Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman’s age and markers of ovarian reserve

Paola, R. Di; Garzon, Simone; Giuliani, Sara; Laganà, Antonio Simone; Noventa, Marco; Parissone, Francesca; Zorzi, C; Raffaelli, Ricciarda; Ghezzi, Fabio; Franchi, Massimo Piergiuseppe; Zaffagnini, Stefano

doi:10.1007/s00404-018-4906-2

Cited by 71 publications

(60 citation statements)

References 37 publications

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“…Their findings indicated that the starting dose of FSH in IVF cycles should be individualised 14. In patients of PCOS, specifically with high AMH level, the nomogram does not appear adequate 15. In our patient, the dose was decided based on her response during previous IVF attempt, age and ovarian reserve markers.…”

Section: Discussionmentioning

confidence: 87%

Severe early-onset ovarian hyperstimulation syndrome with liver dysfunction in an IVF segmentation cycle

et al. 2020

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Severe early-onset ovarian hyperstimulation syndrome (OHSS) with deranged liver function tests is an entity that cannot be eliminated wholly even after gonadotropin-releasing hormone (GnRH) agonist trigger without any luteal human chorionic gonadotropin (hCG) rescue in a GnRH antagonist protocol with the freeze-all approach. We describe a case of young polycystic ovary syndrome patient with prior history of severe early-onset OHSS in her last in vitro fertilisation cycle in which she received antagonist protocol followed by blastocyst transfer. Given her history, she was planned for agonist trigger and freeze all approach during the present cycle. Despite segmentation of the cycle without any luteal rescue hCG, she developed early-onset severe OHSS with markedly deranged liver function tests for which she underwent ascitic tapping and remained hospitalised for 8 days. Her symptoms improved with conservative management, and she was discharged satisfactorily. She underwent letrozole based frozen–thawed embryo transfer cycle after 4 months. One good quality blastocyst was transferred, and she conceived in the same cycle.

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Section: Discussionmentioning

confidence: 87%

Severe early-onset ovarian hyperstimulation syndrome with liver dysfunction in an IVF segmentation cycle

et al. 2020

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“…14,15 Thirdly, the starting dose of hMG was 150 IU for patients with high AFC (>20) or slightly increased FSH level (7-10 IU/L), whereas 225 IU hMG was applied initially for all other PCOS patients. 10 Nonetheless, similar to other clinical trials, 14,35,36 this tailored starting dose was based on single center's experience and was not evidently validated in comparison with the standard starting dose. Considering the limited number of individualized gonadotropin dosing studies for the PCOS subgroup, 37 this program deserves further investigation in future studies.…”

Section: Discussionmentioning

confidence: 99%

<p>Progestin-Primed Ovarian Stimulation with Dydrogesterone versus Medroxyprogesterone Acetate in Women with Polycystic Ovarian Syndrome for in vitro Fertilization: A Retrospective Cohort Study</p>

Huang

Xie

Lin

et al. 2020

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Dydrogesterone (DYG) is an alternative progestin in progestin-primed ovarian stimulation (PPOS) protocol with weaker pituitary suppression than medroxyprogesterone acetate (MPA) in normal ovulatory women. However, the endocrinological characteristics, oocyte retrieval and pregnancy outcomes of DYG application in polycystic ovarian syndrome (PCOS) patients undergoing in vitro fertilization (IVF) remain unclear. Patients and methods: This retrospective cohort study included 420 PCOS patients who underwent controlled ovarian stimulation with human menopausal gonadotropin (hMG) and DYG (n=105) or MPA (n=315) from January 2014 to December 2017. Baseline characteristics of the two groups were balanced with propensity score matching using the nearestneighbor random matching algorithm in a ratio of 1:3. The primary outcome measure was the number of oocytes retrieved. Other main outcome measures included the number of viable embryos, incidence of premature luteinizing hormone (LH) surge and live birth rate per frozen-thawed embryo transfer (FET) cycle. Results: A similar number of oocytes was retrieved in the two protocols (16.1±6.5 vs 15.1±10.0, P=0.342). Patients in both groups achieved consistent LH suppression with no premature LH surge detected. In the DYG + hMG group, the mean LH levels were significantly higher than the MPA + hMG group on cycle day 9-11 and trigger day (all P<0.001), and the dose of hMG was significantly lower (1710.7±431.6 vs 1891.3±402.2 IU, P<0.001). No significant between-group differences were found in the number of viable embryos (5.3±3.1 vs 5.0±4.1, P=0.139) and live birth rate per FET cycle (43.5% vs 47.7%, P=0.383). None of the participants experienced moderate-to-severe ovarian hyperstimulation syndrome in either group. Conclusion: Our results showed that the application of DYG in PPOS protocol could achieve comparable oocyte retrieval and pregnancy outcomes to MPA, but significantly reduce the consumption of gonadotropins in PCOS women for IVF treatment.

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“…Women often complain of the burden of treatment, particularly in IVF. Physicians should adopt any available strategies to increase success of ART and reduce the risk of drop -out as well as the risk of complications, interruption of ovarian stimulation, and failure, such as the use of nomograms in the definition of gonadotropins doses for ovarian stimulation [34]. In this regard, the impact of procedure failure, particularly due to failed ovarian stimulation or complication as Ovarian Hyperstimulation syndrome on the psychology and wellbeing of patients could be a further point of investigation.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey

et al. 2020

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Objective To evaluate the impact of infertility and Medically Assisted Reproduction (MAR) throughout all aspects of life among infertile women and men. Materials and methods An online survey included 1 045 French patients (355 men, 690 women) who were living or had lived the experience of infertility and MAR. The questionnaire included 56 questions on several domains: global feelings, treatment burden, rapport with medical staff, psychosocial impact, sexual life and professional consequences.

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Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman’s age and markers of ovarian reserve

Cited by 71 publications

References 37 publications

Severe early-onset ovarian hyperstimulation syndrome with liver dysfunction in an IVF segmentation cycle

Severe early-onset ovarian hyperstimulation syndrome with liver dysfunction in an IVF segmentation cycle

<p>Progestin-Primed Ovarian Stimulation with Dydrogesterone versus Medroxyprogesterone Acetate in Women with Polycystic Ovarian Syndrome for in vitro Fertilization: A Retrospective Cohort Study</p>

Psychosocial and professional burden of Medically Assisted Reproduction (MAR): Results from a French survey

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