Follicular Phase FSH Research Articles

SAT-LB3 Developing an Integrative Medicine Patient Care Protocol for Natural Fertility in Primary Infertile Couples: A Case Series

Background:Although advances in the field of Assisted Reproduction have improved significantly the reproductive outcome for infertile couples, success rates nonetheless remain low. Furthermore, several infertile couples are skeptical of using experimental or even established ART treatments, resulting in the need for reproductive health professionals to discuss other models which might best benefit patients who need fertility care.Clinical case series:All patients that were referred to our clinic for primary infertility (no positive pregnancy test after at least 2 years of unprotected intercourse) and had been either offered to proceed with IVF or had already a history of at least 1 failed IVF cycle, in the course of 1 year (March 2018-February 2019) were included in this study. All patients were younger than 42 years of age, AMH less than 1 ng/mL, FSH less than 12 IU/L (follicular phase FSH normal range 2.8-9.3 IU/L) and normal ovulation was present. Couples were counseled regarding a novel integrative model of achieving spontaneous pregnancy through expectant management while modifying key parameters affecting female fertility, developed after evidence-based appraisal of all relative literature. All 14 patients were examined for insulin resistance, subclinical thyroid disease, thrombophilia, and chronic endometritis and were offered the appropriate treatment, aiming for optimal (as opposed to within normal range) figures. For chronic endometritis both spouses received a one-month long triple antibiotic treatment. All patients were given careful personalized nutritional and vitamin supplementation guidelines. Regarding the psychological component of fertility all patients underwent monthly homeopathy and/or weekly acupuncture courses. All patients were designed to be followed-up for 6 months after completion of treatment (9 months after antibiotic treatment). 3 patients dropped out before receiving full treatment (rate 21%). 2 patients did not have a positive pregnancy test. All 9 remaining patients came back with a positive pregnancy test (rate 81% of those who completed treatment) on the first month of follow-up that resulted in an uncomplicated pregnancy and delivery of healthy singleton babies. Conclusion:This is the first case series indicating that expectant management could be the answer to some cases of infertility. Poor responders are sometimes reluctant to be involved in the global trend of IVF and ART, therefore a more holistic integrative approach might balance the imbalances and increase their fecundity. However, no causal inferences should be made from this consecutive case series regarding the efficacy of the investigated treatment.

Association between diminished ovarian reserve and luteal phase deficiency

To determine the association between biomarkers of ovarian reserve and luteal phase deficiency (LPD). Secondary analysis of a prospective time-to-conceive cohort study. Not applicable. Women attempting conception, aged 30-44years, without known infertility. Measurement of early follicular phase serum levels of antimüllerian hormone, FSH, inhibin B, and E2. The primary outcome was LPD, defined by luteal bleeding (LB) (≥1day of LB) or a short luteal phase length (≤11days). Overall, 755 women provided information on 2,171 menstrual cycles and serum for measurement of at least one biomarker of ovarian reserve. There were 2,096 cycles from 754 women in the LB cohort, of which 40% experienced LB. After adjusting for age, race, previous miscarriages, and previous pregnancies, diminished ovarian reserve (DOR) was not significantly associated with LB. Low early follicular phase FSH levels increased the odds of LB (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.25-2.71), as did high early follicular phase E2 levels (OR 1.59; 95% CI 1.26-2.01). A total of 608 cycles from 286 women were included in the analysis of luteal phase length, of which 13% had a short luteal phase. After adjusting for age, there was no significant association between DOR and a short luteal phase. The risk of a short luteal phase decreased with increasing inhibin B (OR 0.61; 95% CI 0.45-0.81). Although DOR is not associated with LPD, hormone dysfunction in the early follicular phase may contribute to LPD in women of older reproductive age.

Cycle-phase dependent associations between CRP, leptin, and reproductive hormones in an urban, Canadian sample.

