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Objective: The aim of this study was to assess which of the basal ovarian reserve markers provides the best reflection of the changes occurring in ovarian function over time (i.e., reproductive aging)., Design: Prospective longitudinal study., Setting: Healthy volunteers in an academic research center., Patient(s): Eighty-one women with normal reproductive performance during the course of their lives were longitudinally assessed. In this select group of women, becoming chronologically older was considered as a proxy variable for becoming older from a reproductive point of view., Intervention(s): The women were assessed twice, with on average a 4-year interval (T(1) and T(2)). The number of antral follicles on ultrasound (AFC) and blood levels of antimullerian hormone (AMH), FSH, inhibin B, and E(2) were assessed., Main Outcome Measure(s): Longitudinal changes of the markers mentioned and the consistency of these parameters over time., Result(s): The mean ages at T(1) and T(2) were 39.6 and 43.6 years, respectively. Although AFC was strongly associated with age in a cross-sectional fashion, it did not change over time. The AMH, FSH, and inhibin B levels showed a significant change over time, in contrast to E(2) levels. The AMH and AFC were highly correlated with age both at T(1) and T(2), whereas FSH and inhibin B predominantly changed in women more than 40 years of age. To assess the consistency of these parameters over time, we investigated whether a woman's individual level above or below the mean of her age group at T(1) remained above or below the mean of her age group at T(2). Serum AMH concentrations showed the best consistency, with AFC as second best. The FSH and inhibin B showed only modest consistency, whereas E(2) showed no consistency at all., Conclusion(s): These results indicate that serum AMH represents the best endocrine marker to assess the age-related decline of reproductive capacity.

Objective: To investigate whether IVF outcome of patients older than 40 years of age with basal FSH levels less than 15 IU/L differs from that in patients 40 years of age or younger with basal FSH levels of 15 IU/L or greater., Design: Prospective observational study., Setting: Tertiary academic fertility center., Patient(s): Women 41 years of age or older with basal FSH levels less than 15 IU/L (n = 50), and women 40 years of age or younger with elevated basal FSH levels (n = 36) undergoing their first IVF cycle., Intervention(s): IVF treatment using a long suppression protocol with recombinant FSH at a fixed starting dose of 150 IU/L., Main Outcome Measure(s): Ovarian response, ongoing pregnancy rates, and implantation rates., Result(s): The high FSH group experienced more cycle cancellations due to absent follicular growth than did the high age group (31% vs. 8%). However, the high FSH group had better implantation rates per embryo (34% vs. 11%), higher ongoing rates per ET (40% vs.13%), and higher ongoing pregnancy rates per cycle (25% vs. 10%). In both groups, poor responders had lower pregnancy rates., Conclusion(s): The outcome of IVF differs between patients older than 40 years of age with normal FSH levels and relatively young patients with elevated FSH levels. This finding may have implications for the management of these patients.