Normal Basal FSH Research Articles

Increased maternal hCG concentrations in early in vitro pregnancy with elevated basal FSH.

ObjectiveTo investigate factors that influence maternal hCG concentration in early pregnancy and the relationship between hCG concentration in early pregnancy and basal FSH (bFSH) level.DesignRetrospective cohort study.SettingReproductive medical center.Patient(s)In total, 482 women aged 22 to 38 years with elevated basal FSH (> 10 IU/L) and who experienced a single live birth after in vitro fertilization-embryo transfer were selected. These 482 women were age-matched with an equal number of women with normal basal FSH (≤10 IU/L) who also experienced a single live birth.Intervention(s)None.Main Outcome Measure(s)HCG concentration.Result(s)The hCG concentrations on Day 14 and Day 21 were 560.46 (363.63–842.52) IU/L and 9862.00 (6512.25–14029.50) IU/L, respectively, in the elevated bFSH group, and these values were significantly increased compared with the normal bFSH group. After adjusting for confounding factors, the concentrations of maternal hCG on Day 14 and Day 21 were significantly associated with basal FSH. In addition, crude linear regression analysis demonstrated that hCG concentrations increased as the basal serum levels of FSH increased.Conclusion(s)Elevated basal FSH has implications for the interpretation of hCG concentrations in early pregnancy after in vitro fertilization-embryo transfer (IVF-ET) that led to a single live birth.

Loss of PI3K p110α in the Adipose Tissue Results in Infertility and Delayed Puberty Onset in Male Mice.

Deletion of PI3K catalytic subunit p110α in adipose tissue (aP2-Cre/p110αflx/flx, α−/− hereafter) results in increased adiposity, glucose intolerance, and liver steatosis. Because this endocrine organ releases hormones like leptin, which are important in reproductive physiology, we investigated the reproductive phenotype of α−/− males. Compared to controls, α−/− males displayed delayed onset of puberty accompanied by a reduction in plasma LH levels and testicular weight. At postnatal day 30, α−/− mice exhibited normal body weight but elevated fasted plasma leptin levels. Testicular leptin gene expression was increased, whereas expression of the cholesterol transporter StAR and of P450 cholesterol side chain cleavage enzyme was decreased. Adult α−/− males were infertile and exhibited hyperandrogenemia with normal basal LH, FSH, and estradiol levels. However, neither sperm counts nor sperm motility was different between genotypes. The mRNA levels of leptin and of 17-beta-dehydrogenase 3, and enzyme important for testosterone production, were significantly higher in the testis of adult α−/− males. The mRNA levels of ERα, an important regulator of intratesticular steroidogenesis, were lower in the testis of adult and peripubertal α−/− males. We propose that chronic hyperleptinemia contributes to the negative impact that disrupting PI3K signaling in adipocytes has on puberty onset, steroidogenesis, and fertility in males.

Effectiveness of HP-hMG versus r-FSH in patients undergoing IVF/ICSI cycles with moderate male-factor infertility

The aim of this case-control study was to compare the efficacy of highly purified human menopausal gonadotropin (HP-hMG) versus recombinant follicle stimulating hormone (r-FSH) treatments following gonadotropin-releasing hormone (GnRH) agonist suppression in patients undergoing intracytoplasmic sperm injection (ICSI) with moderate male-factor infertility in terms of oocyte and embryo quality and clinical pregnancy outcomes. Materials and methods: A total of 240 infertile women were treated with HP-hMG (HP-hMG group, n = 120 patients) or r-FSH (r-FSH group, n = 120 patients) following GnRH agonist suppression (long regimen). Inclusion criteria for the study groups were infertility due to moderate oligoasthenoteratospermia with no associated female infertility factor, fewer than 2 previous assisted reproductive technology cycles, and female patients with ages between 19 and 35 years, normal basal FSH, regular ovulatory cycles, and body mass index below 30 kg/m^2. Results: Treatment durations and gonadotropin doses were similar in both groups. Cycle cancellation rates, clinical pregnancy and miscarriage rates, total and metaphase II oocytes retrieved, fertilization rate, and number of embryos transferred were all similar in both groups. The clinical pregnancy rates were 45.9% (n = 50/109) in the r-FSH group and 40.4% (n = 44/109) in the HP-hMG group. Conclusion: HP-hMG is as effective as r-FSH in terms of oocyte and embryo quality and clinical pregnancy outcomes in patients undergoing ICSI with moderate male-factor infertility.

