Antral follicle counts are related to age at natural fertility loss and age at menopause.

Objective: The variability in ultrasound-based antral follicle counts sized 2-10 mm after allowing for age-related decline is considerable. This may represent differences in actual reproductive age among women. This hypothesis was tested by cohort comparison for distribution of age at occurrence of reproductive events.

Anti-müllerian hormone is a promising predictor for the occurrence of the menopausal transition.

Objective: Age at menopause and age at the start of the preceding period of cycle irregularity (menopausal transition) show considerable individual variation. In this study we explored several markers for their ability to predict the occurrence of the transition to menopause.

Design: A group of 81 normal women between 25 and 46 years of age visited the clinic two times (at T1 and T2) with an average interval of 4 years.

Repeated clomiphene citrate challenge testing in the prediction of outcome in IVF: a comparison with basal markers for ovarian reserve.

Background: The aim of this study was to investigate the predictive accuracy and clinical value of performing either a single or a repeated clomiphene citrate challenge test (CCCT) in predicting poor response in IVF, compared to that of currently used basal ovarian reserve markers.

Methods: Sixty-three patients undergoing their first IVF treatment were prospectively included. After measurement of basal markers on cycle day 3 (cd3) [FSH, inhibin B and antral follicle count (AFC)], a CCCT was performed.

Female age in ART: when to stop?

With increasing age the probability of ongoing pregnancy established by the use of assisted reproduction technology (ART) decreases. As a result the question arises whether age limits for the application of ART should be established. From a literature review and ongoing research data it appears that the costs per child born greatly increase after the age of 40 for both intrauterine insemination with mild ovarian stimulation and in vitro fertilisation treatment, while in cases of 44 and over, prognosis is flat zero.

Use of stimulated serum estradiol measurements for the prediction of hyperresponse to ovarian stimulation in in vitro fertilization (IVF).

Purpose: In ovarian stimulation an exaggerated ovarian response is often seen and is related to medical complications, such as ovarian hyperstimulation syndrome (OHSS), and increased patient discomfort. If it were possible to identify hyperresponders at an early stage of the stimulation phase, adaptation of the stimulation protocol would become feasible to minimize potential complications. Therefore, we studied the usefulness of measuring stimulated serum estradiol (E2) levels in predicting ovarian hyperresponse.

High follicle-stimulating hormone levels should not necessarily lead to the exclusion of subfertile patients from treatment.

Objective: To determine ongoing pregnancy rates in subfertile patients with elevated FSH levels and regular cycles and to assess whether or not it is justified to exclude such patients from treatment on the basis of elevated FSH levels alone.

Design: Retrospective follow-up study.

Setting: Tertiary fertility center.

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles.

Objective: To calculate the cumulative ongoing pregnancy rate in patients with a poor response in their first IVF cycle.

Design: Retrospective cohort study.

Setting: In vitro fertilization unit of a university hospital.

Predicting poor ovarian response in IVF: use of repeat basal FSH measurement.

Objective: To evaluate the additional value of a second basal follicle stimulating hormone (FSH) level, in a different cycle, in the prediction of poor response in in vitro fertilization (IVF) by a single basal FSH measurement.

Study Design: In 120 patients, basal FSH was determined prospectively in 2 spontaneous cycles. The additional value of a second basal FSH measurement in the prediction of poor ovarian response in IVF by a single basal FSH measurement was studied.

Impact of repeated antral follicle counts on the prediction of poor ovarian response in women undergoing in vitro fertilization.

Objective: To study the value of a single antral follicle count and the additional value of repeated counts in different cycles for the prediction of poor ovarian response in IVF.

Design: Prospective.

Setting: Tertiary fertility center.

Birth weight and age at menarche in patients with polycystic ovary syndrome or diminished ovarian reserve, in a retrospective cohort.

