Taking a basal follicle-stimulating hormone history is essential before initiating in vitro fertilization

Abstract

Objective: To analyze IVF outcomes in patients with a history of one or more elevations in basal FSH who have a normal basal FSH at the start of their IVF cycle, compared with the general IVF population.

Design: Retrospective clinical study.

Setting: University hospital.

Patient(s): General IVF patient population.

Intervention(s): Patients received standard IVF gonadotropin protocols, oocyte retrieval, and embryo transfer.

Main outcome measure(s): Oocyte yield, fertilization, implantation, clinical pregnancy, and cancellation rate.

Result(s): Oocyte yields were lower in patients with a history of elevated basal FSH, for all age groups, and showed an age-dependent decline in all patients. Over the age of 40 years, both implantation and clinical pregnancy rates were lower in these patients, with no significant difference observed in patients under the age of 40 years. No pregnancies were observed in patients with a history of three or more elevated FSH levels, regardless of age.

Conclusion(s): A history of elevated basal FSH levels in patients under the age of 40 years predicts a lower oocyte yield in IVF cycles with normal basal FSH levels but does not translate to either lower pregnancy or implantation rates. Patients aged >40 years with prior elevations in basal FSH levels have both compromised ovarian response and compromised embryo quality relative to those with normal FSH levels, as illustrated by lower oocyte yield, higher cancellation rates, and lower implantation and pregnancy rates.