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Optimizing the gonadotrophin dose regimen.

Henk J Out¹, Laurie E Thomas

¹Organon International, Oss, The Netherlands. henkjan.out@organon.com

International Surgery

|April 18, 2007

Summary

Individualizing gonadotrophin starting doses for controlled ovarian stimulation (COS) is crucial for successful outcomes. Research indicates varying recombinant follicle-stimulating hormone (rFSH) effectiveness based on patient age and dosage adjustments.

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Area of Science:

Reproductive Endocrinology
Assisted Reproductive Technology (ART)

Background:

The starting dose of gonadotrophin for controlled ovarian stimulation (COS) and ovulation induction (OI) significantly impacts pregnancy rates and adverse events.
Individualization of gonadotrophin dosage is essential for optimizing fertility treatments.

Purpose of the Study:

To review the impact of fixed versus individualized dosing strategies for recombinant follicle-stimulating hormone (rFSH) in COS and OI.
To evaluate the effectiveness of different rFSH dosage regimens in various patient populations undergoing assisted reproductive technology (ART).

Main Methods:

Analysis of five large randomized controlled trials comparing fixed doses of rFSH for COS in ART.
Review of a randomized controlled trial investigating low-dose step-up OI protocols with rFSH.

Main Results:

In young women, 200 IU/day of rFSH yielded more oocytes and transferable embryos compared to 100 IU/day, potentially increasing cumulative pregnancy rates.
No clear dose-response relationship was observed in older women receiving 150 or 250 IU/day of rFSH.
A low-dose step-up protocol with 25 IU/day weekly increments of rFSH was more effective and efficient for OI than 50 IU/day increments.

Conclusions:

Optimal starting doses of rFSH for COS and OI require individualization, with age being a key factor.
Further research is needed to develop a normogram for personalized rFSH dosing to improve ART outcomes.

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