Fine tuning cycle day 3 hormonal assessment of ovarian reserve improves in vitro fertilization outcome in gonadotropin-releasing hormone antagonist cycles.
OBJECTIVE
To identify the cut-off values of the baseline (cycle day 3) levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E(2)) for improving the outcome prediction of GnRH antagonist in vitro fertilization (IVF) cycles and to determine whether the predictive accuracy of these values is affected by the patient's clinical prognosis.


METHODS
Retrospective analysis.


METHODS
An IVF clinic in a tertiary medical center. Women undergoing 230 consecutive IVF cycles using a GnRH antagonist protocol.


METHODS
None.


METHODS
Outcome of IVF, measured by ovarian response and pregnancy rates.


RESULTS
Lower baseline levels of FSH and E(2), but not LH, correlated with improved ovarian response and pregnancy rates in IVF cycles using a GnRH antagonist. Compared with our currently used criteria, the cut-off values of FSH <10 IU/L and E(2) <56 pg/mL would have significantly improved the IVF outcome in a population of patients with normal prognosis. However, a stricter baseline FSH cut-off value of 8 IU/L would have been required to improve the IVF outcome in a population of patients with a poor prognosis.


CONCLUSIONS
The outcome of IVF may be improved by modifying the hormonal starting criteria to take into account individual patient characteristics such as clinical prognosis.
Jurema
Marcus W
MW
Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Bracero
Nabal J
NJ
Garcia
Jairo E
JE
D000328:Adult; D019540:Area Under Curve; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000503:physiopathology*; D007986:Luteinizing Hormone / Q000097:blood*; D008597:Menstrual Cycle / Q000097:blood*; D010053:Ovary / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome
D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone