Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH
Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH
复制标题
DOI：
10.1093/humrep/dei288
复制
发表时间：
2006-01-01
影响因子：
6.1
通讯作者：
Thum, MY
中科院分区：
文献类型：
--
作者：
Abdalla, H;Thum, MY
背景：通常的做法是在周期早期反复检测基础卵泡刺激素水平，只有当卵泡刺激素水平低于某一阈值时才开始IVF治疗。这是基于这样一种观点，即当这些女性在月经周期开始时基础FSH水平较低时，她们对卵巢刺激的反应会更好。本研究的目的是评估这种做法的价值。方法：1995年1月至2003年1月，对39名妇女进行了鉴定。这些妇女在12个月内接受了两次体外受精治疗周期。已知每个周期之前的基础卵泡刺激素水平已经改变。治疗周期分为高基础FSH周期（>= 10 IU/l）和低基础FSH周期（< 10 IU/l）。结果：39名妇女共接受了78个治疗周期（第一个周期中20名FSH水平升高，19名FSH水平较低，第二个周期中反之亦然）。因此，FSH高周期39个，FSH低周期39个。第一个治疗周期明显无活产，故患者在第一个治疗周期后12个月内再次接受治疗周期。高FSH组6例妊娠[妊娠率(PR) = 15.4%]， 5例分娩[活产率(LBR) = 12.8%]。在低FSH组，3人怀孕（PR = 7.7%）， 2人分娩（LBR = 5.1%）。然而，PR和LBR的差异不显著。两组在收集卵母细胞数量、受精卵母细胞数量、胚胎移植数量和流产率方面均无显著差异。结论：本研究结果表明，反应不良或卵巢储备减少的妇女预后较差，反复检测不会增加任何价值。有卵泡刺激素升高病史的骑行女性应立即接受治疗。对这些妇女推迟治疗可能会适得其反，因为她们可能要等好几个月，在这段时间里，她们会变老，接近更年期。
BACKGROUND: It is a common practice to repeatedly test the level of basal FSH early in the cycle and to start IVF treatment only when the FSH level is below a certain threshold value. This is based on the idea that these women will respond better to ovarian stimulation when the basal FSH level is lower at the start of the cycle. The aim of this study is to assess the value of this practice. METHODS: Between January 1995 and January 2003, 39 women were identified. These women underwent two IVF treatment cycles within a 12 month period. The basal FSH level prior to each of these cycles was known to have changed. The treatment cycles were divided into cycles with a high basal FSH (>= 10 IU/l) and cycles with a low basal FSH (< 10 IU/l). RESULTS: The 39 women underwent a total of 78 treatment cycles (in the first cycle 20 had elevated level of FSH and 19 had low FSH and vice versa in the second cycle). Therefore, there were 39 cycles with high FSH and 39 cycles with low FSH. There was obviously no live birth in the first treatment cycle, hence the reason for the patient undergoing another treatment cycle within 12 months of the first one. In the high FSH group, six became pregnant [pregnancy rate (PR) = 15.4%] and five delivered [live birth rate (LBR) = 12.8%]. In the low FSH group, three became pregnant (PR = 7.7%) and two delivered (LBR = 5.1%). The difference in PR and LBR, however, was not significant. Neither were there significant differences between the two groups with regard to the number of oocytes collected, oocytes fertilized, embryos transferred or miscarriage rate. CONCLUSION: The results of this study reveal that women who are poor responders or with reduced ovarian reserve have a poor outcome and repeatedly testing them will add no value. Cycling women with a history of elevated FSH should be offered treatment without further delay. Delaying treatment for these women could be counterproductive, as they may have to wait for many months, during which time they are getting older and closer to their menopause.