Effectiveness of HP-hMG vs r-FSH in Patients undergoing IVF/ICSI Cycles with Moderate Male Factor Infertility

ABSTRACTAimThe aim of this case-control study was to compare the efficacy of highly purified human menopausal gonadotropin (HPhMG) vs recombinant follicle stimulating hormone (r-FSH) treatments following GnRH agonist suppression in patients undergoing intracytoplasmic sperm injection (ICSI) with moderate male factor infertility in terms of oocyte and embryo quality and clinical pregnancy outcomes.Materials and methodsA total of 240 infertile women were treated with HP-hMG group (n: 120 patients) or (r-FSH group, n: 120 patients) following GnRH agonist suppression (long regimen). Inclusion criteria for the study groups were infertility due to moderate oligoastheno-teratospermia with no associated female infertility factor, previous ART cycles <2, female patients aged 19 to 35 years with normal basal FSH, regular ovulatory cycles and BMI <30 kg/m2.ResultsTreatment durations and gonadotropin doses were similar in both groups. Cycle cancellation rates, clinical pregnancy and miscarriage rates, total and metaphase II oocytes retrieved, fertilization rate, number of embryos transferred were all similar in both groups. The clinical pregnancy rates were 45.9% (n: 50/109) in the r-FSH group and 40.4% (n: 44/109) in the HP-hMG group.ConclusionHP-hMG is effective as r-FSH in terms of oocyte and embryo quality and clinical pregnancy outcomes in patients undergoing ICSI with moderate male factor infertility.How to cite this articleDalal RJ, Pai H, Palshetkar N. Effectiveness of HP-hMG vs r-FSH in Patients undergoing IVF/ICSI Cycles with Moderate Male Factor Infertility. Int J Infertility Fetal Med 2012;3(2):51-56.

Clinical outcomes in relation to the daily dose of recombinant follicle-stimulating hormone for ovarian stimulation in in vitro fertilization in presumed normal responders younger than 39 years: a meta-analysis

The optimal ovarian stimulation dose to obtain the best balance between the probability of pregnancy and the risk of complications, while maximizing cost-effectiveness of in vitro fertilization (IVF) treatment, is yet to be established. A systematic search of the electronic databases PubMed, EMBASE and Cochrane library, from 1984 until October 2009 for randomized controlled trials comparing different doses of recombinant FSH in IVF, was performed. Ten studies (totaling 1952 IVF cycles) were included in the present meta-analysis, comprising patients younger than 39 years with regular menstrual cycle, normal basal FSH levels and two normal ovaries. Comparison was made between studies using a daily dose of 100 versus 200 IU recFSH, and between 150 versus 200 IU recFSH or higher. Although oocyte yield was greater in the >200 IU/day dose group, pregnancy rates were similar compared with lower dose groups. The risk of insufficient response to ovarian stimulation was greatest in the 100 IU/day dose group. The risk of developing ovarian hyperstimulation syndrome was greater in the >200 IU/day dose group. The number of embryos available for cryopreservation was lowest in the 100 IU/day group, but similar comparing the 150 IU/day and the >200 IU/day dose groups. This meta-analysis suggests that the optimal daily recFSH stimulation dose is 150 IU/day in presumed normal responders younger than 39 years undergoing IVF. Compared with higher doses, this dose is associated with a slightly lower oocyte yield, but similar pregnancy and embryo cryopreservation rates. Furthermore, the wide spread adherence to this optimal dose will allow for a considerable reduction in IVF costs and complications.