To assess the relationships among reproductive hormones, follicular development, inflammation, and adiposity in a sample of urban, Canadian women. Participants (n = 41) had blood collected every 3 days through one interovulatory interval (IOI) to measure estradiol, progesterone, LH, FSH, leptin, and C-reactive protein (CRP). Participants underwent daily transvaginal ultrasound examinations during the IOI to quantify all follicles > 2 mm. CRP and leptin tertiles were used to compare conditions of high and low inflammatory processes and adiposity, respectively. Luteal phase estradiol, luteal phase LH, and follicular phase progesterone were lower among individuals in the highest CRP tertile (adjusted r(2) = 0.63, 0.70, 0.76, respectively). Luteal and follicular phase follicle diameter was greatest in the high CRP tertile (adjusted r(2) = 0.68, 0.71). Follicular phase progesterone was lowest among individuals in the highest leptin tertile, and follicular phase FSH was lowest among individuals in the lowest leptin tertile (adjusted r(2) = 0.54, 0.45). Luteal phase follicle diameter was highest among those in the moderate leptin tertile (adjusted r(2) = 0.49). This study is a first comprehensive assessment of the relationship between multiple ovarian function components and inflammatory biomarkers. The results are interpreted to mean that inflammatory and energetic stressors produce differential effects depending on population, adiposity, and cycle phase. Am J Phys Anthropol 160:389-396, 2016. © 2016 Wiley Periodicals, Inc.

Genetic variants associated with female reproductive ageing – potential markers for assessing ovarian function and ovarian stimulation outcome

This study searched for genetic markers of ovarian function, ovarian stimulation and IVF treatment outcome among genetic variants related to female reproductive ageing. It included 471 treatment cycles from 306 women undergoing IVF treatment. Genotypes for 36 single nucleotide polymorphisms (SNPs) were evaluated for their association with early follicular phase parameters together with ovarian stimulation and IVF outcome parameters. Results show that genetic variation related to menopause timing also affects ovarian function, as several selected genetic markers were associated with studied traits. For example, rs2153157 (SYCP2L) was associated with amount of recombinant FSH (rFSH) necessary for obtaining one oocyte (P = 0.049) and the chances of biochemical and clinical pregnancy (P = 0.024 and P = 0.011, respectively), while rs4886238 (TDRD3) showed association with both the number of punctured ovarian follicles and oocytes obtained (P = 0.008 and P = 0.037, respectively). Furthermore, FSHB polymorphisms influence early follicular phase FSH concentrations and IVF treatment outcome, whereas SNPs in FSHR affect early antral follicle count and follicle numbers obtained during ovarian stimulation. This study suggests that genetic markers of female reproductive ageing are potential new biomarker candidates that could be considered in clinical ovarian reserve and function assessment in assisted conception.

The combination of genetic variants of the FSHB and FSHR genes affects serum FSH in women of reproductive age

What is the effect of FSHB-211G>T together with the FSHR 2039 A>G on serum FSH in women? Serum FSH levels are affected by the combination of genetic polymorphisms in FSHR and FSHB. The relationship between SNPs of the FSHR gene and serum FSH has not been completely clarified. Genetic variants of the FSHB gene have been associated with variation in gene transcription and serum FSH levels in men. No data have been published on the effect of the FSHB-211G>T in women, alone or in combination with the FSHR 2039 A>G. This study was a prospective study including 193 healthy women of reproductive age. Infertile and otherwise healthy eumenorrheic women (n = 193) with normal BMI and serum FSH levels were recruited for the study. In all women early follicular phase FSH and AMH were measured by commercial assays, and antral follicle count was measured by transvaginal ultrasound. Genomic DNA was purified from total peripheral blood and genotyping for the two SNPs was performed. No significant gradients of increasing or decreasing Day 3 FSH across the FSHR 2039 (AA/AG/GG) and FSHB-211 (GG/GT/TT) genotypes, respectively, were observed. When women were stratified according to the FSHR 2039, and FSHB-211 genotypes a statistically significant reduction of d3 FSH was shown in the group of women with the FSHB-211 GT + TT/FSHR2039 AA genotype compared with the FSHB-211 GG/FSHR2039 GG genotype, hence confirming a possible additive effect of the different SNPs in FSHR and FSHB on regulating serum FSH. This finding requires an independent confirmation. However, it confirms the relationship between serum FSH and FSHB together with FSHR gene polymorphisms already reported in males. The knowledge of the FSHB/FSHR genotype combination is fundamental for the proper interpretation of serum FSH levels in women of reproductive age. Merck Serono supported the study in the form of a research grant for the laboratory session. None of the authors have any competing interest to declare.

