NONRESPONSE TO OVARIAN STIMULATION IN NORMOGONADOTROPHIC, NORMOGONADAL WOMEN - A CLINICAL SIGN OF IMPENDING ONSET OF OVARIAN FAILURE PREEMPTING THE RISE IN BASAL FOLLICLE-STIMULATING-HORMONE LEVELS

The most important aspect of diminished ovarian reserve is the associa ted decline in reproductive potential. Assessment of ovarian reserve i s mainly based on measurement of early follicular phase follicle stimu lating hormone (FSH) concentration. The objective of this study was to report the identification of a group of 12 infertile women initially diagnosed as having unexplained or anovulatory infertility, who had a normal baseline hormonal profile and did not respond to repeated ovari an stimulation with gonadotrophins. All developed ovarian failure with in a relatively short time span. Non-response to ovarian stimulation w as defined by failure to achieve development of follicles >12 mm and f ailure to raise oestradiol concentration >350 pmol/l in two successive cycles of human menopausal gonadotrophin (HMG) doses of up to five am poules per day for 5-8 days. Within a mean of 9 months following the f ailed attempts of ovarian stimulation the mean day 3 FSH concentration s rose from 5.4 +/- 2.7 IU/1 to 53.5 +/- 19.7 IU/1. In these patients, day 3 FSH concentration failed to indicate the low ovarian reserve ma nifested only by lack of clinical response to treatment with gonadotro phins which was the first sign of impending ovarian failure. We conclu de that women with normal early follicular phase serum FSH concentrati ons who do not respond to ovarian stimulation by HMG are at risk of de veloping ovarian failure within several months.