Department of Obstetrics and Gynecology, Dumlupinar Bulvari, Akdeniz University, School of Medicine, Kadin Hastaliklari ve Dogum A.D., Antalya, Turkey.
Arch Gynecol Obstet. 2009 Nov;280(5):761-5. doi: 10.1007/s00404-009-1003-6. Epub 2009 Mar 3.
To determine whether monitoring follicle stimulating hormone (FSH) levels in over-responding patients whom the gonadotropins were withheld would predict pregnancy outcome.
A group of 33 female infertility patients aged between 20-40 years who had to be coasted during controlled ovarian hyperstimulation were recruited for this study. The FSH concentrations on human chorionic gonadotropin (HCG) day and on the four preceding days were measured to determine the threshold FSH concentration for follicular growth and conception. Mean and standard deviation were used for presenting parametric data. Student's t test and the Mann Whitney U test were used for statistical analysis. Two-tailed P < 0.05 was taken as significant. Receiver-operating characteristic (ROC) curves were performed to identify the cutoff level for FSH and E2 at HCG day and four preceding days.
Of 33 cycles, 16 were stimulated with recombinant FSH and 17 with recombinant FSH and human menopausal gonadotropin (HMG). The basal and mean coasting FSH levels of FSH and FSH + HMG cycles did not reveal any differences. FSH concentrations decreased the day after coasting began in 26 cycles and fell by 30.2 +/- 2.7% (range 2-53). In 7 cycles, we observed 34.5 +/- 7.4% (range 6-56) declines in FSH levels beginning 2 days after coasting. Of the 31 women who received HCG, 21 conceived during in vitro fertilization and embryo transfer (IVF-ET). Gestational sac and fetal heart activity were visualized in 14 patients. ROC analysis releaved a cutoff value of 4.9 in FSH level at HCG day discriminative of conception or nonconception.
The results from this study show that monitoring serum FSH levels during coasting may be helpful in predicting the pregnancy outcome.
确定在促性腺激素被停用的超反应患者中监测卵泡刺激素（FSH）水平是否可以预测妊娠结局。
本研究纳入了 33 名年龄在 20-40 岁之间的女性不孕患者，这些患者在控制性卵巢超刺激期间需要 coasting。测量人绒毛膜促性腺激素（HCG）日和前四天的 FSH 浓度，以确定卵泡生长和受孕的阈值 FSH 浓度。使用均值和标准差表示参数数据。使用学生 t 检验和曼-惠特尼 U 检验进行统计分析。双尾 P < 0.05 被认为具有统计学意义。进行Receiver-operating characteristic（ROC）曲线分析以确定 HCG 日和前四天的 FSH 和 E2 的截断值。
在 33 个周期中，16 个周期使用重组 FSH 刺激，17 个周期使用重组 FSH 和人绝经促性腺激素（HMG）刺激。FSH 和 FSH+HMG 周期的基础和平均 coasting FSH 水平没有差异。在 26 个周期中， coasting 开始后的第二天 FSH 浓度下降，下降了 30.2 +/- 2.7%（范围 2-53）。在 7 个周期中，我们观察到 coasting 开始后第 2 天 FSH 水平下降了 34.5 +/- 7.4%（范围 6-56）。在接受 HCG 的 31 名女性中，21 名在体外受精和胚胎移植（IVF-ET）中受孕。在 14 名患者中可见孕囊和胎心活动。ROC 分析显示，HCG 日 FSH 水平的截断值为 4.9，可区分受孕和未受孕。
本研究结果表明，在 coasting 期间监测血清 FSH 水平可能有助于预测妊娠结局。