Mitochondrial D-loop variations in infertile women undergoing a long stimulation protocol

To study a high frequency of mtDNA D-loop variations in infertile women undergoing a long stimulation protocol and their potential relevance with endpoints of IVF. Peripheral blood was taken from 156 patient ≤ 42 years of age. The entire D-loop region of mtDNA was amplified in three overlapping polymerase chain reaction fragments, and variations were evaluated by direct DNA sequencing methods in 156 infertile women undergoing a long stimulation protocol. A total of 48 variations were found at 47 positions in the D-loop of all patients. Median age of the patients was 34.09 years (26-42 years). The incidence of variations was significantly higher in the group of patients aged >34.09 years (P=0.001), especially 16191 C → T (P=0.017) and 199 T → C (P=0.045). In contrast, the incidence of variations was significantly lower on the day of hCG administration in the group of patients with E₂>8037.97 pmol/L (P=0.001). However, variations were not significantly associated with early follicular phase FSH (P=0.262), the number of oocytes retrieved (P=0.191) or the pregnancy rate (P=0.487). Our data suggest that the increase in mtDNA variations in peripheral blood from infertile women could have a predictive value for the response of infertile women undergoing a long stimulation protocol.

Implications of blood type for ovarian reserve

We explored the relevance of blood type to ovarian reserve, as reflected by early follicular phase FSH levels. For this cross-sectional observational study, early follicular phase serum levels of FSH (mIU/ml) and estradiol (E2, pg/ml), and information on blood type (A, B, AB and O) and patient age were procured for female patients, ≤ 45 years age (n= 544), who were undergoing fertility evaluation at one of two tertiary care facilities. Serum FSH > 10 mIU/ml was taken to reflect diminished ovarian reserve (DOR). Data distribution for FSH and age was analyzed and non-parametric tests used for comparisons across blood groups. Multivariable logistic regression analyses determined the relationship between elevated FSH and respective blood types after adjusting for age and study site. Prevalence of blood types according to order of frequency was: O (45%), A (35%), B (16%) and AB (5%). After adjusting for age and study site, patients with blood type O were twice as likely to exhibit FSH > 10 mIU/ml compared with those with A or AB blood types [odds ratio (OR) 2.36; 95% confidence interval (CI) 1.27-4.41; P= 0.007], and three times as likely to manifest FSH > 12 m IU/ml (OR 3.48, 95% CI 1.46-7.32, P= 0.004). The B blood group antigen failed to exhibit any relationship with ovarian reserve as reflected by baseline FSH (P> 0.05). The A blood group antigen appears to be protective for ovarian reserve, whereas blood type O appears to be associated with DOR, in a relationship that is independent of advancing age. Further studies are needed to establish causality and identify the underlying mechanisms for the association.

