Vol 94, No 6 (2023)
Research paper
Published online: 2022-04-07

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The relationship between serum FSH level and ovarian response during controlled ovarian stimulation

Ping-Ping Sun1, Yue-Min Zhang1, Hai-Ying Zhu1, Na Sun1, Hua-Gang Ma1
Pubmed: 35419793
Ginekol Pol 2023;94(6):470-475.


Objectives: To evaluate whether serum follicle stimulating hormone (FSH) level during the early controlled ovarian stimulation can be used as a predictor of the ovarian response in the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles.

Material and methods: The participants of this retrospective study were chosen from Reproductive Medicine Center, Weifang People’s Hospital between January 2015 and December 2020.The participants of this study met the age of 20~43 years old, anti-Müllerian hormone (AMH) ≥ 1.2 ng/mL, antral follicle count (AFC) ≥ 5, and the data was complete and no cancellation cycle. Each participant was given GnRH agonist protocol and given a fixed dose of recombinant FSH in the first four days during the controlled ovarian stimulation (COS). According to the number of oocytes retrieved, the participants were divided into two different ovarian response groups. Serum FSH level after the fourth recombinant follicle stimulating hormone (rFSH) injection were compared during the different ovarian responders.

Results: The number of participants who met both the inclusion criteria and exclusion criteria was 235. Serum sFSH levels (mean: 11.76 ± 3.10 IU/L) in the inappropriate responders was significantly higher than serum sFSH levels (mean: 10.79 ± 2.52 IU/L) in the superior responders(p = 0.029). There was a weak correlation between serum sFSH levels and the number of oocytes retrieved (r = −0.134, p = 0.041). Serum sFSH levels had significant clinical valuable (p = 0.0346) in predicting the number of oocytes retrieved.

Conclusions: Serum sFSH levels may be a potential marker to predict the ovarian response during the early COS in the IVF/ICSI cycles, which can guide the adjustment of the exogenous rFSH dose.

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  1. Iliodromiti S, Anderson RA, Nelson SM. Technical and performance characteristics of anti-Müllerian hormone and antral follicle count as biomarkers of ovarian response. Hum Reprod Update. 2015; 21(6): 698–710.
  2. Tsakos E, Tolikas A, Daniilidis A, et al. Predictive value of anti-müllerian hormone, follicle-stimulating hormone and antral follicle count on the outcome of ovarian stimulation in women following GnRH-antagonist protocol for IVF/ET. Arch Gynecol Obstet. 2014; 290(6): 1249–1253.
  3. Moolhuijsen LME, Visser JA. Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. J Clin Endocrinol Metab. 2020; 105(11): 3361–3373.
  4. Broekmans FJ, Kwee J, Hendriks DJ, et al. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006; 12(6): 685–718.
  5. Broer SL, Mol BW, Hendriks D, et al. The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril. 2009; 91(3): 705–714.
  6. Fourati S, Merdassi G, Khrouf M, et al. [Basal fsh level is only predictive of the quantitative aspect of the ovarian response]. Tunis Med. 2012; 90(7): 524–529.
  7. Lan VT, Linh NK, Tuong HoM, et al. Anti-Müllerian hormone versus antral follicle count for defining the starting dose of FSH. Reprod Biomed Online. 2013; 27(4): 390–399.
  8. Khan HL, Bhatti S, Suhail S, et al. Antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) are the predictors of natural fecundability have similar trends irrespective of fertility status and menstrual characteristics among fertile and infertile women below the age of 40 years. Reprod Biol Endocrinol. 2019; 17(1): 20.
  9. Massarotti C, La Pica V, Sozzi F, et al. Influence of age on response to controlled ovarian stimulation in women with low levels of serum anti-Müllerian hormone. Gynecol Endocrinol. 2020; 36(12): 1074–1078.
  10. Food and Drug Administration (1995). Gonal-f R (follitropin alfa for injection) For Subcutaneous Injection. 3–28. https://www.accessdata.fda.gov/drugsatfda_docs/label/2004/20378scf015_gonal_lbl.pdf (15.09.2021).
  11. Ben-Rafael Z, Levy T, Schoemaker J. Pharmacokinetics of follicle-stimulating hormone: clinical significance. Fertil Steril. 1995; 63(4): 689–700.
  12. Fletcher P, Reichert L. Cellular processing of follicle-stimulating hormone by Sertoli cells in serum-free culture. Mol Cell Endocrinol. 1984; 34(1): 39–49.
  13. Cai J, Lou Hy, Dong My, et al. Poor ovarian response to gonadotropin stimulation is associated with low expression of follicle-stimulating hormone receptor in granulosa cells. Fertil Steril. 2007; 87(6): 1350–1356.
  14. Esteves SC, Roque M, Bedoschi GM, et al. Defining Low Prognosis Patients Undergoing Assisted Reproductive Technology: POSEIDON Criteria-The Why. Front Endocrinol (Lausanne). 2018; 9: 461.
  15. Malchau SS, Henningsen AA, Forman J, et al. Cumulative live birth rate prognosis based on the number of aspirated oocytes in previous ART cycles. Hum Reprod. 2019; 34(1): 171–180.
  16. Hu L, Sun Bo, Ma Y, et al. The Relationship Between Serum Delta FSH Level and Ovarian Response in IVF/ICSI Cycles. Front Endocrinol (Lausanne). 2020; 11: 536100.
  17. Bentov Y, Burstein E, Firestone C, et al. Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization? Reprod Biol Endocrinol. 2013; 11: 12.
  18. Stilley JAW, Segaloff DL. FSH Actions and Pregnancy: Looking Beyond Ovarian FSH Receptors. Endocrinology. 2018; 159(12): 4033–4042.
  19. Zhou Ge, Hu RK, Xia GC, et al. Tyrosine nitrations impaired intracellular trafficking of FSHR to the cell surface and FSH-induced Akt-FoxO3a signaling in human granulosa cells. Aging (Albany NY). 2019; 11(10): 3094–3116.
  20. König TE, van der Lee J, Schats R, et al. The relationship between FSH receptor polymorphism status and IVF cycle outcome: a retrospective observational study. Reprod Biomed Online. 2019; 39(2): 231–240.
  21. Regan SLP, Knight PG, Yovich JL, et al. Infertility and ovarian follicle reserve depletion are associated with dysregulation of the FSH and LH receptor density in human antral follicles. Mol Cell Endocrinol. 2017; 446: 40–51.