH concentration is associated with an increase in fetal aneuploidy. Our findings suggest that the association between diminished ovarian reserve and SAB may result from nonkaryotypic factors.