Abstract
BackgroundGonadotropins are used in ovulation induction (OI) for patients with anovulatory infertility. Pharmacologic OI is associated with risks of ovarian hyperstimulation syndrome and multiple pregnancy. Treatment protocols that minimize these risks by promoting monofollicular development are required. A starting dose of 37.5 IU/day follitropin alfa has been used in OI, particularly among women at high risk of multifollicular development and multiple pregnancy. A retrospective case series study was performed to evaluate rates of monofollicular development and singleton pregnancy following standard treatment with 37.5 IU/day follitropin alfa.MethodsSpanish centers that had performed at least five OI cycles during 2008 using 37.5 IU/day follitropin alfa as a starting dose were invited to participate. Data could be provided from any cycle performed in 2008 (up to a maximum of 12 consecutive cycles per site). Case report forms were collected during April-November 2009 and reviewed centrally. Descriptive statistics were obtained from all cases, and follicular development and clinical pregnancy rates assessed. Potential associations of age and body mass index with follicular development and clinical pregnancy were assessed using univariate correlation analyses.ResultsThirty centers provided data on 316 cycles of OI using a starting dose of 37.5 IU/day follitropin alfa. Polycystic ovary syndrome was the cause of anovulatory infertility in 217 (68.7%) cases. Follitropin alfa at 37.5 IU/day was sufficient to achieve ovarian stimulation in 230 (72.8%) cycles. A single follicle ≥16 mm in diameter developed in 193 cycles (61.1%; 95% confidence interval [CI] 55.7-66.4%). Seventy-eight women (24.7%; 95% CI 19.9-29.5%) became pregnant: 94.9% singleton and 5.1% twin pregnancies. Fourteen started cycles (4.4%) were cancelled, mainly due to poor response. Univariate correlation analyses detected weak associations.ConclusionsMonofollicular growth rate was comparable with optimal rates reported elsewhere and the pregnancy rate exceeded that in other studies of OI using gonadotropins. A starting dose of 37.5 IU/day follitropin alfa is an effective option in selected cases to prevent ovarian hyper-response without loss of efficacy. The analysis could not identify a single selection criterion for individuals who would benefit from this treatment approach; this merits further investigation in prospective studies.
Highlights
Gonadotropins are used in ovulation induction (OI) for patients with anovulatory infertility
The main aim of the study was to determine the rate of monofollicular development with a starting dose of 37.5 IU/day follitropin alfa in OI
Case series and scope This retrospective case series study was based on data from case reports of women with anovulatory infertility who were treated with follitropin alfa (GONAL-f®, Merck Serono S.A. - Geneva, Switzerland, a branch of Merck Serono S.A., Coinsins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany) at a starting dose of 37.5 IU/day to induce ovulation according to standard practice criteria
Summary
Gonadotropins are used in ovulation induction (OI) for patients with anovulatory infertility. Efforts have been made to modulate ovarian response to gonadotropins by concurrent treatment with anti-estrogens, aromatase inhibitors, and gonadotropin-releasing hormone analogs to reduce the dose of gonadotropin required [12,13,14], and by directly lowering the standard doses of gonadotropins administered [15,16,17]. These approaches have had limited success and multiple follicular development, multiple pregnancy, and OHSS still remain as major, unresolved issues in OI
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