High initial FSH dosage reduces the number of available cleavage-stage embryos in a GnRH-antagonist protocol: Real-world data of 8,772 IVF cycles from China

Abstract

To evaluate the relationship between the initial follicle stimulating hormone (FSH) dose and the number of available cleavage-stage embryos in in vitro fertilization (IVF) cycles.We included 8772 fresh IVF cycles using a GnRH antagonist protocol at the Genetic and Reproductive Institution of Chongqing, P. R. China, from January 2016 to June 2021.Univariate linear regression was used to evaluate the associations between the initial FSH dosage (≤ 150, 187.5–200, 225, 250, or 300 IU) with the number of available cleavage-stage embryos on day 3. A two-factor linear regression model was applied to calculate the threshold effect of the initial FSH dosage on the number of available cleavage-stage embryos based on a smoothing plot. The initial FSH dose was negatively correlated with the number of available cleavage-stage embryos, independent of female age, body mass index, infertility factors, duration of infertility, anti-Müllerian hormone and basal FSH levels, antral follicle count and the proportions of patients with poor ovarian response or polycystic ovarian syndrome. Using a two-factor linear regression model, we calculated the inflection point to be 200 IU of FSH. The relationship between the initial FSH dose and the number of available cleavage-stage embryos was nonlinear. The initial FSH dose was negatively associated with the number of available cleavage-stage embryos when the initial FSH dose was > 200 IU. Therefore, clinicians should try to avoid unnecessarily increasing the initial FSH dose.

Clinical pregnancy outcomes prediction in vitro fertilization women based on random forest prediction model: A nested case-control study

“…During a cycle of IVF, women receive daily doses of FSH to induce multi-follicular development in the ovaries, which is associated with the quantity and quality of oocytes retrieved. [ 22 ] In the present study, the level of FSH was also a vital predictor for pregnancy outcome in patients receiving IVF-ET.…”

IDoser: Improving individualized dosing policies with clinical practice and machine learning

“…For assumption 1 (positive monotonicity), while some evidences in cows may defy it [23], in the human species, no increment of FSH dose results in a lower number of oocytes retrieved under the same circumstances (same patient, same menstrual cycle) [35, 3, 27, 1]. The only negative effects of higher doses of FSH observed in human relate to the quality of oocytes [29] and not their quantity. As such, the positive monotonicity assumption holds.…”

Dose-response functional and transcriptomic effects of follicle-stimulating hormone onex vivomouse folliculogenesis

“…In women undergoing IVF, higher doses of FSH utilized to stimulate the reduced ovarian follicle pool characteristic of diminished ovarian reserve were associated with reduced numbers of retrieved oocytes and rates of clinical pregnancy and live birth (26)(27)(28); these clinical outcomes may reflect the diminished ovarian reserve or the higher doses of FSH administered (28,32). Women with "normal" ovarian reserve receiving high doses of FSH for infertility treatment have an increased risk of ovarian hyperstimulation syndrome (OHSS), a potentially life-threatening iatrogenic complication of ART characterized by ovarian swelling and leak of ovarian fluid into the peritoneal cavity due to increased capillary permeability and ovarian neo-angiogenesis (29,30).…”