Evaluation and Preparation of the Infertile Couple for In Vitro Fertilization pptx

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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 coor￾dinator 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 carries

much more meaning in older women. Sometimes, particularly in older

women, follicular maturation is very rapid and the follicle-stimulating hor￾mone (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 cancel￾lation 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

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