Prenatal Determinants of Uterine Volume and Ovarian Reserve in Adolescence

Adequate uterine volume and ovarian reserve are essential for reproductive health. Antenatal events such as restricted fetal growth and maternal tobacco smoking are hypothesized to impact on reproductive function in later life, although not studied in a large prospective normal pregnancy population to date. The objective of the study was to determine the relationship between intrauterine growth, birth weight, and maternal tobacco smoking on uterine volume and ovarian reserve in adolescence. This was a prospective study in which half the cohort underwent intensive ultrasound monitoring in utero. Intrauterine growth was measured using ultrasound at 18, 24, 28, and 34/36 wk gestation (n = 115 girls). Maternal smoking data were prospectively collected at 18 and 34/36 wk from the whole cohort. Uterine (n = 229) and early follicular ovarian volume and antral follicle count (n = 225) were measured using transabdominal ultrasound (n = 230). Ovarian reserve was estimated using early follicular phase anti-Mullerian hormone, inhibin B, and FSH (n = 213). The relationship between maternal tobacco smoking, intrauterine growth trajectories, and markers of ovarian reserve and uterine size in adolescence was measured. Linear regression showed that daughters of mothers who smoked had a significantly smaller uterus compared with nonsmokers (P = 0.019). No significant relationship between maternal tobacco smoking and ovarian volume (P = 0.164) or markers of ovarian reserve (antral follicle count, plasma FSH, anti-Mullerian hormone, and inhibin B) in adolescence was determined. Our findings indicate that maternal smoking, but not variations in fetal growth, may lead to a reduction in uterine volume and does not appear to impact ovarian reserve.

Reproductive hormone dynamics identify distinctions between diminished ovarian reserve (DOR) and chronological aging

OBJECTIVE: We have described distinctions in urinary reproductive hormone in young infertile DOR patients (reflected by Day 3 serum FSH >10mIU/ml & poor response to ovarian stimulation) compared to healthy controls. The current study was aimed at assessing if hormone profiles in DOR patients are similar to those seen with natural aging. DESIGN: Prospective observational study. MATERIALS AND METHODS: Gonadotropins (FSH & LH), and metabolites of estrogen & progesterone (E1c & Pdg) were assessed in daily urine samples collected in an unstimulated menstrual cycle in 8 DOR patients (aged 32-37) & in 12 perimenopausal women (aged 43-52). A Pdg algorithm was used to confirm the ovulatory status. Area under the curve (AUC) was estimated for each hormone and comparisons were made between the two groups using student's t test. RESULTS: Distinct differences in hormone profiles were observed between DOR patients and older perimenopausal women. Both the amplitude & duration of the LH surge were more pronounced in DOR vs. perimenopausal women. DOR patients had significantly lower early follicular phase FSH & lower whole-cycle E1c.Tabled 1Hormonal comparisons between DOR & perimenopausal womenPerimenopausalDORControlsFSH of Day -14 to -7 (mU/mgCr)26 ± 2.87.48 ± 0.66‡6.23 ± 0.33∗These numbers are included for references. No comparison done with the other groups.LH peak amp (mU/mgCr)32 ± 7.7564 ± 1641 ± 7.87∗These numbers are included for references. No comparison done with the other groups.LH surge duration (days)1.42 ± 0.153.25 ± 0.45‡p<0.05 when compared with perimenopausal data.1.93 ± 0.24∗These numbers are included for references. No comparison done with the other groups.E1c AUC (ng/mgCr)1646 ± 296654 ± 104‡p<0.05 when compared with perimenopausal data.1054 ± 83∗These numbers are included for references. No comparison done with the other groups.Pdg AUC (ug/mgCr)75 ± 1255 ± 11.5116 ± 19.4∗These numbers are included for references. No comparison done with the other groups.∗ These numbers are included for references. No comparison done with the other groups.‡ p<0.05 when compared with perimenopausal data. Open table in a new tab Luteal Pdg levels were similar in both groups. CONCLUSIONS: Despite having low ovarian reserve, women with DOR had lower FSH, lower E1c and a more robust LH surge than older perimenopausal women. These data suggest that DOR is a distinct entity in the paradigm of reproductive senescence. Age may mitigate the hormonal manifestations of ovarian follicular depletion.