Risk charts to identify low and excessive responders among first-cycle IVF/ICSI standard patients

Ovarian stimulation carries a risk of either low or excessive ovarian response. The aim was to develop prognostic models for identification of standard (ovulatory and normal basal FSH) patients’ risks of low and excessive response to conventional stimulation for IVF/intracytoplasmic sperm injection. Prospectively collected data on 276 first-cycle patients treated with 150 IU recombinant FSH (rFSH)/day in a long agonist protocol were analysed. Logistic regression analysis was applied to the outcome variables:low (seven or less follicles) and excessive (20 or more follicles) response. Variables were woman’s age, menstrual cycle length, weight or body mass index, ovarian volume, antral follicle count (AFC) and basal FSH. The predictive performance of the models was evaluated from the prediction error (Brier score, %) where zero corresponds to a perfect prediction. Model stability was assessed using 1000 bootstrap cross-validation steps. The best prognostic model to predict low response included AFC and age (Brier score 7.94) and the best model to predict excessive response included AFC and cycle length (Brier score 15.82). Charts were developed to identify risks of low and excessive ovarian response. They can be used for evidence-based risk assessment before ovarian stimulation and may assist clinicians in individual dosage of their patients.

Clinical outcomes for various causes of infertility with natural-cycle in vitro fertilization combined with in vitro maturation of immature oocytes

The clinical outcomes of different infertility causes (tubal factor, male factor, unexplained infertility, combination of tubal and male factors, and other/mixed factors) with natural-cycle in vitro fertilization/maturation (IVF/M) treatment were evaluated. There were no significant differences in the rates of IVM, IVF, and cleavage as well as the clinical pregnancy (30.4%-46.9%) and live birth rates among the five subgroups, which suggests that natural-cycle IVF/M is a suitable treatment for infertility of various causes with acceptable pregnancy and live birth rates.

Transdermal testosterone may improve ovarian response to gonadotrophins in low-responder IVF patients: a randomized, clinical trial

Studies in macaques have indicated that androgens have some synergistic effects with FSH on folliculogenesis. This study investigated the usefulness of pretreatment with transdermal testosterone in low-responder IVF patients. Randomized clinical trial including 62 infertile women who had a background of the first IVF treatment cycle cancelled because of poor follicular response. Patients were randomized in two treatment groups in their second IVF attempt. In patients in Group 1 (n = 31), transdermal application of testosterone preceding standard gonadotrophin ovarian stimulation under pituitary suppression was used. In Group 2 (n = 31 patients), ovarian stimulation was carried out with high-dose gonadotrophin in association with a minidose GnRH agonist protocol. The primary end-point was the incidence of low-responder patients. The main secondary outcome was the incidence of patients reaching ovum retrieval. The percentage of cycles with low response was significantly lower in Group 1 than in Group 2 (32.2 versus 71% 95% confidence interval for the difference, 15.7-61.6; P < 0.05). The number of patients with ovum retrieval tended to be higher in Group 1 than in Group 2 (80.6 versus 58.1% P = 0.09), the difference reaching statistical significance (81.2 versus 41.1%; P < 0.05) when only patients having normal basal FSH levels (16 and 17 patients in Groups 1 and 2, respectively) were considered. Pretreatment with transdermal testosterone may improve the ovarian sensitivity to FSH and follicular response to gonadotrophin treatment in previous low-responder IVF patients. This approach leads to an increased follicular response compared with a high-dose gonadotrophin and minidose GnRH agonist protocol.

Is it worth testing for AMH in young oocyte donors?

Is it worth testing for AMH in young oocyte donors?

The predictive value for in vitro fertility delivery rates is greatly impacted by the method used to select the threshold between normal and elevated basal follicle-stimulating hormone

To evaluate the predictive accuracy of different methodologies for selecting a basal FSH threshold level that prognosticates live birth after IVF. Retrospective. Academic private practice. Eight thousand nineteen patients who had their basal FSH levels determined by the program's endocrinology laboratory. Thresholds between normal and elevated basal FSH levels were calculated by using six different methodologies. Live birth rate per initiated IVF cycle. The thresholds selected by using the manufacturer's normal range or using 95% confidence intervals of a fertile population, the infertile population, or distinct age groups within the infertile population all proved unsatisfactory. The live birth rates for patients in whom there had been a previously elevated FSH level were <or=43.7%. The efficiency curves that were created for each of the five age groups were the most useful. With appropriately selected thresholds, the predictive value of an abnormal result approaches 100%. The methodology used to select thresholds for basal FSH levels has enormous impact on the utility of the screening test. The use of anything other than clinical outcome-based methods to select the threshold greatly decreases the utility of the test and may lead to false conclusions or inaccurate patient counseling.

Moderately elevated levels of basal follicle-stimulating hormone in young patients predict low ovarian response, but should not be used to disqualify patients from attempting in vitro fertilization

To evaluate and compare IVF outcomes of patients within different age categories who had a normal basal FSH level with outcomes of patients with an elevated day 3 FSH level. Retrospective analysis. Large, private IVF center. We analyzed 2,708 patients. Of these, 2,477 had normal basal FSH levels, and 231 had elevated basal FSH levels (> or =13.03 IU/L). Patients were segregated into various age groups. Follow-up. Outcomes of IVF overall, including cancellation rates, oocyte yield, and fertilization, implantation, and clinical pregnancy rates (PRs). Cancellation rates were significantly higher in patients with elevated day 3 FSH levels compared with patients with normal FSH levels in all age groups. A significantly lower oocyte yield was observed in patients with elevated basal FSH. Fertilization rates were not affected by FSH levels. A significant decrease in the number of embryos available for transfer in patients > or =38 with an elevated day 3 FSH level was found. Implantation and clinical PRs were lower in patients >40 years of age who had an elevated day 3 FSH level when compared to same age patients with a normal day 3 FSH level. Loss rates were not significantly different. Young women with an elevated basal FSH level should be counseled differently than older women, and should be given adequate counseling and granted the opportunity to undergo an IVF cycle.

Pretreatment with transdermal testosterone may improve ovarian response to gonadotrophins in poor-responder IVF patients with normal basal concentrations of FSH

Treatment of poor-responder patients to controlled ovarian stimulation for assisted reproduction, who have normal basal FSH concentrations, is one of the most difficult challenges in reproductive medicine. This study investigated the usefulness of testosterone pretreatment in such patients. Prospective, therapeutic, self-controlled clinical trial including 25 consecutive infertile patients who had a background of the first and second IVF treatment cycle cancellations due to poor follicular response, in spite of vigorous gonadotrophin ovarian stimulation and having normal basal FSH levels. In the third IVF attempt, all patients received transdermal testosterone treatment (20 microg/kg per day) during the 5 days preceding gonadotrophin treatment. Twenty patients (80%) showed an increase of over fivefold in the number of recruited follicles, produced 5.8+/-0.4 (mean+/-SEM) oocytes, received two or three embryos and achieved a clinical pregnancy rate of 30% per oocyte retrieval. There were 20% cancelled cycles. Pretreatment with transdermal testosterone may be a useful approach for women known to be low responders on the basis of a poor response to controlled ovarian stimulation but having normal basal FSH concentrations.

Facteurs échographiques prédictifs de la réponse ovarienne en fécondation in vitro

Evaluate whether ovarian antral follicles number, ovarian volume and ovarian area are predictive of ovarian response. Prospective cohort analysis of 41 women with normal basal serum FSH concentration, who were undergoing their IVF cycle. The ovarian antral follicle number, the ovarian volume and area were determined by transvaginal ultrasonography on the third menstrual day for 20 women, and after pituitary suppression for 21 women. The main outcome measures are the number of follicles the day of HCG with a diameter >or=14 mm, the number of oocytes retrieved and the number of embryos. The antral follicle count was significantly correlated to the number of follicles (R=0.7; P<0.001), to the number of oocytes retrieved (R=0.46; P=0.008) and to the number of embryos (R=0.44; P=0.01). The ovarian volume and area was significantly correlated to the number of follicles. The total antral follicle number on day 3 has a predictive value for favourable IVF outcome. Because this sonographic count is easy, safe and inexpensive it should be performed prior every IVF cycle.

