Key indicator for successful treatment of infertile couples

Couples have choices in infertility treatments. A recent finding by Marlene Goldman, MS, ScD of the Geisel School of Medicine at Dartmouth and colleagues, published in Fertility and Sterility, gives doctors and couples a new tool to determine which technique may be more effective for their situation.

"As a woman approaches menopause, her level of follicle stimulating hormone (FSH) rises," explained Goldman. "A higher FSH level is a key indicator that the woman may not be as fertile as necessary to conceive using certain common methods of infertility treatment."

The study determined if FSH and estrogen at the upper limits of normal, as measured on day three of the menstrual cycle, could predict treatment success as measured in live birth rates. The essential question was: should women with higher levels of FSH and estrogen be "fast-tracked" to in vitro fertilization (IVF), bypassing the conventional treatment trajectory?

Goldman and collaborators recorded no live births in the group with FSH and estrogen at the upper limits of normal, yet when the couples later pursued IVF, 33% were able to have babies.

"Some women express a preference to begin treatment for infertility with controlled ovarian hyper-stimulation (COH), whether by pill or injection, along with intrauterine insemination (IUI)," said Goldman. "When counseling women with day-three testing for FSH or estrogen at the upper limits of normal, it may be helpful for them to know that COH-IUI has not been successful in others with similar levels. Fortunately, IVF is a successful treatment for many women and if we can 'fast-track' them to IVF, bypassing COH-IUI, treatments will be quicker and may be less expensive."

Insurance companies may use FSH levels to determine if they will continue payments for future treatment cycles in women with high levels.

The next steps for Goldman include probing what makes IVF so successful and how to keep the success rate while reducing costs.

Marlene Goldman, MS, ScD, is Professor of Obstetrics & Gynecology, and of Community & Family Medicine at Dartmouth's Geisel School of Medicine. Her work in cancer is facilitated by Dartmouth's Norris Cotton Cancer Center in Lebanon, NH. She is the Vice-chair for Research in the Department of Obstetrics & Gynecology at Dartmouth-Hitchcock Medical Center. This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Institutes of Health grants RO1 HD38561 and RO1 HD44547. Her collaborators included Richard Reindollar, MD PI; Daniel J. Kaser, MD, first author; June L. Fung, PhD, all from Dartmouth; and Michael M. Alper, MD from Boston IVF.

About Norris Cotton Cancer Center at Dartmouth-Hitchcock Norris Cotton Cancer Center combines advanced cancer research at Dartmouth and the Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center in Lebanon, NH, at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.

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Key indicator for successful treatment of infertile couples