Domenico Massimo Ranieri

Simultaneous evaluation of basal follicle-stimulating hormone and 17β-estradiol response to gonadotropin-releasing hormone analogue stimulation: an improved predictor of ovarian reserve

OBJECTIVEnTo compare different predictors of ovarian reserve.nnnDESIGNnProspective study.nnnSETTINGnThe Assisted Conception Unit, University College London Hospitals.nnnPATIENT(S)nOne hundred seventy-seven patients undergoing IVF treatment.nnnINTERVENTION(S)nBlood samples were collected on cycle day 2 to determine basal levels of FSH and 17beta-E2 and the FSH/LH ratio, and on cycle days 3 and 4 to assess the increase in FSH (deltaFSH) and 17beta-E2 (deltaE2) after the commencement of GnRH analogue (GnRH-a) stimulation. Ultrasound scans were performed during ovarian stimulation to assess the number of follicles.nnnMAIN OUTCOME MEASURE(S)nDay 2 FSH and 17beta-E2 levels, the FSH/LH ratio, and the deltaFSH and deltaE2 after the commencement of GnRH-a stimulation were correlated with the number of follicles obtained after ovarian stimulation.nnnRESULT(S)nAll the possible predictors considered, except for the day 2 E2 level and the deltaFSH, correlated significantly with the ovarian response. The best single correlation was between the number of follicles and the deltaE2 (GnRH-a test). When the FSH level was evaluated simultaneously, the correlation was strengthened, resulting in a better negative predictive value.nnnCONCLUSION(S)nSimultaneous evaluation of basal levels of FSH and of the response of E2 to GnRH-a stimulation seems to be the best marker of ovarian reserve and a sensitive predictor of response to ovarian stimulation in patients undergoing IVF treatment.