Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertili
- PDF / 259,672 Bytes
- 6 Pages / 595.28 x 793.7 pts Page_size
- 36 Downloads / 181 Views
RESEARCH
Open Access
Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization? Yaakov Bentov1,2,3*, Eliezer Burstein1,2,3, Courtney Firestone2,3, Ross Firestone2,3, Navid Esfandiari1,2 and Robert F Casper1,2,3
Abstract Background: When stimulating a patient with poor ovarian response for IVF, the maximal dose of gonadotropins injected is often determined by arbitrary standards rather than a measured response. The purpose of this study was to determine if serum FSH concentration during an IVF stimulation cycle reflects follicular utilization of FSH and whether serum FSH values may inform dose adjustments of exogenous FSH. Methods: In this retrospective cross sectional study we studied 155 consecutive IVF cycles stimulated only with recombinant human FSH. We only included long GnRH agonist protocols in which endogenous FSH levels were suppressed. We correlated the serum concentration of cycle day (CD) 7 FSH with the number of oocytes retrieved, cleaving embryos and pregnancy rate. Results: We found that a CD7 FSH concentration above 22 IU/L was associated with poor response regardless of the daily dose of FSH injected and a lower pregnancy rate. Conclusions: We concluded that CD7 FSH concentration during stimulation could be used to guide FSH dosing in poor responders. If the CD7 FSH concentration is above 22 IU/L increasing the dose of FSH in an attempt to recruit more growing follicles is unlikely to be successful. Keywords: Serum FSH concentration, FSH elimination, Poor ovarian response, In vitro fertilization, Ovarian stimulation
Background The stimulation of ovarian follicular development is an essential part of in vitro fertilization (IVF) and has a major impact on the treatment outcome. Over the years multiple protocols for ovarian stimulation have been developed containing different combinations of gonadotropins, GnRH analogues and other adjuvants [1-3]. Despite the differences between protocols it is clear that the major component responsible for follicular maturation is follicle stimulating hormone (FSH) [4]. Furthermore a direct dose response relationship between amount of FSH administered and follicle recruitment and growth has been described [5]. * Correspondence: [email protected] 1 Toronto Centre for Advanced Reproductive Technology, Toronto, ON, Canada 2 Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada Full list of author information is available at the end of the article
Typically, stimulation for IVF would involve daily subcutaneous injections of recombinant or urinary-derived FSH usually at a constant daily dose for 10–13 days. Poor ovarian response may be defined as a low oocyte yield despite treatment with a high dose of FSH [6]. Poor ovarian response is one of the main obstacles to pregnancy success in IVF since treatment is dependent on the quantity as well as the quality of oocytes and embryos. Since poor ovarian response involves resistance to the act
Data Loading...
