Expected poor responders on the basis of an antral follicle count do not benefit from a higher starting dose of gonadotrophins in IVF treatment: a randomized controlled trial*

Purpose The objective of this study was the elucidation of the possible role of the single-nucleotide polymorphisms (SNP) at position -29 and 2039 of the FSH receptor gene (FSHR) as independent predictive markers of ovarian response. Indeed, the tailoring of reproductive treatments is crucial for both maximizing the success of IVF patients and obtaining a reduction in hypo-or hyper-response rates. Methods This prospective, observational study analyzed the association of -29 and 2039 FSHR polymorphisms with the number of retrieved oocytes in 140 patients attending an IVF/ ICSI cycle for severe male factors (≤5,000,000 spermatozoa/ mL) or tubal factors at the ANDROS Day

Section: Discussionsupporting

confidence: 92%

The carriers of the A/G-G/G allelic combination of the c.2039 A>G and c.-29 G>A FSH receptor polymorphisms retrieve the highest number of oocytes in IVF/ICSI cycles

Allegra

Marino

Raimondo

et al. 2016

“…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. In support of this theory is the recent publication by Pal et al [35] who have described a reduced likelihood of clinical pregnancy and live birth and a trend towards a higher likelihood of miscarriage with the use of high dosages of gonadotrophin.…”

Section: Discussionmentioning

confidence: 99%

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

Lekamge

Lane

Gilchrist³

et al. 2008

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.

“…There is only one randomised controlled trial that looked at the efficacy of doubling the starting dose in women who are anticipated to respond poorly [19]. Those patients with <5 antral follicles just prior to starting gonadotrophins were recruited for the study.…”

Section: Expected Poor Respondersmentioning

confidence: 99%

“…As mentioned previously, the RCTs by Out et al [14] and Yong et al [15] elegantly demonstrated that higher starting doses of FSH in normal responders do not result in more eggs once they are over the age of 33 years. Similarly, expected poor responders experienced no benefit from being started on a dose of 300 IU instead of 150 IU [19]. If they do not already do so in the first cycle, it seems irrational to expect older women to respond better to a higher dose in a subsequent cycle.…”

Section: Dose Following a Poor Responsementioning

confidence: 99%

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

Rombauts

2007

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.