Theodora C van Tilborg1, Frank J M Broekmans1, Madeleine Dólleman1, Marinus J C Eijkemans2, Ben Willem Mol3, Joop S E Laven4, Helen L Torrance1. 1. Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands. 2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 3. The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia. 4. Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Abstract
INTRODUCTION: This systematic review examines whether individualized gonadotropin dosing in in vitro fertilization (IVF) leads to better outcomes with respect to safety, costs, and live birth rates compared with standard dosing. MATERIAL AND METHODS: Electronic databases searched were PubMed, Embase, and Cochrane. The primary outcome was live birth rate. The secondary outcomes included pregnancy rate, costs, and safety. Papers were critically appraised by two reviewers. RESULTS: A total of 7022 articles were retrieved and assessed for eligibility, of which seven randomized controlled trials were selected. All studies used gonadotropin-releasing hormone agonist co-treatment. Clinical and methodological heterogeneity was present, so data could not be pooled for meta-analysis. Only one study, that mainly included women with a good prognosis, revealed an increased chance of ongoing pregnancy in the individualized dosing group compared with standard treatment. With respect to safety, individualized dosing might reduce the occurrence of hyper-response and ovarian hyperstimulation syndrome, without affecting the outcome of pregnancy. In predicted poor responders, higher than standard dosages do not reduce the incidence of poor response. A cost-efficacy analysis was not performed in any of the studies included. CONCLUSION: It is currently not possible to conclude whether individualized dosing leads to higher pregnancy or live birth rates compared with standard dosing, because evidence from well-designed studies that are adequately powered for one of these outcomes is lacking. So, large well-designed studies that evaluate the impact of individualized dosing on live birth rates are needed to assess whether individualized dosing should become the standard in IVF practice.
INTRODUCTION: This systematic review examines whether individualized gonadotropin dosing in in vitro fertilization (IVF) leads to better outcomes with respect to safety, costs, and live birth rates compared with standard dosing. MATERIAL AND METHODS: Electronic databases searched were PubMed, Embase, and Cochrane. The primary outcome was live birth rate. The secondary outcomes included pregnancy rate, costs, and safety. Papers were critically appraised by two reviewers. RESULTS: A total of 7022 articles were retrieved and assessed for eligibility, of which seven randomized controlled trials were selected. All studies used gonadotropin-releasing hormone agonist co-treatment. Clinical and methodological heterogeneity was present, so data could not be pooled for meta-analysis. Only one study, that mainly included women with a good prognosis, revealed an increased chance of ongoing pregnancy in the individualized dosing group compared with standard treatment. With respect to safety, individualized dosing might reduce the occurrence of hyper-response and ovarian hyperstimulation syndrome, without affecting the outcome of pregnancy. In predicted poor responders, higher than standard dosages do not reduce the incidence of poor response. A cost-efficacy analysis was not performed in any of the studies included. CONCLUSION: It is currently not possible to conclude whether individualized dosing leads to higher pregnancy or live birth rates compared with standard dosing, because evidence from well-designed studies that are adequately powered for one of these outcomes is lacking. So, large well-designed studies that evaluate the impact of individualized dosing on live birth rates are needed to assess whether individualized dosing should become the standard in IVF practice.
Authors: Sarah F Lensen; Jack Wilkinson; Jori A Leijdekkers; Antonio La Marca; Ben Willem J Mol; Jane Marjoribanks; Helen Torrance; Frank J Broekmans Journal: Cochrane Database Syst Rev Date: 2018-02-01