Basal follicle stimulating hormone level correlated to age is a good prognostic criterion for the outcome of intracytoplasmic sperm microinjection.

BACKGROUND: Age and increased FSH serum level in women are prognosis criteriae associated with decreased fertility.

OBJECTIVE: The aim of this study was to investigate whether age-specific FSH concentration can be a predictor of the outcome of ovarian stimulation in women undergoing IVF.

METHODS: A total of 676 women undergoing their first IVF cycle over a 3-year period were included in this retrospective cohort study. Patients were grouped according to age (< or ≥  38 years), and within each age range, patients were grouped into bFSH quartiles (< or ≥  9.6 mUI/L). We have considered four study groups: group A (Age < 38 years and FSH < 9.6 m UI/l), group B (Age < 38 years and FSH ≥ 9.6 m UI/l), group C (Age ≥ 38 years and FSH < 9.6 m UI/l), group D (Age ≥ 38 years and FSH ≥ 9.6 m UI/l). The outcome measures in each group included: consumed quantity of gonadotrophin, poor response, cycle cancellation, oocyte yield, number of embryos obtained, embryonic quality (grade 1 embryo), as well as, fertilization, implantation, clinical pregnancy and childbirth rates. Analysis of the Results compares laboratory parameters and ICSI Results, based on a statistical analysis that is essentially descriptive.

RESULTS: High bFSH levels in young patients (< 38 years) predicts a higher poor response (p < 0.0001), higher stopped cycles (p < 0.0001), lower oocyte yield (p < 0.0001) and lower embryos obtained (p < 0.0001) in IVF cycles but does not translate to either lower pregnancy, childbirth or implantation rates. In old women high FSH level does not influence ICSI outcome but may increase poor response (p <0.01) and stopped cycles (p < 0.0001). In each age group, the rate of spontaneous miscarriage does not increase according to FSH level. The pregnancy rate and child birth rate are better in young women with high FSH levels than in older women with normal FSH levels (p < 0.05).

CONCLUSION: The findings of this study suggest that basal FSH concentrations when correlated to age is a good predictive factor of ovarian response for assisted reproductive treatment. In young women a high FSH level may affect laboratary parametres but not pregnancy rate. In old women normal FSH level does not improve ICSI outcome but may increase "avorted" cycles. Pregnancy rate and child birth rate are better in young women with high FSH levels than in older women with normal FSH levels.