title: Predictive value and clinical impact of Basal follicle-stimulating hormone in subfertile, ovulatory women.
abstract: BACKGROUND
  Basal FSH is a marker for ovarian reserve.
  
  
  OBJECTIVE
  The objective of the study was to investigate the predictive value of basal FSH on spontaneous ongoing pregnancy in subfertile ovulatory women.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  The study was conducted in 19 fertility centers in The Netherlands.
  
  
  METHODS
  Subfertile ovulatory women without two-sided tubal pathology and in whom the man had normal sperm parameters (total motile count > or = 3 x10(6)) participated in the study.
  
  
  METHODS
  Interventions included a fertility work-up, including a basal FSH measurement on cycle d 3.
  
  
  METHODS
  Spontaneous ongoing pregnancy was measured.
  
  
  RESULTS
  We included 3519 consecutive couples of which 562 (16%) had a spontaneous ongoing pregnancy within 1 yr. Basal FSH levels of 8 IU/liter or higher were associated with a decreased probability of spontaneous ongoing pregnancy [hazard ratio (HR) 0.93/IU.liter (95% confidence interval [CI] 0.87-0.98)]. In a multivariable analysis, female age (HR 0.97/yr, 95% CI 0.95-0.99), cycle length (HR 0.96/d, 95% CI 0.93-1.0), and FSH levels 8 IU/liter or greater (HR 0.93/IU.liter, 95% CI 0.87-0.99) were strong negative predictors for spontaneous ongoing pregnancy. Addition of FSH to a prediction model based on female age, duration of subfertility, previous pregnancy, referral status, and semen analysis changed the probability to conceive spontaneously from 30% or greater to less than 30% in 97 of 3219 couples (3.0%).
  
  
  CONCLUSIONS
  In ovulatory women, a basal FSH level of 8 IU/liter or higher is associated with decreasing fecundity, independent of female age and cycle length. Because the number of couples in whom the FSH level alters management decisions is low, we do not recommend routine testing of basal FSH in subfertile couples.
authors.affiliation: Academic Medical Center, Center of Reproductive Medicine, Room H4-213, Department of Obstetrics/Gynecology, Meibergdreef 9, Amsterdam, The Netherlands. j.w.vandersteeg@amc.uva.nl
authors.forename: Jan W
authors.initials: JW
authors.lastname: van der Steeg
authors.forename: Pieternel
authors.initials: P
authors.lastname: Steures
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
authors.forename: Peter G A
authors.initials: PG
authors.lastname: Hompes
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Broekmans
authors.forename: Peter X J M
authors.initials: PX
authors.lastname: Bouckaert
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010060:Ovulation; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D005640:Follicle Stimulating Hormone