Abstract
Purpose: In a retrospective study, the prognostic factors of in vitro fertilization outcome were studied in women of 39 years of age or older, with an elevated cycle day 3 follicle-stimulating hormone (FSH) level.
Methods: Ovarian stimulation was achieved with a combination of gonadotropin-releasing hormone agonist/human menopausal gonadotropin in a short protocol. All patients underwent FSH dosage on cycle day 3 prior to stimulation. The pregnancy rate was studied according to age, FSH levels, and stimulation parameters.
Results: There was a negative correlation between day 3 FSH levels and the number of ovocytes retrieved. Cycles canceled because of the absence of ovarian response had a significantly higher mean FSH value (18.2 mlU/ml) than cycles ending in ovocyte retrieval (14.6 mlU/ml). Patients with three or more growing follicles during stimulation achieved a significantly higher pregnancy rate per egg retrieval (16%) compared to patients with fewer than three growing follicles (6%). Eighty percent of those pregnancies were obtained during the first two IVF cycles. Even with an elevated FSH level, some patients developed three or more follicles after stimulation. In such cases, the number of embryos available for transfer was the only significant limiting factor to achieving pregnancy.
Conclusions: As our results suggest, there is a discrepancy between biological and chronological ovarian age. In patients with an elevated cycle day 3 FSH level and over 40 years of age, alternatives to fertility treatments (ovum donation, adoption, or no treatment) should not be considered as first choices. Indeed, even with elevated FSH levels, a 16% pregnancy rate per egg retrieval may be obtained if three or more growing follicles can be seen during ovarian stimulation. However, in the presence of fewer than three growing follicles during ovarian stimulation, the patient should be informed about the discouraging prognosis of the running cycle.
Similar content being viewed by others
REFERENCES
Spandorfer S, Avrech O, Colombero L, Palermo G, Rosenwaks Z: Effect of parental age on fertilization and pregnancy: Characteristics in couples treated by intracytoplasmic sperm injection. Hum Reprod 1998;13:334–338
Navot D, Rosenwaks Z, Margalioth E: Prognostic assessment of female fecundity. Lancet 1987;2:645–647
Loumaye E, Billion J, Mine J, Psalti I, Pensis M, Thomas K: Prediction of individual response to controlled ovarian hyperstimulation by means of Clomiphene citrate challenge test. Fertil Steril 1990;53:295–301
Scott R, Toner J, Muasher S, Oehninger S, Robinson S, Rosenwaks Z: FSH levels on cycle day 3 are predictive of IVF outcome. Fertil Steril 1989;51:651–654
Rysselberge M, Puissant F, Barlow P, Lejeune B, Delvigne A, Leroy F: Fertility prognosis in IVF treatment of patients with cancelled cycles. Hum Reprod 1989;4:663–666
Jenkins J, Davies D, Devonport H, Anthony F, Gadd S, Watson R, Masson G: Comparison of “poor” responders with “good” responders using a standard buserelin/human menopausal gonadotrophin regime for in vitro fertilization. Hum Reprod 1991;6:918–921
Ferldberg D, Farhi J, Ashkenazi J, Dieker D, Shalev J, Ben-Rafael Z: Minidose gonadotrophin-releasing hormone agonist is the treatment of choice of poor responders with high follicular stimulating hormone levels. Fertil Steril 1994;62:343–346
Van Hoof M, Alberda A, Huisman G, Zeilmaker G, Leerentveld R: Doubling the human menopausal gonadotrophin dose in the course of an in-vitro fertilization treatment cycle in low responders: A randomized study. Hum Reprod 1993;8:369–373
Bassil S, Magritte JP, Roth J, Nisolle M, Donnez J, Gordts S: Uterine vascularity during stimulation and its correlation with implantation in in vitro fertilization. Hum Reprod 1995;10:1497–1501
Buyalos R, Daneshmand S, Brzechffa P: Basal estradiol and follicle-stimulating hormone predict fecundity in women of advanced reproductive age undergoing ovulation induction therapy. Fertil Steril 1997;68:272–277
McNaughton J, Banah M, McCloud M, Hee J, Burger H: Age-related changes in FSH, LH, estradiol and immunoreactive inhibin in women of reproductive age. Clin Edocrinol 1992;36:339–345
Faddy M, Gosden R, Gougeon A, Richardson S, Nelson J: Accelerated disappearance of ovarian follicles in mid life, implications for forecasting menopause. Hum Reprod 1992;7:1342–1346
Magarelli P, Pearlstone A, Buyalos R: Discrimination between chronological and ovarian age in infertile women aged 35 years and older: Predicting pregnancy using basal follicle stimulating hormone, age and number of ovulation induction/intra-uterine insemination cycles. Hum Reprod 1996;11:1214–1219
Toner J, Philiput C, Jones G, Muasher S: Basal follicle stimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril 1991;55:784–791
Wilcox A, Weiberg C, O'Connor J, Baird D, Schlatterer J, Canfield R, Armstrong E, Nosula B: Incidence of early loss of pregnancy. N Engl J Med 1988;319:189–194
Medrom D: Female reproductive ageing-ovarian and uterine factors. Fertil Steril 1993;59:1–5
Gougeon A, Chainy GB: Morphometric studies of small follicles in ovaries of women at different age. J Reprod Fertil 1987;81:433–442
Feldberg D, Farhi J, Ashkenazi J, Dicker D, Shalev J, Ben-Rafael Z: Minidose gonadotrophin-releasing hormone agonist is the treatment of choice in poor responders with high follicle-stimulating hormone levels. Fertil Steril 1994;62:343–346
Olivennes F, Righini C, Fanchin R, Torrisi C, Hazout A, Glissant M, Fernandez H, Frydman R: A protocol using a low dose of gonadotrophin-releasing hormone agonist might be the best protocol for patients with high follicle stimulating hormone concentrations on day 3. Hum Reprod 1996;11:1169–1172
Staessen C, Nagy ZP, Liu J, Janssenwillen C, Camus M, Devroey P, Van Steirteghem A: One year's experience with elective transfer of two good quality embryos in the human in-vitro fertilization and intracytoplasmic sperm injection programmes. Hum Reprod 1995;10:3305–3312
Scott R, Hofmann G, Oehninger S, Muasher S: Intercycle variability of day 3 follicle-stimulating hormone levels and its effect on stimulation quality in in vitro fertilization. Fertil Steril 1990;54:297–302
Hedon B, Baltier-Dereure F, Dechaud H: Women's age and assisted medical procreation. In Proceedings of the 15th World Congress on Fertility and Sterility, B Hedon, J Bringer, P Mares (eds). London, Parthenon, 1995, pp 379–385
Lavy G, Pellicer A, Diamond MP, De Cherney A: Ovarian stimulation for in vitro fertilization and embryo transfer, human menopausal gonadotrophin versus pure human follicle stimulating hormone: A randomized prospective study. Fertil Steril 1988;50:74–78
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bassil, S., Godin, P.A., Gillerot, S. et al. In Vitro Fertilization Outcome According to Age and Follicle-Stimulating Hormone Levels on Cycle Day 3. J Assist Reprod Genet 16, 236–241 (1999). https://doi.org/10.1023/A:1020359211343
Issue Date:
DOI: https://doi.org/10.1023/A:1020359211343