Human Reproduction, Vol. 17, No. 1, 118-123,
January 2002
© 2002 European Society of Human Reproduction and Embryology
A moderately elevated day 3 FSH concentration has limited predictive value, especially in younger women
1 Division of Human Reproduction, Center for Reproductive Medicine and Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104-4283 and 2 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center and Health System, Philadelphia, PA, USA
BACKGROUND: A cycle day 3 FSH concentration is a popular screening tool for predicting success in achieving pregnancy after IVF. Difficulties interpreting this test have resulted from lack of consensus in defining an elevated FSH concentration, a change in the assays, and lack of controlling for factors which may confound the association between FSH concentration and pregnancy. METHODS: Assessment was made of the ability of a moderately elevated (10–11.4 mIU/ml, World Health Organization 2nd International Standard (IRP 78/549) and elevated FSH (>11.4 mIU/ml, conversion factor to SI units, 1.00) in predicting ability to achieve pregnancy through IVF and embryo transfer, both independently, and after controlling for confounding variables such as age, diagnosis, and response to gonadotrophins. RESULTS: A total of 293 IVF cycles were retrospectively reviewed. An FSH (>11.4) was strongly associated with inability to achieve pregnancy after IVF both independently (P < 0.01) and after multivariate analysis (P < 0.01), and had a strong predictive value (100%). A moderately elevated FSH (10–11.4) was not statistically associated with pregnancy outcome either independently or after multivariate analysis, and had a low predictive value (71%). CONCLUSIONS: Much of the predictive value of an elevated FSH is confounded by poor response to gonadotrophin stimulation, which may be overcome in younger women.
Key words: IVF/moderately elevated FSH/ovarian reserve/screening test
3 To whom correspondence should be addressed at: Division of Human Reproduction and Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania Medical Center, 106 Dulles, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA. E-mail: KBarnhart{at}mail.obgyn.upenn.edu
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