ART Fertility Clinic, Royal Marina Village, B22-23, Abu Dhabi, UAE.
ART Fertility Clinic, Royal Marina Village, B22-23, Abu Dhabi, UAE; Department of Reproductive Medicine UZ Ghent, Belgium.
Reprod Biomed Online. 2024 Mar;48(3):103701. doi: 10.1016/j.rbmo.2023.103701. Epub 2023 Nov 10.
Are basal FSH measurements, when elevated within its normal range, useful for assessing overall ovarian response and predicting unexpected poor or suboptimal ovarian response?
Retrospective cohort study of ovarian stimulation cycles.
A total of 1058 ovarian stimulation cycles (891 first, 167 repeated) were included. Anti-Müllerian hormone (AMH) values were categorized into four (0 to ≤0.6, >0.6 to ≤1.2, >1.2 to ≤3.0, >3.0 to ≤6.25 ng/ml) and basal FSH levels into four groups (<25th percentile: >3.5 to 6.1 IU/ml; 25-75th percentile: >6.1 to ≤8.5 IU/ml; >75-90th percentile: >8.5 to ≤9.9 IU/ml; >90th percentile: >9.9 to ≤12.5 IU/ml). Including only first cycles, a significant independent effect of basal FSH on retrieved cumulus-oocyte complex (COC) count was seen for all basal FSH categories (>90th, >75 to ≤90th, >25 to ≤75th compared with ≤25th percentile, P < 0.001, P = 0.001 and P = 0.007, respectively), when adjusted for age, body mass index (BMI), AMH, antral follicle count (AFC), starting dose and gonadotrophin type. Including only first cycles, patients aged 35 years or older with AFC of 5 or above and AMH 1.2 ng/ml or above, showed significantly higher odds of unexpected poor or suboptimal response if they had higher basal FSH values. Most prominently in the above 90th percentile group (OR 8.64, 95% CI 2.84 to 28.47 compared with <25th percentile) but lower categories (>25th to ≤75th percentile: OR 3.04, 95% CI 1.42 t 6.99; >75th to ≤90th percentile: OR 3.47, 95% CI 1.28 to 9.83 compared with ≤25th percentile) also showed a significant association after adjusting for age, AMH, BMI, AFC, dose, and gonadotrophin type. In patients with a second cycle, an increase in FSH levels in the second round compared with the first was associated with fewer retrieved COCs (estimate: -0.44, 95% CI -0.44 to -0.05, P = 0.027). This effect was adjusted for changes in age, FSH, AFC, starting dose, stimulation duration and change in medication type.
Basal FSH is independently associated with overall ovarian response. Moreover, it is associated with unexpected poor or suboptimal response in patients, who would fulfill POSEIDON group 2 criteria after oocyte retrieval.
基础卵泡刺激素（FSH）在正常范围内升高时，是否有助于评估整体卵巢反应并预测意外的卵巢反应不良或不理想？
卵巢刺激周期的回顾性队列研究。
共纳入 1058 个卵巢刺激周期（891 个首次周期，167 个重复周期）。抗苗勒管激素（AMH）值分为四组（0 至≤0.6、>0.6 至≤1.2、>1.2 至≤3.0、>3.0 至≤6.25ng/ml），基础 FSH 水平分为四组（<第 25 百分位数：>3.5 至 6.1IU/ml；25-75 百分位数：>6.1 至≤8.5IU/ml；>75-90 百分位数：>8.5 至≤9.9IU/ml；>90 百分位数：>9.9 至≤12.5IU/ml）。仅包括首次周期时，所有基础 FSH 类别（>90 百分位数、>75 至≤90 百分位数、>25 至≤75 百分位数与≤25 百分位数相比，P<0.001、P=0.001 和 P=0.007）的基础 FSH 对获得的卵丘-卵母细胞复合物（COC）计数有显著的独立影响，调整年龄、体重指数（BMI）、AMH、窦卵泡计数（AFC）、起始剂量和促性腺激素类型后。仅包括首次周期时，年龄≥35 岁且 AFC 为 5 或以上且 AMH 为 1.2ng/ml 或以上的患者，如果基础 FSH 值较高，发生意外卵巢反应不良或不理想的可能性显著增加。最显著的是在上述>90 百分位数组（OR 8.64，95%CI 2.84 至 28.47 与<25 百分位数相比），但较低的类别（>25 至≤75 百分位数：OR 3.04，95%CI 1.42 至 6.99；>75 至≤90 百分位数：OR 3.47，95%CI 1.28 至 9.83 与<25 百分位数相比）在调整年龄、AMH、BMI、AFC、剂量和促性腺激素类型后也显示出显著的相关性。在第二次周期的患者中，与第一次相比，第二轮 FSH 水平升高与获得的 COC 数量减少相关（估计值：-0.44，95%CI -0.44 至-0.05，P=0.027）。该效应调整了年龄、FSH、AFC、起始剂量、刺激持续时间和药物类型变化的影响。
基础 FSH 与整体卵巢反应独立相关。此外，它与意外的卵巢反应不良或不理想相关，在进行卵母细胞采集后符合 POSEIDON 组 2 标准的患者中尤其如此。
