Increasing the human menopausal gonadotropin dose—does the response really improve?

Pantos, Constantine; Thornton, Simon J.; Speirs, Andrew L.; Johnston, Ian

doi:10.1016/s0015-0282(16)53337-8

Cited by 23 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This phenomenon, known as "regression to the mean" occurs because the low response group might have included women who usually have a normal response but by chance were low in the first cycle. Regression to the mean has been mentioned previously as an explanation for the spurious effect of increasing the dose after a poor response in the first cycle (35).…”

Section: Fertility and Sterilitymentioning

confidence: 78%

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

Klinkert

Broekmans

Looman

et al. 2004

Fertility and Sterility

102

View full text Add to dashboard Cite

Objective: To calculate the cumulative ongoing pregnancy rate in patients with a poor response in their first IVF cycle. Design: Retrospective cohort study. Setting: In vitro fertilization unit of a university hospital. Patient(s): Two hundred twenty-five women who experienced a poor response in their first IVF or intracytoplasmic sperm injection cycle. These patients were divided into 64 expected (aged Ն41 years and/or elevated FSH level) and 161 unexpected poor responders (aged Ͻ41 years and FSH level not elevated). Intervention(s):In vitro fertilization treatment with a long-suppression protocol with FSH-urofollitropin or recombinant FSH. Main Outcome Measure(s): Cumulative ongoing pregnancy rate. This rate was calculated in two ways to correct for dropouts: pessimistic (zero chance of pregnancy for the dropouts) and optimistic (the same chance for the dropouts as for patients who continued). Result(s):The cumulative ongoing pregnancy rate of women with an unexpected poor response in the first cycle was 37% (pessimistic) to 47% (optimistic) after three cycles. Women with an expected poor response had a cumulative ongoing pregnancy rate of 16% (pessimistic) to 19% (optimistic) after 3 cycles. Sixty-four percent of the unexpected poor responders and 31% of the expected poor responders had a normal response in the second cycle, most of them after receiving a higher dose of gonadotropins. Conclusion(s):Most patients with an unexpected poor response in the first cycle had a normal response in the second cycle, leading to an acceptable cumulative ongoing pregnancy rate after three cycles. Patients with an expected poor response in the first cycle should be advised to withdraw from treatment after the first cycle because of a poor prognosis. (Fertil Steril 2004;81:1247Ϫ53.

show abstract

Section: Fertility and Sterilitymentioning

confidence: 78%

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

Klinkert

Broekmans

Looman

et al. 2004

Fertility and Sterility

102

View full text Add to dashboard Cite

show abstract

“…This suggests that while ultra-high doses of FSH may recruit "resistant" follicles, their oocytes are of poor quality and do not result in the generation of good quality embryos. Another study which compared the number of retrieved oocytes and IVF cancellation rates in previous poor responders found absolutely no benefit from increasing the starting dose of FSH above 150 IU/day [4]. Furthermore, predicted poor responders, based on either marginally elevated levels of basal FSH [23] or low antral follicle count [34], were not shown to benefit from an increase in starting dose of FSH.…”

Section: Discussionmentioning

confidence: 99%

“…The starting dose of FSH used in any subsequent cycle is then adjusted according to the individual patient's response in their first cycle. Unfortunately this approach is less than ideal since it results in an inadequate response in about 50% of patients and an excessive response in 2-5% of cycles [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…A prospective randomized control trial that compared a standard starting dose of gonadotrophins in the first cycle of IVF (150 IU/day FSH) with an individualized starting dose (100-250 IU/day) based on such a predictive normogram (age, antral follicle count, ovary volume , Doppler score and smoking status) confirmed that an individualized starting dose was more effective at achieving an "ideal response" (5-14 oocytes) than a standard starting dose (77.1% v 65.6% ideal response, p < 0.05). While some studies have shown a positive benefit from increasing the starting dose of gonadotrophin [3,5], many others have not shown a benefit [4,23,26]. Therefore, it is presently uncertain if upward adjustment of gonadotrophin starting dose has any clinical value.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Lekamge

Lane

Gilchrist³

et al. 2008

J Assist Reprod Genet

View full text Add to dashboard Cite

Purpose This retrospective study was carried out to evaluate whether increasing the starting dose of FSH stimulation above the standard dose of 150 IU/day in patients with low predicted ovarian reserve can improve IVF outcomes. Method A total of 122 women aged less than 36 years in their first cycle of IVF were identified as having likely low ovarian reserve based on a serum AMH measurement below 14 pmol/l. Thirty five women were administered the standard dose of 150 IU/day FSH, while the remaining 87 received a higher starting dose (200-300 IU/day FSH). There were no significant differences in age, BMI, antral follicle count, serum AMH, FSH or aetiology of infertility between the two dose groups.Results No significant improvement in oocyte and embryo yield or pregnancy rates was observed following an upward adjustment of FSH starting dose. While increasing the dose of FSH above 150 IU/day did not produce any adverse events such as OHSS, it did consume an extra 1,100 IU of FSH per IVF cycle. ConclusionThe upward FSH dose adjustment in anticipation of low ovarian reserve can not be advocated as it is both expensive and of no proven clinical value.

show abstract

“…Natural cycle-to-cycle variation, which are more likely in unexpected poor responders, may also account for some of the observed "improvement." Three non-randomised studies showed that increasing the dose of hMG up to 450 IU/day in a second cycle did not increase the number of available embryos, nor did it improve the outcome of the treatment cycle compared to the previous cycle in which the patients had been started on a lower hMG dose [28][29][30]. A retrospective analysis by Land et al [30] analysed outcomes of 126 patients who had undergone two IVF cycles, the first cycle starting on 225 IU/day and the second cycle starting on 450 IU/day.…”

Section: Dose Following a Poor Responsementioning

confidence: 99%

Is there a recommended maximum starting dose of FSH in IVF?

Rombauts

2007

J Assist Reprod Genet

View full text Add to dashboard Cite

This report reviews and discusses the existing evidence on recommended FSH doses in IVF cycles. A comprehensive search for relevant data was performed in the Cochrane Library, MEDLINE, EMBASE and NICE clinical guidelines database, and the reference lists of manuscripts. A good body of evidence exists looking at starting doses of FSH for first IVF attempts. Only one randomised controlled trial was identified looking at the efficacy of increasing doses during an IVF cycle. Some observational studies dealt with the question whether a suboptimal ovarian response should be managed by an increased FSH dose in a subsequent cycle, but no randomised trials addressed this issue.

show abstract

Increasing the human menopausal gonadotropin dose—does the response really improve?

Cited by 23 publications

References 9 publications

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Is there a recommended maximum starting dose of FSH in IVF?

Contact Info

Product

Resources

About