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43A - The Maximum Effective Dose of FSH for Ovarian Stimulation in IVF Is 300 IU

For

from Section VIII - Ovarian Stimulation

Published online by Cambridge University Press:  25 November 2021

By
Sarah Lensen
Edited by
Roy Homburg ,
Adam H. Balen  and
Robert F. Casper
Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

The objective of ovarian stimulation in an IVF cycle is the production of between 5 and 15 oocytes, avoiding both a poor and a hyper-response which are generally associated with worse outcomes for the patient. In women predicted to have a low response, it has become common practice to increase the daily FSH dose to 300 IU or above, in order to increase the oocyte yield, and achieve a normal response. While evidence from randomised trials demonstrates that higher doses tend to result in fewer cycle cancellations and a higher oocyte yield, there is no evidence that these effects translate to an improvement in the pregnancy and live birth rates. Given that increased FSH dosing is associated with higher costs, increasing the dose beyond 300 IU is not recommended.

Type
Chapter
Information
50 Big Debates in Reproductive Medicine , pp. 222 - 224
Publisher: Cambridge University Press
Print publication year: 2021

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References

Sunkara, SK, Rittenberg, V, Raine-Fenning, N, Bhattacharya, S, Zamora, J, Coomarasamy, A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011;26:1768–74.CrossRefGoogle ScholarPubMed
Lensen, SF, Wilkinson, J, Mol, BWJ, La, MA, Torrance, H, Broekmans, FJ. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing IVF/ICSI. Cochrane Database of Syst Rev. 2018.CrossRefGoogle Scholar
Van Tilborg, TC, Torrance, HL, Oudshoorn, SC, et al. Individualized versus standard FSH dosing in women starting IVF/ICSI: an RCT. Part 1: the predicted poor responder. Hum Reprod. 2017;32(12):2496–505.CrossRefGoogle ScholarPubMed
ESHRE Reproductive Endocrinology Guideline Group. Ovarian stimulation for IVF/ICSI. Guideline of the European Society of Human Reproduction and Embryology. 2019.Google Scholar
Arce, JC, Andersen, AN, Fernandez-Sanchez, M, et al. Ovarian response to recombinant human follicle-stimulating hormone: a randomized, antimullerian hormone-stratified, dose response trial in women undergoing in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril. 2014;102(6):1633–40.CrossRefGoogle ScholarPubMed

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