A moderately elevated day 3 FSH concentration has limited predictive value, especially in younger women.
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.
Esposito
M A
MA
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, USA.
Coutifaris
C
C
Barnhart
K T
KT
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D006063:Chorionic Gonadotropin; D005640:Follicle Stimulating Hormone