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High basal LH levels in combination with low basal FSH levels are associated with high success rates at assisted reproduction
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Klinisk och experimentell reproduktionsbiologi/Olovsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Klinisk och experimentell reproduktionsbiologi/Olovsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
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2009 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 24, no 11, 2755-2759 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND The objective of this study was to evaluate the associations of basal gonadotrophins with pregnancy and delivery rates at IVF/ICSI. METHODS A prospective observational study was conducted at a university-affiliated private infertility centre. Patients were 745 women, who underwent 1328 IVF/ICSI treatment cycles. Basal FSH, basal LH and combinations of FSH and LH versus treatment data and pregnancy and delivery rates were measured. RESULTS Combinations of FSH and LH gave significantly better information than the LH:FSH ratio, or each gonadotrophin alone: highest mean pregnancy rate (39%) was achieved in women with low FSH (<6.7 U/l) and with high LH levels (>4.9 U/l), whereas pregnancy rate was lowest (22%) in women with high FSH and low LH levels. Pregnancy rates were intermediate (27-28%) if FSH and LH were either both low or both high (P for trend = 0.0004). Associations to delivery rates and measures of ovarian response and embryo quality followed the same pattern. CONCLUSIONS Basal LH modifies and improves the information given by basal FSH alone. Low FSH level combined with high LH probably reflects a well-preserved ovarian reserve and is associated with the highest success rates at IVF/ICSI.

Place, publisher, year, edition, pages
2009. Vol. 24, no 11, 2755-2759 p.
Keyword [en]
FSH, infertility, IVF, ICSI outcome, luteinizing hormone, ovarian reserve
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-107635DOI: 10.1093/humrep/dep254ISI: 000271107700013PubMedID: 19617206OAI: oai:DiVA.org:uu-107635DiVA: diva2:232214
Available from: 2009-08-20 Created: 2009-08-20 Last updated: 2013-03-05Bibliographically approved
In thesis
1. Ovarian Reserve and Assisted Reproduction
Open this publication in new window or tab >>Ovarian Reserve and Assisted Reproduction
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Treatment success in IVF-ICSI is mainly limited by female age, but differences in ovarian reserve (OR; the remaining pool of oocytes and their quality) between individuals modify treatment prerequisites among women of similar age. OR may be assessed by OR tests (ORTs). The main aims of this work were to study menstrual cycle length (MCL), basal levels of circulating gonadotrophins, antral follicle count (AFC) and serum Anti-Müllerian hormone (AMH) levels and their associations with and prognostic capacities regarding IVF-ICSI outcome in large cohorts of unselected women.

Age-adjusted MCL was positively and linearly associated with pregnancy rates (PRs), live-birth rates (LBRs) and ovarian response to controlled ovarian hyperstimulation. An MCL of >34 days almost doubled the LBR compared with an MCL of <26 days.

The grouped variable ‘combined FSH and LH levels’ was superior to both individual gonadotrophin levels and the LH:FSH ratio. The highest mean PR was seen in connection with a combination of FSH <6.7 U/l with LH >4.9 U/l; PRs were lowest when FSH-LH levels were opposite to this (high-low) and intermediate when FSH-LH levels were low-low or high-high. Associations with LBR and ovarian response were similar as those for PR.

AFCs and serum AMH levels were positively and log-linearly associated with PR, LBR and ovarian response. Success rates levelled out above AFC 30 or AMH 5 ng/ml. Treatment outcome was superior among women with polycystic ovaries.

Among the studied ORTs, logAFC and logAMH concentration correlated most strongly. After multivariate testing, entering all studied ORTs, AMH and female age remained independently associated with LBR. AMH + AFC + age predicted both poor and excessive ovarian responses with high accuracy.

Adjusting for age and oocyte yield, all ORTs remained significant for LBR, implying that ORTs also capture information on oocyte quality.

In conclusion, measures of OR are strongly associated with PR, LBR and ovarian response in a log-linear fashion, and partly reflect oocyte quality. The OR spectrum is continuous, from small ‘oligofollicular’ ovaries (the low extreme) to polycystic ovaries (the high extreme). Among the studied ORTs, AMH together with age provide the most powerful basal estimate for IVF/ICSI outcome.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 88 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 865
Keyword
AFC, AMH, anti-Müllerian hormone, antral follicle count, follicle-stimulating hormone, FSH, ICSI, infertility, intracytoplasmic sperm injection, in vitro fertilization, IVF, LH, live birth, luteinizing hormone, menstrual cycle, menstrual cycle length, ovarian reserve, pregnancy, reproductive endocrinology, reproductive technology
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-192998 (URN)978-91-554-8592-4 (ISBN)
Public defence
2013-03-22, Sal IX, Universitetshuset, Uppsala, 13:15 (English)
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Available from: 2013-02-28 Created: 2013-01-28 Last updated: 2013-03-05Bibliographically approved

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