Doubling the human menopausal gonadotrophin dose in the course of an in-vitro fertilization treatment cycle in low responders: a randomized study

Hooff, M.H.A. van; Alberda, Albert Th.; Huisman, Gerritdina J.; Zeilmaker, G. H.; Leerentveld, Robert A.

doi:10.1093/oxfordjournals.humrep.a138053

Cited by 127 publications

(37 citation statements)

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“…However, recently this approach has been challenged, van Hoof et al (1) performed a prospective, randomized study in which the dose of gonadotropins was increased in 22 patients with low E2 levels after 5 days of ovarian stimulation, while in 25 controls exhibiting the same E2 response the dose remained unchanged. No significant improvement of high-dose gonadotropin treatment on pregnancy rate was found.…”

Section: Discussionmentioning

confidence: 99%

The need to step up the gonadotropin dosage in the stimulation phase of IVF treatment predicts a poor outcome

Hock

Louie

Shelden

et al. 1998

J Assist Reprod Genet

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Section: Discussionmentioning

confidence: 99%

The need to step up the gonadotropin dosage in the stimulation phase of IVF treatment predicts a poor outcome

Hock

Louie

Shelden

et al. 1998

J Assist Reprod Genet

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“…Dose increases mid-cycle do not make a significant difference as the recruitment window of growing, receptive follicles has passed (22). The closest correlator determining the number of follicles recruited is the patient's age, which is related to the number of follicles in the current recruitable growth wave.…”

Section: Dosagementioning

confidence: 99%

“…Increasing the dose of gonadotrophin stimulation is widely used within the range 100-450 IU daily, but there is little evidence to support higher doses (22,65). Changing from a long agonist protocol to a flare has been demonstrated to reduce the incidence of cycle cancellation for poor response (66).…”

Section: Poor Respondersmentioning

confidence: 99%

GnRH analogues: applications in assisted reproductive techniques

Hayden

2008

European Journal of Endocrinology

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The ability to prevent an endogenous LH surge revolutionised the efficacy of assisted reproductive techniques (ART) such that GnRH agonists were rapidly adopted in the 1980s. Prior to this, premature luteinisation occurred in up to 25% of superovulated cycles leading to cycle cancellation and severely compromised outcomes. Analogues have been applied in a variety of drug protocols (long, short flare) but there has been little research to moderate the degree of pituitary suppression. There has also been ongoing and unresolved debate about the role of LH in supporting follicular development.By 2001, the first GnRH antagonists were registered for use in ART. Their ability to cause immediate suppression of gonadotrophin (particularly LH) secretion means that they can be given after exogenous stimulation has begun and thereby dramatically shorten the total duration of a treatment cycle. After initial enthusiasm and then scepticism that pregnancy rates may not be as high as the established agonist regimens, these preparations are now being increasingly adopted with at least comparable outcomes in large trials. They are certainly favoured by patients for their reduced side-effect profile and particularly for the shortening of the total cycle length. This shift in practice is occurring alongside gathering momentum in favour of milder stimulation protocols and a new perception of what constitutes successful treatment. The focus is moving away from surrogate outcomes such as oocyte numbers and conception rates towards long-term outcomes for women and their offspring, namely the achievement of a live singleton birth per treatment started.

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“…It has not been firmly established whether increasing the daily dose during stimulation yields a better result. The only prospective randomized controlled trial showed that doubling the administered dose in patients with a low response after 5 days of 225 IU human menopausal gonadotropin (hMG) did not result in a higher number of oocytes retrieved compared with patients treated with a fixed dose of hMG (15). The results of the present study suggest that a dose increase improves the outcome (in terms of numbers of oocytes retrieved) since compared to the previous fixed dose trials using 100 IU follitropin-β (Puregon), an average four to five extra oocytes were retrieved.…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Double-Blind, Multicenter Study Comparing a Starting Dose of 100 IU or 200 IU of Recombinant Follicle Stimulating Hormone (Puregon�) in Women Undergoing Controlled Ovarian Hyperstimulation for IVF Treatment

Tan

Child

Cheung

et al. 2005

J Assist Reprod Genet

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Purpose : To compare the efficiency and efficacy of two starting doses of recombinant FSH (follitropin-β, Puregon) in women undergoing IVF treatment. Methods : This prospective, randomized, double-blind, multicentric (N = 6) study included 192 women undergoing IVF using the long protocol of GnRH agonist who received either 100 IU or 200 IU of r-FSH per day. Gonadotropin dose adjustment was allowed after day 4 of stimulation. Results : The average (SD) number of oocytes retrieved was 10.9 (5.4) and 12.2 (5.6) in the 100 IU and 200 IU group respectively (p = 0.067). The total doses of Puregon administered were 1887 IU and 2559 IU in the 100 IU and 200 IU group respectively. The number of transferable embryos, and the rates of pregnancies, cancelled cycles, miscarriages and adverse events including OHSS were comparable between the two groups. Conclusions : Women undergoing IVF have similar outcomes whether recombinant FSH is commenced in a dose of 100 IU or 200 IU for the first 4 days of stimulation.

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Doubling the human menopausal gonadotrophin dose in the course of an in-vitro fertilization treatment cycle in low responders: a randomized study

Cited by 127 publications

References 0 publications

The need to step up the gonadotropin dosage in the stimulation phase of IVF treatment predicts a poor outcome

The need to step up the gonadotropin dosage in the stimulation phase of IVF treatment predicts a poor outcome

GnRH analogues: applications in assisted reproductive techniques

A Randomized, Double-Blind, Multicenter Study Comparing a Starting Dose of 100 IU or 200 IU of Recombinant Follicle Stimulating Hormone (Puregon�) in Women Undergoing Controlled Ovarian Hyperstimulation for IVF Treatment

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