IVF Outcomes in Patients Age 38 Years or Older With a Normal Basal FSH (≤10 mIU/ml) vs. an Elevated Basal 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 compare IVF outcomes between older patients with normal basal FSH levels ≤10 mIU/ml vs. those with basal FSH levels > 10 mIU/ml.

Taking a basal follicle-stimulating hormone history is essential before initiating in vitro fertilization

To analyze IVF outcomes in patients with a history of one or more elevations in basal FSH who have a normal basal FSH at the start of their IVF cycle, compared with the general IVF population. Retrospective clinical study. University hospital. General IVF patient population. Patients received standard IVF gonadotropin protocols, oocyte retrieval, and embryo transfer. Oocyte yield, fertilization, implantation, clinical pregnancy, and cancellation rate. Oocyte yields were lower in patients with a history of elevated basal FSH, for all age groups, and showed an age-dependent decline in all patients. Over the age of 40 years, both implantation and clinical pregnancy rates were lower in these patients, with no significant difference observed in patients under the age of 40 years. No pregnancies were observed in patients with a history of three or more elevated FSH levels, regardless of age. A history of elevated basal FSH levels in patients under the age of 40 years predicts a lower oocyte yield in IVF cycles with normal basal FSH levels but does not translate to either lower pregnancy or implantation rates. Patients aged >40 years with prior elevations in basal FSH levels have both compromised ovarian response and compromised embryo quality relative to those with normal FSH levels, as illustrated by lower oocyte yield, higher cancellation rates, and lower implantation and pregnancy rates.

Comparison of plasmatic steroid levels with and without previous oral contraceptive administration in GnRH antagonist IVF cycles

ObjectiveThe primary objective of the study was to assess the differences in plasmatic levels of oestradiol, FSH and LH in GnRH antagonist IVF cycles with or without previous oral contraceptive administration.DesignThe design of this study was prospective.Materials and methodsSeventy-five patients participated in this study. The patients were divided into 2 groups: Group I, 35 patients who were not prescribed oral contraceptives before stimulation and Group II, with 41 patients who took oral contraceptives prior to stimulation. All patients were normoresponders with normal basal FSH, LH, oestradiol and prolactin levels, normal BMI, the mean patient age was 32.67 ± 2.87. Patients with endometriosis, uterine pathology, PCO, and patients over 37 were excluded. Ovarian stimulation was initiated with 225 IU of rFSH, administering 75 IU of rLH the first day of the antagonist. The first stimulation check-up was performed on day 4 of stimulation, starting the daily administration of 0.25 mg of Cetrorelix when by sonography a ≥ 14 mm follicle was detected. When 2 or more follicles ≥17 mm were found, 10000 IU of HCG was administered and the puncture was performed 36 hours later. The embryo transfer was on day +3. Levels of FSH, LH and oestradiol were determined the theoretical day of antagonist administration (1), the following day(2) and the day of HCG adminstration(3).ResultsThe results are found in the following tables: Table 1 and Table 2. üConclusionView Large Image Figure ViewerDownload Hi-res image Download (PPT) ObjectiveThe primary objective of the study was to assess the differences in plasmatic levels of oestradiol, FSH and LH in GnRH antagonist IVF cycles with or without previous oral contraceptive administration. The primary objective of the study was to assess the differences in plasmatic levels of oestradiol, FSH and LH in GnRH antagonist IVF cycles with or without previous oral contraceptive administration. DesignThe design of this study was prospective. The design of this study was prospective. Materials and methodsSeventy-five patients participated in this study. The patients were divided into 2 groups: Group I, 35 patients who were not prescribed oral contraceptives before stimulation and Group II, with 41 patients who took oral contraceptives prior to stimulation. All patients were normoresponders with normal basal FSH, LH, oestradiol and prolactin levels, normal BMI, the mean patient age was 32.67 ± 2.87. Patients with endometriosis, uterine pathology, PCO, and patients over 37 were excluded. Ovarian stimulation was initiated with 225 IU of rFSH, administering 75 IU of rLH the first day of the antagonist. The first stimulation check-up was performed on day 4 of stimulation, starting the daily administration of 0.25 mg of Cetrorelix when by sonography a ≥ 14 mm follicle was detected. When 2 or more follicles ≥17 mm were found, 10000 IU of HCG was administered and the puncture was performed 36 hours later. The embryo transfer was on day +3. Levels of FSH, LH and oestradiol were determined the theoretical day of antagonist administration (1), the following day(2) and the day of HCG adminstration(3). Seventy-five patients participated in this study. The patients were divided into 2 groups: Group I, 35 patients who were not prescribed oral contraceptives before stimulation and Group II, with 41 patients who took oral contraceptives prior to stimulation. All patients were normoresponders with normal basal FSH, LH, oestradiol and prolactin levels, normal BMI, the mean patient age was 32.67 ± 2.87. Patients with endometriosis, uterine pathology, PCO, and patients over 37 were excluded. Ovarian stimulation was initiated with 225 IU of rFSH, administering 75 IU of rLH the first day of the antagonist. The first stimulation check-up was performed on day 4 of stimulation, starting the daily administration of 0.25 mg of Cetrorelix when by sonography a ≥ 14 mm follicle was detected. When 2 or more follicles ≥17 mm were found, 10000 IU of HCG was administered and the puncture was performed 36 hours later. The embryo transfer was on day +3. Levels of FSH, LH and oestradiol were determined the theoretical day of antagonist administration (1), the following day(2) and the day of HCG adminstration(3). ResultsThe results are found in the following tables: Table 1 and Table 2. ü The results are found in the following tables: Table 1 and Table 2. ü Conclusion

