Targeted gonadotrophin stimulation using the PIVET algorithm markedly reduces the risk of OHSS

Abstract

PIVET Medical Centre has developed an empirical algorithm for the dose of FSH administration based upon day-2 FSH, antral follicle count, anti-Müllerian hormone, body mass index, age and smoking parameters in an attempt to reduce the incidence of ovarian hyperstimulation syndrome particularly in at-risk women with elevated antral follicle count and anti-Müllerian hormone. The algorithm utilized the incremental dosage capabilities of the recombinant FSH pens to fine-tune the daily concentration of FSH. Application of the algorithm aimed to minimize any form of excessive follicle recruitment that necessitated increased clinical awareness. The measure used to assess the impact of the algorithm was the number of women who, after oocyte retrieval, were considered to be potentially at risk of any degree of OHSS and were allocated to increased monitoring. Compared with the previous 20-month period, introduction of the algorithm significantly reduced both the incidence of referral for increased monitoring, treatment for OHSS and the incidence of freeze-all cycles (all P < 0.05). This was particularly focused on those considered to be at risk without reducing the fresh cycle pregnancy rate.

A new ovarian response prediction index (ORPI): implications for individualised controlled ovarian stimulation

“…Other published studies also aimed to assess the ovarian response by combining variables [9,11,20,22,39]. However, either these formulas were too complex compared to the simplicity of the ORPI [9,24] or a wide variety of variables were included, which made the assessment complex [11,20,22]. Other studies [51,52] described an index whose calculation required at least 1 cycle of treatment.…”

The Difficult In Vitro Fertilization Patient: An Individualized Approach

“…Thus, careful attention to body weight, anti-müllerian hormone (AMH) levels, antral follicular count and postresponse patterns is critical to achieving this goal. 2 The antral follicle count tends to be the most salient marker of response, as AMH, while useful, is not a perfect biomarker 3,4 ; recent data have emerged suggesting as much as a 50% reduction in AMH levels after 2 months of oral contraceptive exposure, and we have noted on several occasions marked variations of AMH levels within individuals. 5,6 Nonetheless, AMH levels may be used to guide starting medication dosages.…”

Expand evaluation of the ovarian response prediction index (ORPI) for individualised controlled ovarian stimulation

“…The simplicity of the calculation, which requires clinicians to perform simple mathematical operations using the variable values directly, and a direct correlation with the results are the major strong points of the ORPI. Other published studies also aimed to assess the ovarian response by combining variables (la Cour Freiesleben et al,2011, Lekamge et al,2007, Muttukrishna et al,2005, Younis et al,2010, Yovich et al,2012. However, either these formulas were too complex compared to the simplicity of the ORPI (Lekamge et al,2007, Spencer et al,2010] or a wide variety of variables were included, which made the assessment complex (Younis et al,2010, Yovich et al,2012.…”

“…Other published studies also aimed to assess the ovarian response by combining variables (la Cour Freiesleben et al,2011, Lekamge et al,2007, Muttukrishna et al,2005, Younis et al,2010, Yovich et al,2012. However, either these formulas were too complex compared to the simplicity of the ORPI (Lekamge et al,2007, Spencer et al,2010] or a wide variety of variables were included, which made the assessment complex (Younis et al,2010, Yovich et al,2012. Other studies (Biasoni et al,2011, Gallot et al,2012 described an index whose calculation required at least 1 cycle of treatment.…”

“…In fact, in addition to age, several clinical, endocrine and ultrasound markers, and dynamic tests have been proposed for the prediction of the ovarian response to stimulation (Broekmans et al,2006. Among these markers, use of the level of anti-Müllerian hormone (AMH) and the antral follicle count (AFC) is of particular interest (Broekmans et al,2006, Hendriks et al,2005, Jayaprakasan et al,2010, La Marca et al,2009,2012, Lekamge et al,2007, Nelson et al,2012, Yovich et al,\ 2012. However, despite the predictive power that each marker for the ovarian response may have individually, all of these markers have errors associated with their estimation.…”