Poor response to ovulation induction is a stronger predictor of early menopause than elevated basal FSH: a life table analysis

BACKGROUND: During the course of assisted reproduction treatment, a number of women exhibit a 'poor response' to ovulation induction, or demonstrate an elevated basal FSH level (greater than or equal to10 IU/l) at a young age. We sought to determine whether these women are at increased risk of early menopause and poor reproductive performance. METHODS: A retrospective cohort study included 118 'poor responders' with normal basal FSH level (<10 IU/l), 164 women with raised basal FSH (greater than or equal to10 IU/l), and 265 controls, who underwent assisted reproduction treatment between 1987 and 1998. All women were <40 years of age at the time of treatment and had normal menstrual cycles. Participants were sent a postal questionnaire in 2000-2001, seeking information on ovarian function and reproductive performance following cessation of treatment. RESULTS: After adjusting for age and smoking habits, women with poor response and raised basal FSH levels were more likely to experience symptoms of the peri-menopause [hazard ratios 2.4, 95% confidence interval (CI) 1.52-3.78, and 2.76, 95% CI 1.78-4.29 respectively, P = 0.0001]. Poor responders were six times and 23 times more likely to experience the menopause within 10 years of treatment than those with raised basal FSH levels and controls respectively (hazard ratio 5.97 and 23.9, P = 0.015 and 0.002 respectively). Poor responders and those with raised basal FSH levels have half the chance of spontaneous conception after discontinuation of treatment compared with controls (P < 0.007). CONCLUSIONS: Both poor response to ovarian stimulation and raised basal FSH are markers of reduced ovarian reserve and predict an increased risk of early menopause.