An upper limit of gonadotropin dose in patients undergoing ART should be advocated

Abstract

Aim: As no upper limit of the daily dose of gonadotropins (DD GN) used for controlled ovarian hyperstimulation (COH) in patients undergoing assisted reproductive technology (ART) has been established, we aimed to evaluate the efficacy of using different DD GN in terms of live-birth achievement.

Methods: Data of patients treated at a single university medical center during the same period was analyzed retrospectively. Four groups were analyzed according to the DD GN administered: group I (“high dose”):  >225– ≤ 375 IU; Group II (“Very high dose”): 376–450 IU; group III (“extremely high dose”): 451–600 IU. Normo-responders treated with DD GN ≤250 IU served as control (C). Variables included were DD GN, total GN dose/cycle, age, FSH, BMI, gravidity, parity, cycle number, IVF/ICSI, infertility diagnosis treatment protocol and outcome parameters.

Results: The analysis of 1394 treatment cycles of 943 patients indicated that DD and total dose of GN correlated negatively with the number of oocytes, implantation, clinical pregnancy and live-birth rate (25.9%, 14.6%, 11.4% and 4.7% in groups C, I, II and III, respectively) The logistic regression analysis indicated that the adjusted odds ratios for LBR correlated inversely with the DD administered – independently from age, baseline FSH, BMI and previous failed cycles.

Conclusions: Increasing the daily dose of GN to doses higher than 450 IU or a total dose of 3000 IU/cycle is at least questionable if not harmful.

Chinese abstract

目的: 行辅助生殖技术(ART)的患者为控制性超排卵(COH)使用促性腺激素的日剂量(DD GN)上限尚未确定, 我们的目标是评估不同DD GN对活产的疗效。

方法: 回顾性分析在同一时间段在单一大学医疗中心就诊的患者数据。根据DD GN分为四组: I组(“大剂量”): >225-≤375 IU；II组 (“超大剂量”): 376-450 IU；III组 (“极大剂量”): 451-600 IU。DD GN ≤250 IU的正常反应者作为对照组(C)。变量包括DD GN, 总GN剂量/周期, 年龄, FSH, BMI, 妊娠, 产次, 周期数, IVF/ICSI, 不孕症诊断治疗协议和结果参数。

结果: 分析了943名患者的1394个治疗周期, 发现GN日剂量和总剂量与卵母细胞数量、移植、临床妊娠和活产率呈负相关(分别为25.9%, 14.6%, 11.4% 和4.7%在对照组, I, II和III组)。Logistic回归分析提示活产率的调整后优势比与日剂量呈负相关, 独立于年龄, 基础FSH, BMI和既往失败周期数。

结论: 增加GN日剂量大于450 IU或者总剂量达3000 IU/周期如果无害也至少是有问题的。

Keywords:

• COH
• gonadotropin dose
• IVF
• live-birth rate
• poor ovarian responder

Declaration of interest

The authors declare that they have no conflict of interest.