Background: Few studies have investigated the association between subfertility in women and factors in early life such as birth weight and age at menarche, and most have produced contradictory results. In the present study, this association was investigated among women undergoing artificial reproductive techniques (ART), including IVF for reason of polycystic ovary syndrome (PCOS) or diminished ovarian reserve. Herein, PCOS included oligomenorrhoea and at least one additional symptom such as hyperandrogenism, hirsutism or polycystic ovaries on ultrasound.

Performance of basal follicle-stimulating hormone in the prediction of poor ovarian response and failure to become pregnant after in vitro fertilization: a meta-analysis.

Objective: To assess the predictive performance and clinical value of basal FSH as a test for ovarian reserve in in vitro fertilization (IVF) patients.

Design: Meta-analysis.

Setting: Tertiary fertility center.

The use of fixed distance embryo transfer after IVF/ICSI equalizes the success rates among physicians.

Background: It is suggested that the skill of the physician performing the embryo transfer may influence the outcome of the procedure. In this study we investigated the effects of a change in embryo transfer technique on the variability in success rates among physicians.

Methods: Retrospectively 4439 transfer cycles in which two different embryo transfer techniques were applied by seven physicians were studied.

The number of antral follicles in normal women with proven fertility is the best reflection of reproductive age.

Background: The purpose of this study was to compare the predictive capacity of several markers of reproductive age in normal women.

Methods: Healthy female volunteers (n = 162) aged 25-46 years with proven, normal fertility and regular menstrual cycles were recruited. In this selected group, chronological age was assumed to approximate reproductive age and, therefore, was taken as the proxy-variable for reproductive age.

Women older than 40 years of age and those with elevated follicle-stimulating hormone levels differ in poor response rate and embryo quality in in vitro fertilization.

Objective: To investigate whether IVF outcome of patients older than 40 years of age with basal FSH levels less than 15 IU/L differs from that in patients 40 years of age or younger with basal FSH levels of 15 IU/L or greater.

Design: Prospective observational study.

Setting: Tertiary academic fertility center.

Do cycle disturbances explain the age-related decline of female fertility? Cycle characteristics of women aged over 40 years compared with a reference population of young women.

Background: The cause of declining fertility with age, in women who still have regular menstrual cycles, is not clear.

Methods: Follicle development, endometrial growth and hormonal patterns were evaluated in cycles of older women (aged 41-46 years; n = 26) who previously were normally fertile, and these cycles were compared with a reference group of relatively young fertile women (aged 22-34 years; n = 35).

Results: Clearly abnormal cycles were found in only two women in the older age group, and in one woman in the younger group.

Serum anti-Müllerian hormone levels: a novel measure of ovarian reserve.

Background: Anti-Müllerian hormone (AMH) is produced by the granulosa cells of preantral and small antral follicles and its levels can be assessed in serum. Since the number of ovarian follicles declines with increasing age, AMH levels might be used as a marker for ovarian ageing. Therefore, we studied the relationship between AMH levels and ovarian response during ovarian stimulation for IVF.

Quantitative transvaginal two- and three-dimensional sonography of the ovaries: reproducibility of antral follicle counts.

Objective: To assess the intra- and interobserver reproducibilities in addition to the between-method reliability of antral follicle counts using two (2D)- and three (3D)-dimensional transvaginal sonography (TVS).

Methods: Two groups of women with regular menstrual cycles were studied. One group consisted of healthy volunteers with proven fertility and the other group consisted of patients visiting the general infertility clinic.

From HMG through purified urinary FSH preparations to recombinant FSH: a substitution study.

Drugs produced through the use of recombinant DNA techniques have become an integral part of medical practice. Before recombinant FSH (rFSH) was introduced in 1996, FSH purified from the urine of postmenopausal women had been commercially available since the 1960s. We analysed the diffusion and the substitution patterns of the different FSH preparations in The Netherlands.

Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve.

Objective: To identify and quantify predictors of poor ovarian response in in vitro fertilization (IVF). DESIGN; Prospective study. SETTING; Tertiary fertility center.