Does the basal serum FSH level following pituitary suppression in a long IVF protocol predict the ovarian response? [Uzun IVF protokollerinde supresyon sonrasi bakilan bazal serum FSH deǧeri over cevabini belirler mi?]

Abstract

Objective: To investigate whether the ovarian response could be predicted on the basis of the basal serum FSH concentration following pituitary suppression in a long IVF protocol with the midluteal start of the GnRH agonist. Materials and Methods: 174 ICSI cycles with a long protocol (mid-luteal start of the GnRH analog) between November 2001 and August 2003 were analyzed in this retrospective analysis. Cycles with a poor ovarian response, i.e. cancelled cycles due to poor response and those with oocyte aspirations of ≤3 MII oocytes, were compared to cycles with a normal ovarian response (aspiration of >3 MII oocytes) with respect to ovarian reserve tests and basal serum FSH following down-regulation. Receiver operating characteristic and logistic regression analyses were used to analyse the predictive power of ovarian reserve tests for the poor ovarian response. Results: Age, basal serum E2 level, antral follicle count, basal serum FSH level after down-regulation, total gonadotropin dose, duration of stimulation, serum E2 level and number of follicles on the day of hCG and number of oocytes retrieved were significantly different between normal responders and poor responders. Age, basal serum E2 level, antral follicle count, basal serum FSH level after down-regulation were the ovarian reserve tests, which had a significant predictive value for the poor ovarian response. However, basal serum FSH level after down-regulation was not an independent predictor. Conclusion: The basal serum FSH concentration following pituitary suppression in a long IVF protocol can predict the ovarian response, and therefore, can be used as an ovarian reserve test. This supports the idea that FSH secretion is regulated also by significant GnRH-independent mechanisms.