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

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...

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Bibliographic Details
Published in:Journal of assisted reproduction and genetics 2008-11, Vol.25 (11-12), p.515-521
Main Authors: Lekamge, Dharmawijaya N, Lane, Michelle, Gilchrist, Robert B, Tremellen, Kelton P
Format: Article
Language:English
Subjects:
Adult
Age
Anti-Mullerian Hormone - blood
Assisted Reproduction
Dose-Response Relationship, Drug
Embryos
Female
Fertilization in Vitro - methods
Follicle Stimulating Hormone - administration & dosage
Follicles
Gynecology
Human Genetics
Humans
Male
Medicine
Medicine & Public Health
Obstetrics
Ovaries
Ovulation Induction - methods
Ovulation Induction - standards
Pediatrics
Pregnancy
Reproductive health
Reproductive Medicine
Retrospective Studies
Womens health
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Summary: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. Conclusion The 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.
ISSN:1058-0468
1573-7330
DOI:10.1007/s10815-008-9266-6