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Urinary Follicle-Stimulating Hormone as a Measure of Natural Fertility in a Community Cohort

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Abstract

High serum follicle-stimulating hormone (FSH) levels have been associated with diminished ovarian reserve; however, the association between high urinary FSH and reduced natural fertility has yet to be established. We sought to characterize the relationship between a single or multiple measurements of early follicular phase urinary FSH and fertility. Women (n = 209), 30 to 44 years old with no history of infertility, who had been trying to conceive for less than 3 months, provided early follicular phase urine. Participants subsequently kept a diary to record bleeding and intercourse and conducted standardized pregnancy testing for up to 6 months. A subset of women (N = 95) collected urine on cycle day 3 for up to 6 cycles. Urine was analyzed for FSH and creatinine (cr) corrected. Proportional hazard models were used to calculate fecundability ratios (FRs). Urinary FSH levels across cycles from the same woman were highly correlated (adjusted intraclass correlation = .77); within-woman variance was 3-fold lower than variance among women. Women with an initial urinary FSH level <7 mIU/mg cr exhibited a nonsignificant reduction in the probability of pregnancy (adjusted FR 0.71, 95% confidence interval [CI]: 0.45–1.13), as did women with elevated urinary FSH (≥12 mIU/mg cr; adjusted FR 0.78, 95% CI: 0.46–1.32). Using the most recent or maximum urinary FSH value did not strengthen the association. In the general population, urinary FSH levels appear to be nonlinearly associated with fertility; however, broad CIs indicate a lack of statistical significance. Repetitive testing appears to be of little benefit.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of North Carolina, CB#7570, 4001 Old Clinic Building, 27599, Chapel Hill, NC, USA

    Anne Z. Steiner MD, MPH

  2. Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA

    D. Leann Long MS

  3. Department of Biostatistics & Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA

    Amy H. Herring ScD

  4. Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Cincinnati, OH, USA

    James S. Kesner PhD & Juliana W. Meadows PhD

  5. Epidemiology Branch, National Institute of Environmental Health Science/National Institutes of Health, Research Triangle Park, NC, USA

    Donna D. Baird PhD, MPH

Authors
  1. Anne Z. Steiner MD, MPH
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  2. D. Leann Long MS
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  3. Amy H. Herring ScD
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  4. James S. Kesner PhD
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  5. Juliana W. Meadows PhD
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  6. Donna D. Baird PhD, MPH
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Correspondence to Anne Z. Steiner MD, MPH.

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Steiner, A.Z., Long, D.L., Herring, A.H. et al. Urinary Follicle-Stimulating Hormone as a Measure of Natural Fertility in a Community Cohort. Reprod. Sci. 20, 549–556 (2013). https://doi.org/10.1177/1933719112459226

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  • DOI: https://doi.org/10.1177/1933719112459226

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