Embryo transfer technique significantly influences pregnancy rates in an assisted reproduction program

Embryo transfer has been regarded as a rather unimportant variable in IVF. Problematic embryo transfers, have been associated with low pregnancy rates. Some factors including the “physician factor”, type of catheter and insertion control may be readily modified; even intrafallopian transfers have been proposed. The aim of this study is to evaluate the influence of three different ways of embryo transfer: (1) transcervical “blind” catheterization, (2) transcervical ultrasound-guided, and (3) tubal embryo transfer (TET). Retrospective computer data base analysis. Fresh embryo transfers performed transcervically by a single physician, and tubal embryo transfers, were retrospectively analyzed from: January 2001 through December 2003. All patients had: ≤ 37 years, normal basal FSH levels, patent tubes and at least one good quality embryo (class IV or III-scale I to IV-) transferred. Study groups were: 1)(n= 45) soft catheter blind insertion; 2) (n=40) soft catheters and ultrasound (US) guidance; and 3) (n=61) laparoscopic tubal transfer. Clinical pregnancy rates, implantation rates, abortion and ectopic pregnancy rates were calculated. The three groups were comparable in terms of age, time of infertility, and diagnosis. Stimulation protocols were comparable in terms of : use of GnRH-agonists and dose of gonadotropins. Mean maximum estradiol levels were not significantly different; as well as the mean number of oocytes retrieved, fertilization rates and cleavage rates. Mean number of transferred embryos by embryo quality (best quality=IV); were also comparable (Table 1) Abortions/ectopic pregnancies rates were respectively: gr 1: 12.5%/6.25%; gr 2: 0%/0% to date; gr 3:14.6%/2.4%. Tubal embryo transfers do not yield higher pregnancy rates than the transcervical technique carefully performed, under ultrasound guidance. TET’s imply a laparoscopy, with additional morbidity, cost and time expense; and though it may avoid negative factors influencing some problematic transcervical transfers cannot be recomended as a first choice.

Poor response to ovulation induction is a stronger predictor of early menopause than elevated basal FSH: a life table analysis.

