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In candidates for assistedconception serum FSH but not oestradiol is related to declining ovarian reserve in the fourth decadeAP Brown1, L Maddison1, C Fitzgerald2, D Gould2, L Nardo2 and I Laing11Department of Clinical Biochemistry, Manchester Royal Infirmary. 2Department of Reproductive Medicine, St Mary’s Hospital, Manchester

  • Introduction

  • Reproductive performance is assumed to be determined by the decline of the primordial follicle pool in the ovary.

  • Criteria used to assess ovarian function and to accept subfertile patients for ovarian stimulation are still a matter of much debate.

  • Various biochemical and ultrasonographic markers are used to investigate the ovarian reserve in candidates for IVF.

  • The FSH value is critical in clinical decisions.

FSH but not Oestradiol correlates with AFC

  • Study Details

  • Setting: NHS-based tertiary referral centre for reproductive medicine

  • FSH and Oestradiol (E2) routinely measured in IVF candidates

  • FSH value is critical with a current cut-off value of 10.0 IU/L

  • Population: 232 consecutive subfertile women undergoing day 3 hormonal and ultrasound assessment of ovarian function prior to IVF

  • Inclusion criteria

    • First ovarian stimulation treatment

    • Regular menstrual cycles

    • Both ovaries visualised by transvaginal-ultrasonography (TV-US)

    • No previous ovarian surgery

    • No hormone therapy for 6 months

    • No history of endocrine disorders

    • Age <40 years

  • Methods:

  • FSH and Oestradiol measured on a Roche E170 immunoassay system

  • Data analysed by Spearman’s rank correlation (r) and linear regression

  • FSH correlates with AFC (r = -0.28, P<0.0001, n=231)

  • A high FSH corresponds to a low AFC

  • Oestradiol (E2) shows no correlation with AFC

Comparison of the 3rd and 4th decades

  • Aims

  • Relate FSH and Oestradiol levels with age

  • Evaluate the role of FSH and E2 in this clinical setting

Characteristics of the study population

  • Oestradiol shows no significant difference between the age groups

  • FSH and AFC show statistically significant differences between the age groups

FSH increases with age in the 4th decade

*NB Study started before FSH cut-off was lowered to its current level of 10.0 IU/L

FSH but not Oestradiol correlates with age

  • <30 years old group. No correlation with age (n=62)

  • >30 years old group. FSH correlates with age (r = 0.30, P<0.0001, n=170)

  • Conclusions

  • Oestradiol measurement does not appear to add value in this clinical setting

  • No correlation of FSH with age in the under 30 group in this study

  • Rising FSH is likely to predict declining ovarian reserve in the over 30 group

  • Suggests acceptance onto IVF program should be based on a reference range derived from the under 30 group

  • FSH correlates with age (r = 0.39, P<0.0001, n=232)

  • Oestradiol (E2) shows no correlation with age

  • Antral Follicle Count (AFC)

  • Independent objective predictor of ovarian reserve

  • Sum of follicles between 2-5mm in both ovaries determined by TV-US by experienced operators

  • Mean AFC 12.1 ± 6.87 SD

  • AFC correlates with age

  • (r= -0.37, P<0.0001, n=231)


Thanks also to Dr Allen P. Yates, Sarah Robinson and Phil Pemberton (Clinical Research Lab, MRI) and Dr Steve A. Roberts (Biostatistics Group, University of Manchester)