RESUMO
BACKGROUND: age, obesity and increased FSH serum level in women are prognosis criteriae associated with decreased fertility and adverse Assisted Reproductive Technologies (ART) outcomes. OBJECTIVE: To assess the effect of age, FSH and BMI on pregnancy rate in ICSI. METHODS: A retrospective and comparative study of 500 women who underwent ICSI cycle during the study period from January 2004 to December 2005. Age, FSH and BMI were compared in two groups of patients: Those achieving a pregnancy: The "pregnancy+" group and those failing to have a pregnancy: The "pregnancy-"group. For each of previous parameters ROC curve and logistic regression study were performed. RESULTS: age was significantly lower in "pregnancy+" group (32,4±3,9 years vs 33,7±4,8 ans ; p=0,005). Analysis of ROC curve and logistic regression study show that for age, the most discriminative cut-off for predicting pregnancy is 38 years (Se=7,5%, Sp=75,6%) (AUC=0,572; p=0,02) (OR=2,1 ; LR+=6,7 ;IC[1 ;1,4] ; p0,009). FSH was significantly lower in "pregnancy+" group (5,5±1,8UI /L vs 6,2±3UI/L, p=0,003). Analysis of ROC curve and logistic regression study show that for FSH, the most discriminative cut-off for predicting pregnancy is 9UI/L (Se=3,7%, Sp=85.2%) (AUC=0,539 ; p=0,03) (OR=3,6; IC[1,4 ;9,3]; LR+ =10,1; p=0,003). BMI was also significantly lower in "pregnancy+" group (24,7± 3,6 kgm-2 vs 27,1±4,5 kgm-2 ; p<10-3). The most discriminative cut-off for predicting pregnancy is 25,4 kgm- 2 (Se=31,7%, Sp=33,3%) (AUC=0,663 ; p<10-3) (OR=4; IC[2,1 ;7,7]; LR+ =19,38; p<10-3). CONCLUSION: age, FSH and BMI affect markedly the prognosis of ICSI. We found significantly lower Pregnancy rates in older women (> 38 years), in women with elevated FSH (> 9UI/L) or elevated BMI (> 25,4 kgm-2). Our results can be used when counseling and before including patients in an IVF program, to give them probability of success and weight loss required to optimize chances of pregnancy.
