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The value of laboratory tests and ultrasonography in evaluating ovarian response to ovulation induction treatment with low-dose recombinant follicle-stimulating hormone.

OBJECTIVE
To compare basal (cycle day 3) follicle-stimulating hormone (FSH) level, clomiphene citrate challenge test (CCCT), gonadotropin-releasing hormone agonist stimulation test (GAST), and mean ovarian volume estimation by ultrasound for predicting the subsequent ovarian response.


DESIGN
Prospective, randomized, clinical study.


SETTING
Referral university hospital.


PATIENTS
One hundred and forty-four women with unexplained infertility undergoing their first ovulation induction treatment with low-dose recombinant FSH.


INTERVENTIONS
Patients were randomized into four groups. Basal FSH levels were evaluated in group I (n = 36). Clomiphene citrate challenge test (CCCT) and gonadotropin-releasing hormone agonist stimulation test (GAST) were carried out in group II (n = 36) and group III (n = 36), respectively. Transvaginal ultrasound was performed for ovarian volume measurements in group IV (n = 36). In the subsequent cycle, all women received ovulation induction therapy with recombinant FSH.


MAIN OUTCOME MEASURES
Number of mature (> or = 14 mm) follicles and the number of recombinant FSH ampules required for successful ovulation induction.


RESULTS
Ovarian volume estimation by transvaginal ultrasound, compared to the other three tests, had the most powerful positive correlation with the number of mature follicles (r = 0.84, P < .0001) and the most powerful negative correlation (r = -0.75, P < .0001) with the amount of recombinant FSH used per cycle.


CONCLUSION
Mean ovarian volume estimation by transvaginal ultrasound might be more useful than basal FSH values, CCCT, and GAST for predicting ovarian response to low-dose recombinant FSH treatment.