Follicle-stimulating hormone levels on cycle day 3 to predict ovarian response in women undergoing controlled ovarian hyperstimulation for in vitro fertilization using a flare-up protocol.

OBJECTIVE

To determine whether cycle day 3 serum FSH levels predict poor ovarian response and cycle cancellation in women undergoing controlled ovarian hyperstimulation (COH) for IVF.

DESIGN

Prospective case series.

SETTING

University hospital IVF program.

PATIENT(S): The study includes outcomes of 637 initial cycles of IVF.

INTERVENTION(S): Controlled ovarian hyperstimulation was undertaken with a short, flare-up GnRH agonist and hMG protocol. The relation of cycle day 3 FSH levels with various cycle characteristics and outcomes was determined.

MAIN OUTCOME MEASURE(S): The accuracy of cycle day 3 FSH levels in predicting poor ovarian response and cycle cancellation was evaluated. Receiver operating characteristic curves were constructed to determine the optimum cutoff value for the cycle day 3 serum FSH level that best predicted poor ovarian response and cycle cancellation.

RESULT(S): A cycle day 3 serum FSH level > or = 13 mIU/mL (conversion factor to SI unit, 1.00) was associated with a high likelihood of poor ovarian response and cycle cancellation. The sensitivity, specificity, and positive likelihood ratio of an FSH level of 13 mIU/mL in predicting cycle cancellation were 52%, 91%, and 6.04, respectively.

CONCLUSION(S): Cycle day 3 FSH screening appears to be a fairly accurate predictor of poor ovarian response and cycle cancellation in women undergoing COH using a short, flare-up GnRH agonist and hMG protocol.