Women with consistently or variably elevated early follicular phase FSH

Women with consistently or variably elevated early follicular phase FSH

Reply: Managing IVF in women with consistently or variably elevated early follicular phase FSH

Reply: Managing IVF in women with consistently or variably elevated early follicular phase FSH

Increased ovarian volume (IOV) is a good predictor of insulin resistance in a Latino-American population of PCOS women

OBJECTIVE: To establish the ability of increased ovarian volume (IOV), if any, to predict elevations of markers of insulin resistance in a population of Latino-American women affected by PCOS. DESIGN: A prospective, controlled, descriptive clinical trial. MATERIALS AND METHODS: A sample of 49 consecutive PCOS women was prospectively evaluated and compared to a control population of 18 non hirsute, non obese, ovulatory women. Evaluation included a detailed physical examination (FG score; W/H, body mass index – BMI-, acanthosis, acne) and hormonal parameters including early follicular phase FSH, LH, serum androgens, luteal phase progesterone, oral glucose tolerance test with measure of insulin. Insulin sensitivity was determined by calculation of HOMA. Increased ovarian volume was established according to Rotterdam criteria. Comparisons were performed between both, PCOS-IOV and PCOS-normal ovarian volume (NOV) with controls. Compared parameters included age, BMI, menstrual cycle length, FG score, androgens, LH/FSH ratio, OGTT values and HOMA. RESULTS: Women affected by PCOS (both, increased and normal ovarian volume) were younger than controls (26,7 and 28,2 vs 32,3 years). PCOS women with IOV have longer menstrual cycles (67,11 vs 41,5 days), thicker endometrium (10,67 vs 7,70 mm), and higher HOMA levels (2,76 vs 1,97), compared to women with PCOS and NOV. Compared to controls, women with PCOS-IOV have longer menstrual cycles (67,11 vs 28,61 days), higher BMI (28,15 vs 24,06 kg/m2) and FG score (6,78 vs 3), thicker endometrium (10,67 vs 7,64 mm), and were more insulin resistant (HOMA: 2,76 vs 1,30; fasting insulin: 12,53 vs 6,64 uU/ml; 30min insulin: 69,39 vs 43,14 uU/ml). Alternatively, women with PCOS-NOV have longer menstrual cycles (41,65 vs 28,61 days), higher BMI (27,49 vs 23,01 Kg/m2) and FG score (6,21 vs 2,93) but not differences were noted in endometrial thickness, HOMA and fasting insulin levels, compared to controls. The 30min insulin level was the only marker on insulin resistance elevated in PCOS-NOV when compared to controls. CONCLUSIONS: In this population of Latino-American PCOS women, IOV is a marker of higher levels of insulin resistance, and worse reproductive functioning as demonstrated by higher HOMA levels, longer menstrual cycles and thicker endometrium.

Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization

To determine if attempts to maximize oocyte yield during ovarian stimulation translates into improved outcome of in vitro fertilization (IVF) cycles. Retrospective study. Academic tertiary care IVF center. 806 de-identified nondonor IVF cycles. Evaluation of fresh nondonor IVF cycles (n = 806) for the period January 1, 1999, to December 30, 2001. Cycle cancellation, clinical pregnancy, spontaneous miscarriage, and live birth after IVF. Advancing age, independent of ovarian reserve status (reflected by early follicular phase FSH and estradiol) augured a worse prognosis for all outcomes. Higher gonadotropin use lowered cycle cancellations but was associated with a statistically significantly reduced likelihood of clinical pregnancy and live birth and a trend toward a higher likelihood for spontaneous miscarriage after IVF. Our data add to the accruing literature suggesting adverse influences of excess gonadotropin use on IVF outcomes. Although an aggressive approach to controlled ovarian hyperstimulation results in a statistically significant reduction in cycle cancellations, the excessive use of gonadotropins detrimentally influences live birth after IVF.

The endocrine and follicular growth dynamics throughout the menstrual cycle in women with consistently or variably elevated early follicular phase FSH compared with controls

