In vitro fertilization outcome according to age and follicle-stimulating hormone levels on cycle day 3

Purpose: In a retrospective study, the prognostic factors of in vitro ferti lization 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 gonadotropi n-releasing hormone agonist/human menopausal gonadotropin in a short protoc ol. All patients underwent FSH dosage on cycle day 3 prior to stimulation. The pregnancy rate was studied according to age, FSH levels, and stimulatio n 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 ova rian 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 mo re growing follicles during stimulation achieved a significantly higher pre gnancy rate per egg retrieval (16%) compared to patients with fewer than th ree growing follicles (6%). Eighty percent of those pregnancies were obtain ed during the first two IVF cycles. Even with an elevated FSH level, some p atients developed three or more follicles after stimulation. In such cases, the number of embryos available for transfer was the only significant limi ting factor to achieving pregnancy. Conclusions: As our results suggest, there is a discrepancy between biologi cal and chronological ovarian age. In patients with art 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 firs t 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 see n during ovarian stimulation. However, in the presence of fewer than three growing follicles during ovarian stimulation, the patient should be informe d about the discouraging prognosis of the running cycle.