[FSH and IVF management: the best and worst case scenarios]

A recent meta-analysis covering 21 studies shows that, when taken in isolation, the basal FSH level (commonly used to assess the ovarian reserve) is a poor indicator of successful in vitro fertilization (IVF) outcome.

We present a personal series of 3592 IVF procedures. Analysis of the results compares the age and basal FSH values, based on a statistical analysis that is essentially descriptive.

When FSH levels are high, the pregnancy rate remains acceptable in young women (<38 years); it drops sharply, however, in older women. In each age group, the rate of spontaneous miscarriage does not increase according to FSH level. The pregnancy rate is better in young women with high FSH levels than in older women with normal FSH levels.

The results presented agree with the studies published in the literature, which suggest that FSH is a prognostic factor for the quantity of oocytes obtained (ovarian reserve) while age defines the quality of the oocyte: it is this difference in quantity, and not in quality, which makes the difference between cases of poor and normal response to IVF. In young women at least, a high FSH level is not a contra-indication in principle for IVF.