Possible Causes of Infertility in Patients Visiting an IVF Clinic and the Use of Basal Gonadotrophins as Predictive Markers of Ovarian Response in IVF Clients

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Background - Assisted reproduction is expensive, time-consuming and stressful for patients. The development of sufficient number of follicles during ovarian stimulation for IVF is a very important step towards a successful outcome. The accurate determination of ovarian reserve continues to be a challenge for reproductive physicians. Basal hormonal markers may contribute to the prediction of ovarian reserve and as a reflection of the number of oocytes retrieved after ovarian stimulation. Therefore, a major challenge to the IVF team is to predict prospective patients who will be low responders and to appropriately counsel women who are potential candidates for assisted reproduction. Aims - The aim of this study was to assess basal hormonal markers; LH, FSH and prolactin and obesity markers; BMI and WHR as predictive markers of ovarian response in IVF clients. Again it was to determine the effect of some lifestyle and behavioural patterns like exercise and smoking on measurable outcomes of ovarian stimulation by subjects who seek assisted conception. Methods - A total of 104 subjects were recruited at the Lister hospital and fertility centre in Accra - Ghana for this study. Anthropometric measurements performed included body mass index (BMI) and waist to hip ratio (WHR). Other lifestyle features like exercise and smoking patterns were assessed from responses to a provided questionnaire. Blood samples were drawn on second day of their menstrual cycle in the month prior to the IVF procedure and basal LH, FSH and prolactin assayed. A ratio of FSH/LH was calculated. Results – Age, basal FSH and FSH/LH ratio of subjects showed a very significant negative correlation with measured outcomes of ovarian stimulation. Poor responders were significantly older than normal responders (median age; 40 vs. 36, P = <0.01). Basal FSH was significantly higher in poor responders as against normal responders (median FSH; 12.7 vs. 9.7, P = <0.05 respectively). In response to lifestyle, all subjects who engaged in moderate to high forms of exercise recorded a normal response after the ovarian stimulation protocol. Number of retrieved oocytes and ovarian capacity were negatively correlated to both obesity indices; WHR and BMI. Conclusion - By way of predicting ovarian response, our study reveals that basal FSH levels and FSH/LH ratio better predict response of subjects after ovarian stimulation protocol. Obesity negatively impacts on outcomes of in-vitro fertilization process as it has a negative effect on the number of oocytes aspirated. This could probably be due to the fact that in obese persons higher doses of ovarian stimulation drugs are needed to generate a sizable pool of follicles for fertilization.  
A thesis submitted to the School of Graduate Studies, Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirement for the award of Master of Philosophy, September-2013