During the course of assisted reproduction treatment, a number of women exhibit a "poor response" to ovulation induction, or demonstrate an elevated basal FSH level (> or =10 IU/l) at a young age. We sought to determine whether these women are at increased risk of early menopause and poor reproductive performance. A retrospective cohort study included 118 "poor responders" with normal basal FSH level (<10 IU/l), 164 women with raised basal FSH (> or =10 IU/l), and 265 controls, who underwent assisted reproduction treatment between 1987 and 1998. All women were < 40 years of age at the time of treatment and had normal menstrual cycles. Participants were sent a postal questionnaire in 2000-2001, seeking information on ovarian function and reproductive performance following cessation of treatment. After adjusting for age and smoking habits, women with poor response and raised basal FSH levels were more likely to experience symptoms of the peri-menopause [hazard ratios 2.4, 95% confidence interval (CI) 1.52-3.78, and 2.76, 95% CI 1.78-4.29 respectively, P = 0.0001]. Poor responders were six times and 23 times more likely to experience the menopause within 10 years of treatment than those with raised basal FSH levels and controls respectively (hazard ratio 5.97 and 23.9, P = 0.015 and 0.002 respectively). Poor responders and those with raised basal FSH levels have half the chance of spontaneous conception after discontinuation of treatment compared with controls (P < 0.007). Both poor response to ovarian stimulation and raised basal FSH are markers of reduced ovarian reserve and predict an increased risk of early menopause.

Detection of the subendometrial vascularization flow index by three-dimensional ultrasound may be useful for predicting the pregnancy rate for patients undergoing in vitro fertilization–embryo transfer

Objective To obtain quantitative data on endometrial volume and subendometrial blood flow by three-dimensional ultrasound clue to endometrial receptivity. Design A prospective, nonrandomized clinical study. Setting One tertiary center for assisted reproduction. Patient(s) Fifty-four patients aged <38 years with normal basal serum FSH level experiencing their first IVF cycle, whose uteri were morphologically normal as confirmed by 3-dimensional (3-D) ultrasound, were studied. Intervention(s) Ultrasound evaluation was performed for all patients with 3-D facility by a single operator on the day of hCG administration. Main outcome measure(s) Ultrasonographic parameters and conception rates. Result(s) Subendometrial vascularization flow index (VFI) in predicting the pregnancy rate of IVF was superior to that using vascularization index, flow index, or endometrial volume in the receiver operating characteristics curve analysis. The best prediction rate was achieved by a VFI cutoff value of >0.24. Conclusion(s) The detection of subendometrial blood flow by 3-D power Doppler ultrasound may be a useful ultrasound parameter in the prediction of pregnancy rate of IVF, especially subendometrial VFI.

Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age

Objective To evaluate whether the number of ovarian antral follicles, ovarian volume, and ovarian stromal blood flow change with age and to prospectively analyze whether three-dimensional ultrasonographic measurements predict ovarian response and IVF outcome. Design Prospective analysis. Setting Assisted reproductive unit. Patient(s) Fifty-six consecutive women 22 to 43 years of age with normal basal serum FSH concentrations who were undergoing their first IVF cycle. Main outcome measure(seconds) Number of ovarian antral follicles, ovarian volume, and ovarian stromal flow index were determined by three-dimensional and power Doppler ultrasonography. Pretreatment measurements were compared with number of recovered oocytes, fertilization rates, and pregnancy rates. Result(s) As patient age increased, significant trends in ovarian volume, number of follicles, and stromal vascularity decreased. Three-dimensional ovarian measurements and fertilization rates differed significantly among age groups. For each age group, a higher number of antral follicles, greater ovarian volume, and favorable ovarian stromal vascularity was associated with higher number of retrieved oocytes and increased pregnancy rates. Conclusion(s) Increasing patient age is associated with poor ovarian response, as represented by smaller ovarian volume, lower antral follicle count, and poor stromal vascularity. Three-dimensional power Doppler ultrasonography can help to individualize IVF in patients regardless of age.