IVF Stimulation - personalized, optimized, and simplified using an advanced decision-support tool: A randomized trial

Abstract

We assessed the effectiveness of a clinical decision support tool to reduce total cumulative follicle-stimulating hormone dosage used, to eliminate the need for ultrasound exams after day 5 of an individual superovulation cycle, and to improve the number of high-quality embryos obtained. The design we used was a Randomized Control Trial in a private fertility center. This study included 93 women aged 25–45 years undergoing IVF. 48 Test and 45 Control participants included normal and poor responders and patients with polycystic ovarian syndrome. A clinical decision support tool was used to forecast stimulatory hormone dosing for an individual cycle based on follicle size distribution on day 1 and day 5. Cumulative stimulatory hormone doses, oocytes retrieved, number of Mii oocytes, total embryos, high-quality embryos obtained during the cycle, and clinical pregnancy rates was the main outcome measures. Test participants required significantly lower cumulative FSH doses during superovulation cycles (average 1883 IU test, 2530 IU control, p <0.01), with significantly higher numbers of total embryos (average 5.4 test, 3.5 control, p<0.01), and high-quality embryos (average 3.1 test, 1.2 control, p<0.01). Test participants had higher Mii follicles, although the difference was not statistically significant. The clinical pregnancy rate reported was significantly higher for test participants than control participants (52% test, 26% control, p<0.05). The test group had more poor responders and PCOS patients than the control group. In conclusion, the clinical decision support tool eliminated the need for ultrasound exams after day 5, reduced the doses of stimulatory hormone required, yielded significantly higher numbers of high-quality embryos, and resulted in higher clinical pregnancy rates.