This Article Full Text Full Text (PDF) All Versions of this Article: 92/6/2163    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via Google Scholar Google Scholar Articles by van der Steeg, J. W. Search for Related Content PubMed PubMed Citation Articles by van der Steeg, J. W. Pubmed/NCBI databases Substance via MeSH Hazardous Substances DB MENOTROPINS Related Collections Female Endocrinology Neuroendocrinology and Pituitary

Predictive Value and Clinical Impact of Basal Follicle-Stimulating Hormone in Subfertile, Ovulatory Women

Center for Reproductive Medicine (J.W.v.d.S., P.S., F.v.d.V., B.W.J.M.) and Department of Clinical Epidemiology and Biostatistics (P.M.M.B.), Academic Medical Center, 1105 AZ Amsterdam, The Netherlands; Department of Public Health (J.W.v.d.S., P.S., M.J.C.E., J.D.F.H.), Erasmus Medical Center, University Medical Center Rotterdam, 3000 DR Rotterdam, The Netherlands; Department of Obstetrics and Gynecology (J.W.v.d.S., P.S., P.G.A.H.), Vrije Universiteit Medical Center, 1081 HV Amsterdam, The Netherlands; Division of Reproductive Medicine (F.J.B.), Department of Perinatology and Gynaecology, University Medical Center, 3508 GA Utrecht, The Netherlands; Department of Obstetrics and Gynecology (P.X.J.M.B.), Atrium Medisch Centrum, 3503 RE Heerlen, The Netherlands; and Department of Obstetrics and Gynecology (B.W.J.M.), Máxima Medical Center, 5500 MB Veldhoven, The Netherlands

Address all correspondence and requests for reprints to: Jan Willem van der Steeg, Academic Medical Center, Center of Reproductive Medicine, Room H4-213, Department of Obstetrics/Gynecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail: j.w.vandersteeg{at}amc.uva.nl.

Context: Basal FSH is a marker for ovarian reserve.

Objectives: The objective of the study was to investigate the predictive value of basal FSH on spontaneous ongoing pregnancy in subfertile ovulatory women.

Design: This was a prospective cohort study.

Setting: The study was conducted in 19 fertility centers in The Netherlands.

Participants: Subfertile ovulatory women without two-sided tubal pathology and in whom the man had normal sperm parameters (total motile count 3 x10⁶) participated in the study.

Interventions: Interventions included a fertility work-up, including a basal FSH measurement on cycle d 3.

Main Outcome Measures: Spontaneous ongoing pregnancy was measured.

Results: We included 3519 consecutive couples of which 562 (16%) had a spontaneous ongoing pregnancy within 1 yr. Basal FSH levels of 8 IU/liter or higher were associated with a decreased probability of spontaneous ongoing pregnancy [hazard ratio (HR) 0.93/IU·liter (95% confidence interval [CI] 0.87–0.98)]. In a multivariable analysis, female age (HR 0.97/yr, 95% CI 0.95–0.99), cycle length (HR 0.96/d, 95% CI 0.93–1.0), and FSH levels 8 IU/liter or greater (HR 0.93/IU·liter, 95% CI 0.87–0.99) were strong negative predictors for spontaneous ongoing pregnancy. Addition of FSH to a prediction model based on female age, duration of subfertility, previous pregnancy, referral status, and semen analysis changed the probability to conceive spontaneously from 30% or greater to less than 30% in 97 of 3219 couples (3.0%).

Conclusions: In ovulatory women, a basal FSH level of 8 IU/liter or higher is associated with decreasing fecundity, independent of female age and cycle length. Because the number of couples in whom the FSH level alters management decisions is low, we do not recommend routine testing of basal FSH in subfertile couples.