Predictive value and clinical impact of Basal follicle-stimulating hormone in subfertile, ovulatory women.
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.
van der Steeg
Jan W
JW
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
Steures
Pieternel
P
Eijkemans
Marinus J C
MJ
Habbema
J Dik F
JD
Hompes
Peter G A
PG
Broekmans
Frank J
FJ
Bouckaert
Peter X J M
PX
Bossuyt
Patrick M M
PM
van der Veen
Fulco
F
Mol
Ben W J
BW
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
D015415:Biomarkers; D005640:Follicle Stimulating Hormone