title: When is clomiphene or gonadotropin intrauterine insemination futile? Results of the Fast Track and Standard Treatment Trial and the Forty and Over Treatment Trial, two prospective randomized controlled trials.
abstract: OBJECTIVE
  To determine whether day 3 FSH and E2 levels at the upper limits of normal affect live-birth rates and treatment trajectory in a conventional versus "fast track" treatment program for IVF.
  
  
  METHODS
  Secondary analysis of two randomized controlled trials, FASTT and FORT-T.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Infertile women ages 21-42 years randomized to conventional or accelerated treatment with controlled ovarian hyperstimulation (COH)-IUI and/or IVF (n=603 patients contributing 2,717 total cycles).
  
  
  METHODS
  Patients were stratified according to basal FSH and E2: FSH<10 mIU/mL and E2<40 pg/mL (group 1A), FSH<10 mIU/mL and E2≥40 pg/mL (group 1B), FSH, 10-15 mIU/mL and E2<40 pg/mL (group 2A), and FSH, 10-15 mIU/mL and E2≥40 pg/mL (group 2B).
  
  
  METHODS
  Number of cancelled cycles, disenrollment for poor response, and cumulative live-birth rates per couple.
  
  
  RESULTS
  Women in groups 2A and 2B were more likely to have cancelled cycles and be disenrolled for poor response. While no live births occurred in group 2B during COH-IUI (0/19 couples, 0/58 cycles), IVF still afforded these patients a reasonable chance of success (6/18 couples, 6/40 cycles, 33.3% live-birth rate per couple). The specificity and positive predictive value of basal FSH of 10-15 mIU/mL and E2≥40 pg/mL for no live birth during COH-IUI treatment were both 100%.
  
  
  CONCLUSIONS
  Women who initiated infertility treatment with FSH of 10-15 mIU/mL and E2≥40 pg/mL on day 3 testing were unlikely to achieve live birth after COH-IUI treatment.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: dkaser@partners.org.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kaser
authors.affiliation: Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Marlene B
authors.initials: MB
authors.lastname: Goldman
authors.affiliation: Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: June L
authors.initials: JL
authors.lastname: Fung
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Boston IVF, Waltham, Massachusetts.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Alper
authors.affiliation: Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Reindollar
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D006062:Gonadotropins / Q000008:administration & dosage*; D006801:Humans; D007315:Insemination, Artificial / Q000379:methods / Q000706:statistics & numerical data*; D050498:Live Birth / Q000453:epidemiology*; D010062:Ovulation Induction / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene
keywords: Day 3 testing; FSH cutoff; IVF; fast track; ovarian reserve