Elevated early follicular phase (EFP) FSH is frequently observed in subfertile patients. In these women, temporary normalization of FSH concentrations is known to occur. We studied the complete endocrine cycle profile of subfertile young women with elevated basal FSH compared with controls. METHODS Daily bloodsampling and ultrasound monitoring in the follicular phase was performed in 22 patients with elevated basal FSH levels (identified in screening) and in 16 controls during one menstrual cycle and for 5 days of the next cycle. Eleven patients showed elevated basal FSH levels in the study cycle ('High, High'; H,H group) whereas 11 had normalized basal FSH levels ('High, Low'; H,L group). Anti-Müllerian hormone (AMH) was lower in both groups. In the H,H group, FSH was higher in all phases of the cycle and both inhibin A and B were lower during the EFP. In the H,L group, FSH was also higher than in controls in the EFP and the late luteal phase and inhibin A was higher in the periovulatory phase. 'Normalization' of Day 3 FSH in women with previously elevated FSH was associated with normalization of inhibin B levels in the preceding luteal phase. The endocrine cycle profile in younger subfertile patients with consistently elevated basal FSH resembles that in published data from older women and also reflects a low ovarian reserve. Normalization of FSH in association with normal inhibin B suggests a temporary increase of the available cohort.

Randomized controlled pilot trial of luteal phase recombinant FSH stimulation in poor responders

This study investigated whether luteal phase initiation of FSH supplementation would improve oocyte yield compared with follicular phase administration in women with poor ovarian response (POR). A two-arm, randomized, open-label pilot trial was performed at a university-based infertility centre. In nine of 18 infertile women with a history of POR in a previous cycle [<5 follicles on day of human chorionic gonadotrophin (HCG) administration; <5 oocytes retrieved; previous IVF cycle cancellation due to POR] FSH was administered during the mid-luteal phase of the preceding menstrual cycle. The primary outcome measure was the number of oocytes retrieved. Secondary endpoints included: follicles >10 mm and >16 mm and oestradiol concentration on the day of HCG administration, peak oestrogen concentration, pregnancy and live birth rates. All endpoints comparing luteal versus follicular stimulation were similar. In paired analysis of patients in the luteal arm compared with the prior cycle, there was a significant increase in days of stimulation ( P = 0.01) and number of follicles >10 mm ( P = 0.02) and >16 mm ( P = 0.02) on day of HCG administration. IVF outcomes with luteal phase FSH compared with follicular phase FSH were similar. Luteal phase initiation of FSH is a safe and potential alternative protocol in poor responders.

Impact of breast cancer chemotherapy on ovarian reserve: a prospective observational analysis by menstrual history and ovarian reserve markers

To determine whether addition of taxanes to anthracycline and cyclophosphamide regimens impact ovarian function as assessed by menstrual history and ovarian reserve markers. Prospective observational analysis. Large university fertility center. Forty-five women with a history of breast cancer of stages I-IIIA who either received anthracycline, cyclophosphamide, and paclitaxel (ACT) or received anthracycline with cyclophosphamide (AC). Menstrual histories were obtained at 6 months and at a mean of 28 months after chemotherapy. Early follicular phase FSH and E(2) samples were obtained at the second follow-up. Incidence of amenorrhea and abnormal laboratory values. There was no statistically significant difference in the rates of amenorrhea at 6 months after chemotherapy (AC group, 41.7%; ACT group, 29%). At the second follow-up, a mean of 28 months after chemotherapy, there was a trend toward higher amenorrhea in the ACT patients (35.7%, vs. 9.1% in the AC group). When the ovarian markers were included, an additional eight menstruating patients were identified with abnormally elevated FSH or E(2) levels. We found no significant long- or short-term impact of taxanes on rates of amenorrhea. Future studies on the reproductive effects of chemotherapeutic agents should incorporate ovarian reserve markers, because menstrual history alone may underestimate the impact of these cytotoxic agents.

Optimizing the number of cleavage stage embryos to transfer on day 3 in women 38 and older: a SART database study

