Ovarian Response and Pregnancy Rate according to Basal FSH concentration in Controlled Ovarian Hyperstimulation and Clomiphene Citrate stimulated cycle for ART

Hur, Kuol; Yang, Kwang Moon; Kim, Jin Young; Song, In Ok; Song, Ji Hong; Yoo, Keun Jai; Jun, Jong Young; Koong, Mi Kyoung; Kang, Inn Soo

Abstract

OBJECTIVE
To evaluate whether elevation of basal FSH predict poor ovarian response and lowered pregnancy rate in women undergoing controlled ovarian hyperstimulation (COH) and Clomiphene Citrate stimulated cycle (CC cycle) for assisted reproductive technologies (ART). METERIALS AND METHODS: From January 1999 to December 1999, total 1067 COH cycles and 119 CC cycles from 1033 patients were included in this study. At each cycle, on cycle day 2 or 3, basal FSH was measured before GnRH agonist starting. FSH value (mIU/ml) was 2 nd IRP 78/549 standard. We divided COH and CC cycles into 4 groups according to elevated basal FSH concentration, respectively. i) Normal (Basal FSH<10 mIU/ml): Group A (n=796), Group I (n=35), ii) Mildly elevated (10 mIU/ml< OR =basal FSH<15 mIU/ml): Group B (n=192), Group II (n=39), iii) Moderately elevated (15 mIU/ml< OR =basal FSH<20 mIU/ml): Group C (n=44), Group III (n=11), iv) Markedly elevated (basal FSH> OR =20 mIU/ml): Group D (n=35), Group IV (n=34). Retrospectively, we obtained mean total ampules of gonadotropin, mean serum E2 concenturation on hCG day, mean number of retrieved oocyte, mean number of embryo transferred, mean number of good embryo, cancellation rate, clinical pregnancy rate and live birth rate.
RESULTS
Ovarian response by elevation of basal FSH decreased more significantly in COH cycles than CC cycles. In COH cycles, ovarian response of Group B, C and D decreased significantly (P<0.001). In CC cycles, ovarian response of Group IV decreased significantly (P<0.01). Including cycles only under 35 years old, COH cycles with mildly elevated basal FSH had poor ovarian response (P<0.01), but the clinical pregnancy rate (28.3%) and live birth rate (24.2%) did not decrease, compared with normal FSH Group (27.5%, 23.1% respectively). In cycles with markedly elevated basal FSH, clinical pregnancy rate (5.9%) and live birth rate (2.9%) of CC cycles were equal to that of COH cycles (5.7%, 2.9%, respectively).
CONCLUSION
Mildly elevated basal FSH does not predict poor outcome in ART. Poor prognosis conferred by mildly elevated basal FSH may be overcome by maximizing stimulation protocol. Therefore other stimulation protocol for poor ovarian response may be effective in mildly elevated basal FSH cycles. In cycles with moderately to severe elevated basal FSH, lowered pregnancy rate was mainly due to quantitative and qualitative decrease in ovarian response. In cycles with markedly elevated basal FSH, CC stimulated cycle was more cost effective with good compliance.