Day 3 serum inhibin B and FSH and age as predictors of assisted reproduction treatment outcome

Abstract

Recent reports investigating the value of basal inhibin B determination as a predictor of ovarian reserve and assisted reproduction treatment have led to discordant results. This study was undertaken to further assess the relative power of day 3 inhibin B and follicle stimulating hormone (FSH) (defined before treatment) and the woman's age both as single and combined predictors of ovarian response and pregnancy in an in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) programme. A total of 120 women undergoing their first cycle of IVF or ICSI was included. Forty consecutive cycles cancelled because of poor follicular response were initially selected. As a control group, the nearest completed IVF/ICSI cycles before and after each cancelled cycle (i.e. the closest cycles in temporal relationship to the index cycle) were used. Mean age and basal FSH concentrations were significantly higher in the cancelled than in the control group (P: < 0.01 and P: < 0.001 respectively), whereas basal inhibin B was significantly higher in the latter (P: < 0.05). The association of basal FSH (with an accuracy or predictive value of ovarian response of 79%) with cancellation rate was significant, independent of, and stronger than the effects of age and inhibin B (P: < 0.05). Any two or all three of these variables studied did not improve the predictive value of FSH alone. Woman's age was the only variable independently associated with pregnancy rate. It is concluded that the stronger predictors of success in patients undergoing their first IVF/ICSI treatment cycle are age and basal FSH rather than inhibin B. Basal FSH concentration was a better predictor of cancellation rate than age, but age was a stronger predictor of pregnancy rate.

Comparison of Basal and Clomiphene Citrate Induced FSH and Inhibin B, Ovarian Volume and Antral Follicle Counts as Ovarian Reserve Tests and Predictors of Poor Ovarian Response in IVF

“…In a recent study, basal FSH level was reported to be significant and better predictor of cycle cancellation when compared with age and inhibin B, while age was better than both FSH and inhibin B levels in predicting pregnancy (27). Consequently, on the basis of our data and others, it may be suggested that basal inhibin B is not a better predictor of ovarian response than age and basal FSH (21,27). It should also be taken into consideration that there is no international assay standard for inhibin B yet, and comparison of different inhibin B values between various studies seems to be a problem.…”

“…Moreover, it has been shown that age and the number of the oocytes retrieved were the strongest predictors of success; and only a combination of lower FSH (FSH <11.22 mIU/mL) and higher inhibin B (inhibin B ≥76.5 pg/mL) was associated with a greater chance for a successful outcome in IVF (21). In a recent study, basal FSH level was reported to be significant and better predictor of cycle cancellation when compared with age and inhibin B, while age was better than both FSH and inhibin B levels in predicting pregnancy (27). Consequently, on the basis of our data and others, it may be suggested that basal inhibin B is not a better predictor of ovarian response than age and basal FSH (21,27).…”

“…Others also found that number of antral follicles was related to age, number of oocytes retrieved, and cycle cancellations (14)(15)(16)33,34). Nevertheless, the general trend in the literature is such that age is an independent parameter in predicting pregnancy, certainly better than ultrasound and hormonal tests of ovarian reserve (21,27). More studies are needed to draw definitive conclusions regarding follicle count and pregnancy association.…”

High follicle-stimulating hormone levels should not necessarily lead to the exclusion of subfertile patients from treatment

“…In one report, the pregnancy rate after six cycles of ovulation induction was four times higher in patients Ͻ40 years of age than in patients 40 years of age or older, while both had elevated FSH levels (14). In IVF populations, a moderately elevated FSH level had limited predictive value in young women (9) and age seemed a more important predictive factor for the occurrence of pregnancy than FSH (8,18,25). In contrast, it has recently been shown that younger IVF patients with either a poor ovarian response in IVF or elevated FSH levels performed as poorly as the older patients, although pregnancy rates in the older women with raised FSH levels may have been overestimated because of selection (10).…”

Prediction of Poor Ovarian response by Biochemical and Biophysical Markers: A Logistic Regression Model

“…Biochemical markers identified are FSH, inhibin B, AMH, and estradiol. Biophysical markers include antral follicle count and ovarian volume [3]. Many researchers have used single as well as multiple markers to assess the ovarian reserve.…”