Jsb. Martin et al., FUTURE IN-VITRO FERTILIZATION PREGNANCY POTENTIAL OF WOMEN WITH VARIABLY ELEVATED DAY 3 FOLLICLE-STIMULATING-HORMONE LEVELS, Fertility and sterility, 65(6), 1996, pp. 1238-1240
Objectives: To determine the IVF-ET pregnancy potential of women with
variably elevated day 3 FSH. Design: Cohort evaluation of 1,868 consec
utive IVF-ET cycles January 1991 to December 1994. Setting: University
hospital infertility unit. Patients: Four cohorts of couples were def
ined based on day 3 FSH determinations with an arbitrary threshold of
20 mIU/mL, only greater than or equal to 20 mIU/mL, always <20 mIU/mL,
current <20 mIU/mL but one previous greater than or equal to 20 mIU/m
L, and current <20 mIU/mL but two or more previous greater than or equ
al to 20 mIU/mL (conversion factor to SI unit, 1.00). Intervention: In
vitro fertilization-embryo transfer. Main Outcome Measure: Fetal hear
t activity on luteal day 40 transvaginal ultrasound. Results: No pregn
ancies occurred in 53 cycles with day 3 FSH only greater than or equal
to 20 mIU/mL. In 1,750 women whose day 3 FSH levels were always <20 m
IU/mL, the pregnancy rate (PR) per cycle was 16.5%. In 54 cycles in wh
ich day 3 FSH was greater than or equal to 20 one time only, but <20 m
IU/mL during the treatment cycle, the PR was 5.6%. In 11 cycles where
two or more previous FSH determinations were greater than or equal to
20 mIU/mL but with a current day 3 FSH <20 mIU/mL, no pregnancies occu
rred. Conclusion: Our data leads us to the conclusion that day 3 FSH d
etermination precede every IVF cycle and that cycles with FSH greater
than or equal to 20 mIU/mL be canceled. It also suggests that women wi
th two previous elevations of day 3 FSH be discouraged from future IVF
cycles. The 5.6% pregnancy per cycle with one previously elevated FSH
warrants extreme pessimism in discussion of further cycles.