Enrico Papaleo1, Stefano Zaffagnini2, Maria Munaretto3, Valeria Stella Vanni3, Giorgia Rebonato3, Valentina Grisendi4, Rossana Di Paola2, Antonio La Marca4. 1. IRCCS San Raffaele Hospital, Centro Scienze della Natalità, Department of Obstetrics and Gynaecology, 20132 Milan, Italy. Electronic address: papaleo.enrico@hsr.it. 2. Department of Obstetrics and Gynaecology, University of Verona, 37129 Verona, Italy. 3. IRCCS San Raffaele Hospital, Centro Scienze della Natalità, Department of Obstetrics and Gynaecology, 20132 Milan, Italy. 4. Mother-Infant Department, University of Modena and Reggio Emilia and Clinica Eugin Modena, 41100 Modena, Italy.
Abstract
OBJECTIVE: To externally validate a nomogram based on ovarian reserve markers as a tool to optimize the FSH starting dose in IVF/ICSI cycles. STUDY DESIGN: A two-centres retrospective study including 398 infertile women undergoing their first IVF/ICSI cycle (June 2013-June 2014). IVF data were retrieved from two independent IVF centres in Italy (San Raffaele Hospital, Centre 1; Verona Hospital, Centre 2). A central lab for the routine measurement of AMH and FSH was used for both centres. All women were treated based on physical and hormonal characteristics according to locally adopted protocols. The nomogram was then retrospectively applied to the patients comparing the calculated starting dose to the one actually given. RESULTS: In Centre 1, 64/131 women (48.8%) had an ovarian response below the target. While 45 of these patients were treated with a maximal FSH starting dose (≥225 IU), n=19/131 (14.5%) were treated with a submaximal dose. The vast majority of them (n=17/19) would have received a higher FSH starting dose by using the nomogram. Seventeen patients (n=17/131) had hyper response and about half of them would have been treated with a reduced FSH starting dose according to the nomogram. In Centre 2, 142/267 patients (53.2%) had an ovarian response below the target. While 136 of these were treated with a maximal FSH starting dose (≥225 IU), n=6/267 were treated with a submaximal dose. The majority of them (n=5/6) would have received a higher FSH starting dose. Thirty-two (n=32/267) patients had hyper response and more than half of them would have been treated with a reduced FSH dose. CONCLUSION: In both Centres, applying the nomogram would have resulted in more appropriate FSH starting doses compared to the the ones actually given based on clinicians choices. The use of an objective algorithm based on patient's age, serum FSH and AMH levels may thus be an effective advice on the selection of the tailored FSH starting dose. Hence, the use of this easily available nomogram could increase the proportion of patients achieving the optimal ovarian response.
OBJECTIVE: To externally validate a nomogram based on ovarian reserve markers as a tool to optimize the FSH starting dose in IVF/ICSI cycles. STUDY DESIGN: A two-centres retrospective study including 398 infertile women undergoing their first IVF/ICSI cycle (June 2013-June 2014). IVF data were retrieved from two independent IVF centres in Italy (San Raffaele Hospital, Centre 1; Verona Hospital, Centre 2). A central lab for the routine measurement of AMH and FSH was used for both centres. All women were treated based on physical and hormonal characteristics according to locally adopted protocols. The nomogram was then retrospectively applied to the patients comparing the calculated starting dose to the one actually given. RESULTS: In Centre 1, 64/131 women (48.8%) had an ovarian response below the target. While 45 of these patients were treated with a maximal FSH starting dose (≥225 IU), n=19/131 (14.5%) were treated with a submaximal dose. The vast majority of them (n=17/19) would have received a higher FSH starting dose by using the nomogram. Seventeen patients (n=17/131) had hyper response and about half of them would have been treated with a reduced FSH starting dose according to the nomogram. In Centre 2, 142/267 patients (53.2%) had an ovarian response below the target. While 136 of these were treated with a maximal FSH starting dose (≥225 IU), n=6/267 were treated with a submaximal dose. The majority of them (n=5/6) would have received a higher FSH starting dose. Thirty-two (n=32/267) patients had hyper response and more than half of them would have been treated with a reduced FSH dose. CONCLUSION: In both Centres, applying the nomogram would have resulted in more appropriate FSH starting doses compared to the the ones actually given based on clinicians choices. The use of an objective algorithm based on patient's age, serum FSH and AMH levels may thus be an effective advice on the selection of the tailored FSH starting dose. Hence, the use of this easily available nomogram could increase the proportion of patients achieving the optimal ovarian response.
Authors: Duaa Althumairy; Xiaoping Zhang; Nicholas Baez; George Barisas; Deborah A Roess; George R Bousfield; Debbie C Crans Journal: Diseases Date: 2020-09-15
Authors: Ali Abbara; Aaran Patel; Tia Hunjan; Sophie A Clarke; Germaine Chia; Pei Chia Eng; Maria Phylactou; Alexander N Comninos; Stuart Lavery; Geoffrey H Trew; Rehan Salim; Raj S Rai; Tom W Kelsey; Waljit S Dhillo Journal: Front Endocrinol (Lausanne) Date: 2019-08-27 Impact factor: 5.555