Low dose HP-hMG in an antagonist protocol for IVF in ovulatory and anovulatory patients with high AMH

Abstract

Women with high-AMH levels have an increased risk of ovarian hyperstimulation syndrome (OHSS). Studies have suggested that highly purified menotropin (HP-hMG) Menopur® reduces the risk. We, therefore, studied use of low-dose (112.5 IU/day) HP-hMG in ovulatory and anovulatory patients with high AMH (>32 pmol/L). The primary endpoint was the distribution of patients with appropriate, excessive, and inadequate response (5–14, ≥15, and ≤4 oocytes). Another endpoint was frequency of OHSS. Totally 115 women were included and 78 (67.8%) had an appropriate, 8 (7.0%) an excessive, and 29 (25.2%) an inadequate response. The number of oocytes was independent on AMH levels and ovulatory status but declined significantly with increasing bodyweight (R ² = 0.07, p < .01). The ongoing pregnancy rate per started cycle was 47.0%. Three (2.6%) developed OHSS, two had cancelation of the cycle and seven patients had GnRH agonist triggering to prevent OHSS. Selective use of a low dose of HP-hMG in patients with high levels of AMH provides 5–14 oocytes in more than two-thirds of the patients and is safe with low risk of OHSS. The number of aspirated oocytes was independent of AMH levels and ovulatory status, but inversely related to body weight.

Chinese abstract

AMH过高女性在IVF过程中发生卵巢过度刺激综合征的风险（OHSS）明显增加。研究发现高纯度尿促性素（Hp-hMG, 贺美奇）的应用降低了OHSS的发生风险。因此, 本研究对高AMH（> 32 pmol/L）的有排卵和无排卵患者应用低剂量Hp-hMG（112.5IU/天）。主要终点患者卵母细胞的个数：适当（5-14个卵母细胞）、过多（≥15个卵母细胞）和低反应（≤4个卵母细胞）。另一个研究终点是OHSS发生率。115名患者中78人（67.8%）获得适当的卵母细胞, 8人（7.0%）卵母细胞过多, 29人（25.2%）出现卵巢低反应。卵母细胞的数量与AMH水平及患者有无排卵无明显相关性, 但卵母细胞的数量随着患者体重的增加明显降低（R² = 0.07, p < 0.01）。每周期持续妊娠率为47.0%, 其中发生OHSS3例（2.6%）。2例取消周期, 7例因预防OHSS给予GnRH激动剂。在高AMH患者中选择性使用低剂量HP-hMG有三分之二以上的患者获得适当的卵母细胞数量（5-14个）, 同时发生OHSS风险低, 安全有效。因此, 诱发卵母细胞数量与AMH水平和病人自身排卵状况无关, 但与体重秤负相关。

Keywords:

• AMH
• AFC
• menotropin
• IVF
• OHSS

Acknowledgements

The authors wish to thank the staff at the Fertility Clinic, Rigshospitalet, for their role in data acquisition.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Anders Nyboe Andersen has received study grant for Ph.D.’s and clinical trials from MSD, Merck, and Ferring. Additionally, personal honoraria for lectures and advisory functions from MSD, Merck, Ferring, Finox, Novo Nordisk, Abbott.