EXOGENOUS FOLLICLE-STIMULATING-HORMONE OVARIAN RESERVE TEST (EFORT) -A SIMPLE AND RELIABLE SCREENING-TEST FOR DETECTING POOR RESPONDERS ININ-VITRO FERTILIZATION

Predicting ovarian response to stimulation constitutes a pivotal task in the organization of a successful in-vitro fertilization (NF) progra mme. The purpose of the current study was to determine whether a new o varian reserve test, the exogenous follicle stimulating hormone ovaria n reserve test (EFORT), could improve the predictive value of the clas sical follicle stimulating hormone (FSH) measurements on cycle day 3 o f ovarian stimulation regarding results of IVF. In this prospective st udy, 52 IVF candidates aged 27-42 years underwent 52 consecutive IVF c ycles. These women received 300 IU of purified FSH i.m. on cycle day 3 . Blood samples were taken just before the injection to measure plasma FSH and oestradiol; 24 h later, plasma oestradiol concentration was d etermined. Two menstrual cycles later, ovarian stimulation was perform ed for IVF using a time-release gonadotrophin-releasing hormone agonis t (GnRHa) and human menopausal gonadotrophin (HMG). For the interpreta tion of the EFORT results, we considered the post-FSH plasma oestradio l increment (Delta E(2)) and the baseline plasma FSH values (bFSH). Th e results of these two parameters were compared with the subsequent qu ality of the ovarian response to stimulation for IVF and the pregnancy outcome. Our results indicated a statistically significant improvemen t of the predictive value of the bFSH on the ovarian stimulation outco me when the EFORT parameters (bFSH and Delta E(2)) were analysed syner gistically. Indeed, 90% of the women whose EFORT parameters were consi dered to be normal (bFSH less than or equal to 11 mIU/ml, conversion f actor to SI units, 1.00; and Delta E(2) greater than or equal to 30 pg /ml, conversion factor to SI units, 3.671) had adequate responses to o varian stimulation, and 81% of women in whom both parameters were cons idered to be altered (bFSH greater than or equal to 11 mIU/ml and Delt a E(2) < 30 pg/ml) had poor responses to ovarian stimulation. The pred ictive value of bFSH alone was significantly poorer: only 60% of women having bFSH less than or equal to 11 mIU/ml had adequate responses to ovarian stimulation, and only 45% of women having bFSH > 11 mIU/ml ha d poor responses to ovarian stimulation (P < 0.02). We concluded that the EFORT is a simple and effective method for screening 'good' and 'p oor' responders in TVF, and that the addition of a dynamic component ( Delta E(2)) to the classical bFSH measurements has allowed an improvem ent of the predictive value of this test.