Simultaneous evaluation of basal follicle-stimulating hormone and 17 beta-estradiol response to gonadotropin-releasing hormone analogue stimulation: an improved predictor of ovarian reserve.
OBJECTIVE
To compare different predictors of ovarian reserve.


METHODS
Prospective study.


METHODS
The Assisted Conception Unit, University College London Hospitals.


METHODS
One hundred seventy-seven patients undergoing IVF treatment.


METHODS
Blood samples were collected on cycle day 2 to determine basal levels of FSH and 17beta-E2 and the FSH/LH ratio, and on cycle days 3 and 4 to assess the increase in FSH (deltaFSH) and 17beta-E2 (deltaE2) after the commencement of GnRH analogue (GnRH-a) stimulation. Ultrasound scans were performed during ovarian stimulation to assess the number of follicles.


METHODS
Day 2 FSH and 17beta-E2 levels, the FSH/LH ratio, and the deltaFSH and deltaE2 after the commencement of GnRH-a stimulation were correlated with the number of follicles obtained after ovarian stimulation.


RESULTS
All the possible predictors considered, except for the day 2 E2 level and the deltaFSH, correlated significantly with the ovarian response. The best single correlation was between the number of follicles and the deltaE2 (GnRH-a test). When the FSH level was evaluated simultaneously, the correlation was strengthened, resulting in a better negative predictive value.


CONCLUSIONS
Simultaneous evaluation of basal levels of FSH and of the response of E2 to GnRH-a stimulation seems to be the best marker of ovarian reserve and a sensitive predictor of response to ovarian stimulation in patients undergoing IVF treatment.
Ranieri
D M
DM
Department of Obstetrics and Gynaecology, University College London Hospitals, United Kingdom.
Quinn
F
F
Makhlouf
A
A
Khadum
I
I
Ghutmi
W
W
McGarrigle
H
H
Davies
M
M
Serhal
P
P
D000328:Adult; D001481:Basal Metabolism; D004958:Estradiol / Q000378:metabolism*; D005069:Evaluation Studies as Topic; D005260:Female; D005640:Follicle Stimulating Hormone / Q000378:metabolism*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D016014:Linear Models; D010053:Ovary / Q000187:drug effects* / Q000378:metabolism; D011379:Prognosis; D015203:Reproducibility of Results; D012636:Secretory Rate / Q000187:drug effects; D013268:Stimulation, Chemical; D013997:Time Factors
D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D005640:Follicle Stimulating Hormone