Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization?

Yaakov Bentov,Courtney Firestone,Ross Firestone,Eliezer Burstein,Navid Esfandiari,Robert F Casper

doi:10.1186/1477-7827-11-12

Abstract

BackgroundWhen 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.MethodsIn 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.ResultsWe 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.ConclusionsWe 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.

Highlights

When stimulating a patient with poor ovarian response for in vitro fertilization (IVF), the maximal dose of gonadotropins injected is often determined by arbitrary standards rather than a measured response
This observation is especially true in poor responders who are usually treated with high daily doses of follicle stimulating hormone (FSH), at times exceeding 600 International units (IU) a day
We show that a significantly higher concentration of serum FSH following administration of exogenous FSH did not result in a higher number of oocytes and embryos

Summary

Introduction

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. Despite the differences between protocols it is clear that the major component responsible for follicular maturation is follicle stimulating hormone (FSH) [4]. Since poor ovarian response involves resistance to the action of FSH, one way to improve response is to increase the daily dose of FSH administered. This practice potentially allows follicles with fewer FSH receptors, and requiring a higher FSH threshold, to respond to the stimulation. The concept of “the maximal” daily dose of FSH given to a poor responding patient is dependent mostly on clinic policy without any objective tools to guide the decision

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Conclusion