1. In candidates for assisted conception serum FSH but not oestradiol is related to declining ovarian reserve in the fourth decade AP Brown 1, L Maddison 1, C Fitzgerald 2, D Gould 2, L Nardo 2 and I Laing 1 1 Department of Clinical Biochemistry, Manchester Royal Infirmary. 2 Department of Reproductive Medicine, St Mary’s Hospital, Manchester MeanSDRange Age32.6±3.8722.9-39.6 BMI (Kg/m 2 ) 24.4±3.6616.0-38.0 * FSH (IU/L)7.8±2.541.6-20.2 Oestradiol(pmol/L)163±77.48.4-814 Acknowledgements Thanks also to Dr Allen P. Yates, Sarah Robinson and Phil Pemberton (Clinical Research Lab, MRI) and Dr Steve A. Roberts (Biostatistics Group, University of Manchester) Introduction Reproductive performance is assumed to be determined by the decline of the primordial follicle pool in the ovary.Reproductive performance is assumed to be determined by the decline of the primordial follicle pool in the ovary. Criteria used to assess ovarian function and to accept subfertile patients for ovarian stimulation are still a matter of much debate.Criteria used to assess ovarian function and to accept subfertile patients for ovarian stimulation are still a matter of much debate. Various biochemical and ultrasonographic markers are used to investigate the ovarian reserve in candidates for IVF.Various biochemical and ultrasonographic markers are used to investigate the ovarian reserve in candidates for IVF. The FSH value is critical in clinical decisions.The FSH value is critical in clinical decisions. Characteristics of the study population Study Details Setting: NHS-based tertiary referral centre for reproductive medicine FSH and Oestradiol (E2) routinely measured in IVF candidatesFSH and Oestradiol (E2) routinely measured in IVF candidates FSH value is critical with a current cut-off value of 10.0 IU/LFSH value is critical with a current cut-off value of 10.0 IU/L Population: 232 consecutive subfertile women undergoing day 3 hormonal and ultrasound assessment of ovarian function prior to IVF Inclusion criteriaInclusion criteria First ovarian stimulation treatmentFirst ovarian stimulation treatment Regular menstrual cyclesRegular menstrual cycles Both ovaries visualised by transvaginal-ultrasonography (TV-US)Both ovaries visualised by transvaginal-ultrasonography (TV-US) No previous ovarian surgeryNo previous ovarian surgery No hormone therapy for 6 monthsNo hormone therapy for 6 months No history of endocrine disordersNo history of endocrine disorders Age <40 yearsAge <40 years Methods: FSH and Oestradiol measured on a Roche E170 immunoassay systemFSH and Oestradiol measured on a Roche E170 immunoassay system Data analysed by Spearman’s rank correlation (r) and linear regressionData analysed by Spearman’s rank correlation (r) and linear regression Conclusions Oestradiol measurement does not appear to add value in this clinical settingOestradiol measurement does not appear to add value in this clinical setting No correlation of FSH with age in the under 30 group in this studyNo correlation of FSH with age in the under 30 group in this study Rising FSH is likely to predict declining ovarian reserve in the over 30 groupRising FSH is likely to predict declining ovarian reserve in the over 30 group Suggests acceptance onto IVF program should be based on a reference range derived from the under 30 groupSuggests acceptance onto IVF program should be based on a reference range derived from the under 30 group FSH but not Oestradiol correlates with age FSH but not Oestradiol correlates with AFC Comparison of the 3 rd and 4 th decades FSH increases with age in the 4 th decade *NB Study started before FSH cut-off was lowered to its current level of 10.0 IU/L Antral Follicle Count (AFC) Independent objective predictor of ovarian reserveIndependent objective predictor of ovarian reserve Sum of follicles between 2-5mm in both ovaries determined by TV-US by experienced operatorsSum of follicles between 2-5mm in both ovaries determined by TV-US by experienced operators Mean AFC 12.1 ± 6.87 SDMean AFC 12.1 ± 6.87 SD AFC correlates with ageAFC correlates with age (r= -0.37, P<0.0001, n=231) Age Group OestradiolFSHAFC<30(n=62) 162 ± 53 6.7 ± 1.4 16.4 ± 8.5 >30(n=170) 164 ± 85 8.2 ± 2.7 10.5 ± 5.4 P value NS<0.0001<0.0001 Aims Relate FSH and Oestradiol levels with ageRelate FSH and Oestradiol levels with age Evaluate the role of FSH and E2 in this clinical settingEvaluate the role of FSH and E2 in this clinical setting FSH correlates with age (r = 0.39, P<0.0001, n=232)FSH correlates with age (r = 0.39, P<0.0001, n=232) Oestradiol (E2) shows no correlation with ageOestradiol (E2) shows no correlation with age <30 years old group. No correlation with age (n=62) <30 years old group. No correlation with age (n=62) >30 years old group. FSH correlates with age (r = 0.30, P 30 years old group. FSH correlates with age (r = 0.30, P<0.0001, n=170) FSH correlates with AFC (r = -0.28, P<0.0001, n=231)FSH correlates with AFC (r = -0.28, P<0.0001, n=231) A high FSH corresponds to a low AFCA high FSH corresponds to a low AFC Oestradiol (E2) shows no correlation with AFCOestradiol (E2) shows no correlation with AFC Oestradiol shows no significant difference between the age groupsOestradiol shows no significant difference between the age groups FSH and AFC show statistically significant differences between the age groupsFSH and AFC show statistically significant differences between the age groups