To determine the optimal number of embryos to transfer on day 3 in women ≥38 y using an evidence-based process and statistical modeling. To determine how the optimum number will vary according to patient and cycle specific parameters. Retrospective analysis of 2000–2004 national SART data. We evaluated 36,103 day 3 embryo transfers in women ≥38 y undergoing their first cycle of ART. Age related characteristics were compared by χ2 with P<0.05 as statistically significant. We used logistic regression to model the probabilities of a pregnancy (presence of ≥1 fetal heartbeat), delivery, and multiple birth (twin or high order) based on the characteristics of age, number of embryos transferred, maximum follicular phase FSH, number of oocytes retrieved, cryopreservation of excess embryos, and use of ICSI. In women 38–39 y, pregnancy rates (PR), delivery rates (DR), and multiple rates increased with transfer of up to 3 embryos (see figure). Beyond 3, neither PR nor DR increased. Multiple rates continued to increase up to 5 embryos transferred for 38 yo, and beyond 5 for 39 yo. In women ≥40 yo, DR and multiple rates both climbed steadily with increasing numbers transferred. Multivariate analysis confirmed the significant effect of age (P<0.0001; risk ratio [RR] = 0.24, 43–44 y compared to 38 y), number of oocytes retrieved (RR=0.77; ≤4 compared to referent ≥15: P<0.0001) and embryo cryopreservation (RR = 1.33 for ‘yes’ compared to ‘no’; P<0.0001). Maximum FSH level, which was significant in the univariate analyses, was not an independent predictor in the multivariate analyses. Use of ICSI was associated with lower DR (RR = 0.90, P<0.0001). The optimal number of embryos to transfer on day 3 in women 38–39 y differs from that in women ≥40 y. These data are not currently reflected in national embryo transfer guidelines which group women 38–40 yo. Results suggest that no more than 3 embryos should be transferred in 38 and 39 yo, while up to 5 embryos could be transferred in ≥40 yo. Optimal numbers of embryos to transfer should be adjusted according to number of oocytes retrieved and availability of excess embryos to cryopreserve.

Is Factor V Leiden mutation a cause of implantation failure?

Is Factor V Leiden mutation a cause of implantation failure?

Optimizing the number of blastocyst stage embryos to transfer in women 38 and older: a SART database study

To develop practical, evidence-based, clinical recommendations for the optimum numbers of blastocyst stage embryos to transfer in women 38y and older using statistical modeling. To predict how this optimum number will vary according to a variety of patient and cycle specific parameters contained in the SART database. Retrospective analysis of national SART data from 2000–2004. We evaluated 5,569 day 5 and day 6 embryo transfers in women 38y and older undergoing their first cycle of ART. Characteristics of the population for different ages were compared by X2, with P<0.05 considered statistically significant. Logistic regression was used to model the probability of a delivery, twins, and high order multiples (HOM) based on the following patient characteristics: age, number of embryos transferred, maximum follicular phase FSH, number of oocytes retrieved, cryopreservation of excess embryos, and use of ICSI. In 38 and 39 yo there was an increase in delivery rates (DR) up to transfer of 2 embryos. Beyond that, the number transferred did not increase the DR, yet the twin rate continued to increase in the 39 y group. Transfer of 3 embryos in 40 yo women, resulted in an increase in DR with no further increase in multiple rates, while for 41–42 yo the DR was level but the twin rate continued to increase. Multivariate analyses of the parameters significant by univariate analysis showed that increasing age, as expected, decreased DR. Two other variables that influenced DR were ICSI (decreased DR with Risk Ratio [RR]= 0.83, P<0.0002) and cryopreservation (increased DR: RR=1.52, P<0.0001). Increasing numbers of oocytes retrieved significantly increased DR in the univariate analyses but this parameter, though it showed a trend, was not an independent predictor in the multivariate analysis. Optimal numbers of blastocyst stage embryos to transfer on day 5–6 in first cycles for women 38–39 yo differ from those in women ≥40. Numbers transferred should be modified as determined by a model that includes the availability of excess embryos to cryopreserve, whether ICSI was used, and to a lesser extent the number of oocytes retrieved.

P-34: IVF outcomes in women over age 40 years with an elevated cycle day 3 FSH (≥ 10 mIU/mL)

Basal follicular phase FSH levels are utilized to predict the response to controlled ovarian hyperstimulation (COH) for IVF, despite the decreased sensitivity and specificity of these tests in the setting of advancing patient age. The purpose of our study was to evaluate IVF outcomes among older patients with elevated basal FSH levels (≥10 mIU/mL).