38 一對35 歲不孕夫妻求診，經檢驗結果，妻：月經第3 天FSH：15 mIU/mL，E2：50 pg/mL，下列敘
述何者最適當？
為卵巢早期衰竭，需卵子捐贈
為多囊性卵巢囊腫，需刺激排卵
月經第9 天安排clomiphene citrate challenge test
需荷爾蒙療法
C

http://www.advancedfertility.com/day3fsh.htm

Day 3 FSH Fertility Testing of Ovarian Reserve
Follicle Stimulating Hormone

Women in menopause have high FSH hormone levels - above 40 mIU/ml. As women approach menopause their baseline FSH levels (day 3 of their cycle) will tend to gradually increase over the years. When they run out of follicles capable of responding, their FSH will be high and they stop having periods.

If this happens in a woman under age 40, we call it premature ovarian failure or primary ovarian insufficiency

Why do we measure the FSH level on day 3?
By measuring a woman's baseline FSH on day 3 of the cycle (we do it on day 2, 3, or 4), we get an indication as to whether she has normal "ovarian reserve". We are looking at how hard her body needs to "step on the gas" early in the menstrual cycle to get a follicle growing.

Day 3 FSH level	FSH interpretation for DPC Immulite assay
Less than 9	Normal FSH level. Expect a good response to ovarian stimulation.
9 - 11	Fair. Response is between normal and somewhat reduced (response varies widely). Overall, a slightly reduced live birth rate.
11- 15	Reduced ovarian reserve. Expect a reduced response to stimulation and some reduction in embryo quality with IVF. Reduced live birth rates on the average.
15 - 20	Expect a more marked reduction in response to stimulation and usually a further reduction in embryo quality. Low live birth rates. Antral follicle countis an important variable.
Over 20	This is pretty much a "no go" level in our center. Very poor (or no) response to stimulation. "No go" levels should be individualized for the particular lab assay and IVF center.

BY DOING UTRASOUND

Total number of antral follicles	Expected response to injectable stimulating drugs and chances for IVF success
Less than 4	Extremely low count, very poor (or no) response to stimulation. Cycle cancellation is likely. Should consider not attempting IVF at all.
4-6	Low count, we are concerned about a possible/probable poor response to the stimulation drugs. Likely to need high doses of FSH product to stimulate ovaries adequately. Higher than average rate of IVF cycle cancellation. Lower than average pregnancy rates for those cases that make it to egg retrieval.
7-10	Reduced count. Higher than average rate of IVF cycle cancellation. Moderately reduced chances for pregnancy success as a group.
11-15	Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually adequate. Slight increased risk for IVF cycle cancellation. Pregnancy rates as a group slightly reduced compared to the "best" group.
16-30	Normal (good) antral count, should have an excellent response to ovarian stimulation. Likely to respond well to low doses of FSH product. Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation. Best pregnancy rates overall as a group.
Over 30	High count, watch for polycystic ovary type of ovarian response. Likely to have a high response to low doses of FSH product. Higher risk for overstimulation and ovarian hyperstimulation syndrome. Very good pregnancy rate overall as a group, but some cases in the group have egg quality issues and somewhat lower chances for pregnancy.