An AMH-based FSH dosing algorithm for OHSS risk reduction in first cycle antagonist protocol for IVF/ICSI

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)
• Ovarian Stimulation Protocols

Background:

• Ovarian hyperstimulation syndrome (OHSS) is a risk in IVF, particularly with high anti-Müllerian hormone (AMH) levels.
• Optimizing follicle-stimulating hormone (FSH) dosing based on AMH can potentially improve outcomes and reduce OHSS.
• Previous protocols may not adequately balance pregnancy rates with OHSS prevention in diverse AMH groups.

Purpose of the Study:

• To assess an AMH-based algorithm for FSH dosing to maintain pregnancy rates while minimizing OHSS in first IVF antagonist cycles.
• To evaluate the impact of different stimulation protocols on oocyte yield across low, intermediate, and high AMH patient groups.
• To determine the effectiveness of OHSS preventive strategies in high AMH patients.

Main Methods:

• A cohort of 589 patients undergoing their first IVF antagonist cycle was divided into three AMH groups (<12, 12-32, >32 pmol/L).
• Stimulation protocols varied: maximal (corifollitropin) for low AMH, standard (150 IU/day rFSH) for intermediate AMH, and minimal (112 IU/day HP-hMG) for high AMH.
• Oocyte retrieval numbers, pregnancy rates, and OHSS incidence were analyzed, along with the use of preventive measures like agonist triggering and embryo cryopreservation.

Main Results:

• The proportion of patients achieving targeted oocyte yield (5-14) varied significantly by AMH group (42% low, 76% intermediate, 67% high; p<0.001).
• Low oocyte response (≤4) was highest in the low AMH group (55%), while excessive response (≥15) was similar across groups (2.5-6.2%).
• Ongoing pregnancy rates were 41% in the high AMH group. OHSS preventive actions were used in 14 patients, all avoiding OHSS. Three severe OHSS cases (0.5%) occurred in the high AMH group after hCG triggering, linked to late OHSS and aspiration of 10-15 follicles.

Conclusions:

• In high AMH patients, low-dose HP-hMG effectively limits oocyte yield without compromising pregnancy rates, thus lowering OHSS risk.
• While OHSS risk is reduced, it can still occur after hCG triggering, especially in high AMH patients with 10-15 follicles, necessitating strict OHSS preventive actions.
• An AMH-based algorithm for FSH dosing appears effective in optimizing IVF outcomes and safety across different ovarian reserve levels.