Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency

Imani, Babak; Eijkemans, Marinus J.C.; Faessen, G. H.; Bouchard, Philippe; Giudice, Linda C.; Fauser, Bart C.J.M.

doi:10.1016/s0015-0282(01)02928-4

Cited by 111 publications

(65 citation statements)

References 31 publications

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“…Even in women who do not ovulate spontaneously following weight reduction and lifestyle modifications, the response to induction of ovulation is likely to be improved by these measures, although there have been reports of pregnancies after nine or more months of treatment (273). In fact, excess weight or obesity has an adverse effect on ovulation rate and both elevated androgens and high LH negatively affect responsiveness to treatment (273,274,275,276).…”

Section: Therapeutic Approach To the Reproductive Phenotypementioning

confidence: 99%

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

576

492

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Polycystic ovary syndrome (PCOS) is the most common ovarian disorder associated with androgen excess in women, which justifies the growing interest of endocrinologists. Great efforts have been made in the last 2 decades to define the syndrome. The presence of three different definitions for the diagnosis of PCOS reflects the phenotypic heterogeneity of the syndrome. Major criteria are required for the diagnosis, which in turn identifies different phenotypes according to the combination of different criteria. In addition, the relevant impact of metabolic issues, specifically insulin resistance and obesity, on the pathogenesis of PCOS, and the susceptibility to develop earlier than expected glucose intolerance states, including type 2 diabetes, has supported the notion that these aspects should be considered when defining the PCOS phenotype and planning potential therapeutic strategies in an affected subject. This paper offers a critical endocrine and European perspective on the debate on the definition of PCOS and summarises all major aspects related to aetiological factors, including early life events, potentially involved in the development of the disorder. Diagnostic tools of PCOS are also discussed, with emphasis on the laboratory evaluation of androgens and other potential biomarkers of ovarian and metabolic dysfunctions. We have also paid specific attention to the role of obesity, sleep disorders and neuropsychological aspects of PCOS and on the relevant pathogenetic aspects of cardiovascular risk factors. In addition, we have discussed how to target treatment choices based according to the phenotype and individual patient's needs. Finally, we have suggested potential areas of translational and clinical research for the future with specific emphasis on hormonal and metabolic aspects of PCOS.

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Section: Therapeutic Approach To the Reproductive Phenotypementioning

confidence: 99%

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

576

492

View full text Add to dashboard Cite

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“…The daily dose was increased by 1 ⁄2 ampoule if ovarian response (at least one follicle of at least 10 mm) was absent after 14 d. Thereafter the dose was increased by 1 ⁄2 ampoule every 7 d if required. The FSH response dose was defined as the dose at which an ovarian response was observed (24). In case a sufficient ovarian response was observed, the dose was kept constant until administration of 5000 IU human chorionic gonadotropin (Profasi, Ares-Serono).…”

Section: Ovulation Induction Treatmentmentioning

confidence: 99%

Anti-Müllerian Hormone Serum Concentrations in Normoovulatory and Anovulatory Women of Reproductive Age

Laven

Mulders

Visser

et al. 2004

The Journal of Clinical Endocrinology &Amp; Metabolism

474

299

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“…, where BMI ¼ body mass index (14). We used the F-test for ANOVA for comparison of patient groups divided by day of first step-down (# 3 days, .…”

Section: Discussionmentioning

confidence: 99%

“…However, the inconvenience and costs of a 'dose-finding' induction cycle were introduced. A second step was the development of a prediction model from this patient group, treated according to a 'dose-finding' low-dose step-up regimen, for the effective FSH starting dose (14). Using this prediction model, a time consuming 'dose-finding' cycle can be avoided.…”

Section: Discussionmentioning

confidence: 99%

“…The major disadvantage of this regimen, however, is that the initial fixed FSH dose may be too high for some women resulting in enhanced chances of complications and cycle cancellations (13). We recently described a prediction model using initial patient characteristics for the individual FSH starting dose in low-dose regimens for ovulation induction (14). The ability to assess the effective individual FSH response-dose would improve the course and outcome in both low-dose step-up and step-down protocols by reducing the duration of treatment and complication rates.…”

Section: Introductionmentioning

confidence: 99%

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FSH response-dose can be predicted in ovulation induction for normogonadotropic anovulatory infertility

Santbrink

Eijkemans

Macklon

et al. 2002

European Journal of Endocrinology

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Objective: To evaluate the ability of a prediction model to identify the individual starting dose of FSH for ovulation induction using a step-down regimen. Design: Retrospective analysis of clinical data in an academic fertility unit. Fifty-six normogonadotropic anovulatory infertile patients who failed to ovulate or conceive with clomiphene citrate were included. They were treated with exogenous gonadotropins with a flexible starting dose for ovulation induction using a step-down regimen. The clinically applied starting dose of exogenous gonadotropins was compared with the calculated response-dose using a previously published prediction model. Results: Patients were arbitrarily divided into three groups according to the day of the first decrease in gonadotropin dose: (a) early step-down (day 3 or earlier); (b) standard step-down (day 4 or later); (c) no step-down. These groups had average starting doses of 28.5 IU (group a) and 13 IU (group b) above the calculated response -dose, and 43 IU (group c) under the calculated response -dose. A significant correlation between day of first step-down and the difference between clinically applied and calculated response -dose was observed (P , 0:0001; F-test for ANOVA). Conclusions: The patient group with the best step-down profile for ovulation induction exhibited the closest match between the clinically applied and calculated starting dose of gonadotropins. Therefore, this study provides support for the concept that the individual effective FSH starting dose for gonadotropin induction of ovulation in anovulatory infertile patients can be predicted on the basis of initial screening characteristics, such as body mass index, clomiphene resistance or failure, free IGF-I and FSH. This may result in more effective patient treatment protocols, reduced complication rates and health-economic benefits.

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Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency

Cited by 111 publications

References 31 publications

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

The polycystic ovary syndrome: a position statement from the European Society of Endocrinology

Anti-Müllerian Hormone Serum Concentrations in Normoovulatory and Anovulatory Women of Reproductive Age

FSH response-dose can be predicted in ovulation induction for normogonadotropic anovulatory infertility

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