What should be the maximum FSH dose in IVF/ICSI in poor responders?

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)
• Controlled Ovarian Hyperstimulation

Background:

• Poor responders to ovarian stimulation present a significant challenge in achieving successful IVF/ICSI outcomes.
• Current strategies often involve high-dose gonadotropins, primarily follicle-stimulating hormone (FSH), to enhance follicular response.

Purpose of the Study:

• To review clinical trials evaluating high-dose FSH regimens in poor responders undergoing controlled ovarian hyperstimulation.
• To determine the safest and most effective upper limit of FSH dosage for optimizing IVF/ICSI results in this patient group.

Main Methods:

• Systematic review and overview of randomized controlled trials and retrospective studies.
• Analysis of studies examining FSH doses above the 300 IU threshold, including regimens of 450 IU and higher.

Main Results:

• Studies evaluating FSH doses above 300 IU have demonstrated little to no significant clinical benefit for poor responders.
• Higher FSH doses are associated with increased treatment costs and a higher incidence of side-effects.

Conclusions:

• High-dose FSH protocols (above 300 IU) are not clinically beneficial for poor responders and may increase risks.
• Further evaluation is needed to establish a safe and effective upper limit for FSH in controlled ovarian hyperstimulation for this population.