Ovarian Reserve Testing: Quantity Versus Quality

Background and Significance: Day 3 FSH testing and antral follicle counts (AFC) are commonly used to predict ART outcome. However, debate exists regarding whether such tests have better quantitative or qualitative predictive value. Objective: To review ART outcomes based on basal FSH levels and AFC. Materials and Methods: Non donor IVF cycles between 1/2002 and 3/2004 were reviewed. Patients < 38 with FSH levels ≥10 (n=34) were compared to similarly aged patients with FSH levels <10 (n=173). Patients < 38 with FSH levels ≥10 were then compared to patients ≥38 with FSH levels <10 (n=62). Patients were also compared based on AFC. Patients < 38 with an AFC <10 (n=56) were compared to similarly aged patients with an AFC ≥10 (n=148), as well as to patients ≥38 with an AFC ≥10 (n=35). Chi Square and Student’s t testing were utilized for statistical analyses. Results: Patients < 38 with FSH ≥10 required more gonadotropins, had lower peak estradiol levels, and had fewer oocytes than patients with normal FSH levels, regardless of age. However, for patients <38, there was no significant difference in implantation rate (IR) between the FSH ≥10 and FSH <10 groups (46.6% vs 48.4%). In turn, there was no significant difference in pregnancy rate (PR) between the groups (57.6% vs 62.4%). Patients < 38 with FSH ≥10 had higher IR than patients ≥38 with FSH <10 (46.6% vs 22.7%, p<0.001). However there was no significant difference in PR (57.6% vs 48.6%). Patients ≥38 did have more embryos transferred. Qualitative ART outcome was also compared based on AFC. Patients <38 with an AFC <10 (mean =7.2) had similar IR (48% vs 56%) and PR (56% vs 65%) compared to aged matched patients with an AFC ≥10 (mean=16.8). However, patients <38 with an AFC <10 had a significantly higher IR (48% vs 24%, p<.005) than patients ≥38 with an AFC ≥10 (mean =15). PR was similar between the 2 groups (56% vs 48%), again likely secondary to more embryos being transferred in the older patient group. Conclusion: Day 3 FSH testing and antral follicle counts appear to have more quantitative than qualitative predictive value, particularly in younger patients. Table 1Comparison of patients <38 by FSH level<38 and FSH ≥10 n=34<38 and FSH <10 n=173P valueMean Age (yrs)33.8 ± 1.733.1 ± 1.2NSAge Range (yrs)23–3724–37NAMean FSH (mIU/mL)11.5 ± 0.256.2 ± 0.10<.001AFC9.18 ± 0.3115.2 ± 0.76<.005Oocytes (number)8.8 ± 0.5414.4 ± 0.73<.001Gonadotropins (IU)4556 ± 2682775 ± 75<.001Peak E2 (pg/mL)1572 ± 1252316 ± 68<.005Average # tx2.06 ± 0.092.05 ± 0.03NSIR46.6%48.4%NSPR57.6%62.4%NS Open table in a new tab Table 2Comparison of patients by age and FSH level<38 and FSH ≥10 n=34>38 and FSH<10 n=62P valueMean Age (yrs)33.8 ± 1.739.7 ± 1.4<.05Age Range (yrs)23–3738–43NAMean FSH (mIU/mL)11.5 ± 0.256.4 ± 0.17<.001AFC9.18 ± 0.3111.26 ± 0.61<.05Oocytes (number)8.8 ± 0.5412.02 ± 0.58<.05Gonadotropoins (IU)4556 ± 2683928 ± 112<.05Peak E2 (pg/mL)1572 ± 1252177 ± 106<.05Average # tx2.06 ± 0.092.85 ± 0.07<.001IR46.6%22.7%<.001PR57.6%48.6%NS Open table in a new tab