Performance of basal follicle-stimulating hormone in the prediction of poor ovarian response and failure to become pregnant after in vitro fertilization: a meta-analysis.
OBJECTIVE
To assess the predictive performance and clinical value of basal FSH as a test for ovarian reserve in in vitro fertilization (IVF) patients.


METHODS
Meta-analysis.


METHODS
Tertiary fertility center.


METHODS
Patients undergoing IVF.


METHODS
None.


METHODS
Poor ovarian response, nonpregnancy.


RESULTS
We located 21 studies that had reported on basal FSH and IVF outcome. No single study met high standards of methodological rigor; most studies are of moderate methodological quality only. The summary receiver operating characteristic curve indicated a moderate predictive performance for poor response, and a low predictive performance for nonpregnancy. Predictions with a substantial shift from pre-FSH-test probability to post-FSH test probability are only achieved at extreme cut-off levels for basal FSH. Sensitivity of such cut-off levels, for both the prediction of poor response and nonpregnancy, is limited.


CONCLUSIONS
Clinical value of testing for basal FSH is restricted to a small minority of patients. Basal FSH should not be regarded as a useful routine test for the prediction of IVF outcome. The development of better tests to assess ovarian reserve remains of importance.
Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands. lbancsi@azu.nl
László F J M M
LF
Bancsi
Frank J M
FJ
Broekmans
Ben W J
BW
Mol
J Dik F
JD
Habbema
Egbert R
ER
te Velde
D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D010053:Ovary / Q000502:physiology*; D011247:Pregnancy
D005640:Follicle Stimulating Hormone