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Evaluation and Preparation of the Infertile Couple for In Vitro Fertilization

Thorough evaluation of the infertile couple before in vitro fertilization (IVF) is critical in achieving the best outcomes and avoiding complications. Most IVF centers organize the evaluation by using a checklist that the nurse coordinator and physician assure is complete before proceeding with the cycle. DAY 3 FOLLICLE-STIMULATING HORMONE A level exceeding 25 mIU/ml (about 12 mIU/ml using current assays) has been correlated with a very low chance of pregnancy (1). More recent studies have shown that mild elevations in women below 40 yr of age predict a more modest reduction in the pregnancy rate, whereas an elevated level. | __2_ Evaluation and Preparation of the Infertile CoUple for In Vitro Fertilization David R. Meldrum Reproductive Partners Medical Group Redondo Beach California U.S.A. Thorough evaluation of the infertile couple before in vitro fertilization IVF is critical in achieving the best outcomes and avoiding complications. Most IVF centers organize the evaluation by using a checklist that the nurse coordinator and physician assure is complete before proceeding with the cycle. DAY 3 FOLLICLE-STIMULATING HORMONE A level exceeding 25mIU ml about 12mIU ml using current assays has been correlated with a very low chance of pregnancy 1 . More recent studies have shown that mild elevations in women below 40 yr of age predict a more modest reduction in the pregnancy rate whereas an elevated level carries much more meaning in older women. Sometimes particularly in older women follicular maturation is very rapid and the follicle-stimulating hormone FSH can already be decreasing by day 3. Therefore the level of estradiol E2 should also be measured. The impact of an increased day 3 E2 level over 70-80 pg ml in the presence of a normal FSH concentration is unclear but using gonadotropin releasing hormone GnRH agonist and assisted hatching an elevated E2 level correlates with increased cycle cancellation but not with a reduced pregnancy rate 2 . An elevated day 3 E2 has less importance in young women. We also use the FSH assay to predict the 17 18 Meldrum optimal level of stimulation because the ovarian response has been shown to vary inversely with the FSH level 1 . For women with an FSH level over 10mIU ml we generally choose a low responder protocol. FSH assays vary considerably in their normal ranges. Ideally if switching from the Leeco Diagnostics Southfield Michigan Company now Binax Inc. Scarborough Maine assay on which older research was based 1 a series of samples should be run in parallel using both methods so that the new .