Clin Exp Reprod Med.  2018 Dec;45(4):183-188. 10.5653/cerm.2018.45.4.183.

A retrospective analysis of the follicle-stimulating hormone starting dose in expected normal responders undergoing their first in vitro fertilization cycle: proposed dose versus empiric dose

Affiliations
  • 1Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea. blasto@snubh.org
  • 2Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.

Abstract


OBJECTIVE
The purpose of this retrospective study was to evaluate the appropriateness of various follicle-stimulating hormone (FSH) starting doses in expected normal responders based on the nomogram developed by La Marca et al.
METHODS
A total of 117 first in vitro fertilization cycles performed from 2011 to 2017 were selected. All women were expected normal responders and used a recombinant FSH and flexible gonadotropin-releasing hormone antagonist protocol. The FSH starting dose was empirically determined (150, 225, or 300 IU). The FSH starting dose indicated by La Marca's nomogram was determined using female age and serum anti-Müllerian hormone or basal FSH levels. If the administered dose was exactly the same as the proposed dose, the cycle was assigned to the concordant group (34 cycles). If not, it was assigned to the discordant group (83 cycles). Optimal ovarian response was defined as a total of 8-14 oocytes, hypo-response as < 8 oocytes, and hyper-response as >14 oocytes.
RESULTS
Between the concordant and discordant group, ovarian response (optimal, 32.4% vs. 27.7%; hypo-response, 55.9% vs. 54.2%; and hyper-response, 11.8% vs. 18.1%) and the number of total or mature oocytes were similar. Ovarian hyperstimulation syndrome was rare in both groups (0% vs. 1.2%). The implantation rate, clinical pregnancy rate, miscarriage rate, and live birth rate were all similar.
CONCLUSION
The use of the proposed FSH starting dose determined using La Marca's nomogram did not enhance the optimal ovarian response rate or pregnancy rate in expected normal responders. Individualization of the FSH starting dose by La Marca's nomogram appears to have no distinct advantages over empiric choice of the dose in expected normal responders.

Keyword

Follicle-stimulating hormone; In vitro fertilization; Nomograms; Ovarian hyperstimulation syndrome

MeSH Terms

Abortion, Spontaneous
Female
Fertilization in Vitro*
Follicle Stimulating Hormone*
Gonadotropin-Releasing Hormone
Humans
In Vitro Techniques*
Live Birth
Nomograms
Oocytes
Ovarian Hyperstimulation Syndrome
Pregnancy
Pregnancy Rate
Retrospective Studies*
Follicle Stimulating Hormone
Gonadotropin-Releasing Hormone
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