Human Reproduction, Vol 12, 241-243, Copyright © 1997 by Oxford University Press
J Farhi, R Homburg, A Ferber, R Orvieto and Z Ben Rafael
The most important aspect of diminished ovarian reserve is the associated
decline in reproductive potential. Assessment of ovarian reserve is mainly
based on measurement of early follicular phase follicle stimulating 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 ovarian stimulation with
gonadotrophins. All developed ovarian failure within a relatively short
time span. Non-response to ovarian stimulation was defined by failure to
achieve development of follicles >12 mm and failure to raise oestradiol
concentration >350 pmol/l in two successive cycles of human menopausal
gonadotrophin (HMG) doses of up to five ampoules per day for 5-8 days.
Within a mean of 9 months following the failed attempts of ovarian
stimulation the mean day 3 FSH concentrations rose from 5.4 +/- 2.7 IU/l to
53.5 +/- 19.7 IU/l. In these patients, day 3 FSH concentration failed to
indicate the low ovarian reserve manifested only by lack of clinical
response to treatment with gonadotrophins which was the first sign of
impending ovarian failure. We conclude that women with normal early
follicular phase serum FSH concentrations who do not respond to ovarian
stimulation by HMG are at risk of developing ovarian failure within several
months.
ARTICLES
Non-response to ovarian stimulation in normogonadotrophic, normogonadal women: a clinical sign of impending onset of ovarian failure pre- empting the rise in basal follicle stimulating hormone levels
Department of Obstetrics and Gynecology, Sakler Faculty of Medicine, Tel Aviv University, Israel.
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