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21.09.2018 | Gynecologic Endocrinology and Reproductive Medicine

Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman’s age and markers of ovarian reserve

verfasst von: Rossana Di Paola, Simone Garzon, Sara Giuliani, Antonio Simone Laganà, Marco Noventa, Francesca Parissone, Carlotta Zorzi, Ricciarda Raffaelli, Fabio Ghezzi, Massimo Franchi, Stefano Zaffagnini

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 5/2018

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Abstract

Purpose

To evaluate the potential application of a nomogram based on woman’s age and ovarian reserve markers as a tool to optimize the follicle-stimulating hormone (FSH) starting dose in intrauterine insemination (IUI) cycles.

Methods

We conducted a retrospective analysis enrolling 179 infertile women undergoing controlled ovarian stimulation (COS), followed by IUI. Each woman received an FSH starting dose according to clinical decision. After collecting data about COS and IUI procedures, we calculated the FSH starting dose according to the nomogram. The main outcomes measured were women’s baseline characteristics, COS, and clinical outcomes.

Results

The FSH starting dose calculated by the nomogram was significantly lower than the one actually prescribed (p < 0.001), in only 14.8% of the cycles nomogram calculated a higher starting dose. When gonadotropin dose was decreased during COS, and similarly in case of hyper-response (more than two follicles ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (81.8% and 48.8%, respectively). Conversely, when gonadotropin dose was increased during COS and in case of low ovarian response (no follicle ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (64.7% and 100%, respectively); in these groups median anti-Müllerian hormone (AMH) level was 5.62 ng/mL.

Conclusions

The application of this nomogram in IUI cycles would lead to a more tailored FSH starting dose and improved cost-effectiveness, although in PCOS women, particularly the ones with high AMH, it does not seem adequate.

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Titel: Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman’s age and markers of ovarian reserve
verfasst von: Rossana Di Paola
Simone Garzon
Sara Giuliani
Antonio Simone Laganà
Marco Noventa
Francesca Parissone
Carlotta Zorzi
Ricciarda Raffaelli
Fabio Ghezzi
Massimo Franchi
Stefano Zaffagnini
Publikationsdatum: 21.09.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 5/2018
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-018-4906-2

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Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman’s age and markers of ovarian reserve