Gonadotropin dose is negatively correlated with live birth rate Analysis of more than 650000 assisted reproductive technology cycles

Capsule:
Live birth rate decreased with increasing follicle stimulating hormone dose, regardless of number of oocytes retrieved.

Authors:
Valerie L. Baker, M.D., Morton B. Brown, Ph.D., Barbara Luke, Sc.D., M.P.H., George W. Smith, Ph.D., James J. Ireland, Ph.D.

Volume 104, Issue 5, Pages 1145-1152

Abstract:

Objective:
To evaluate the correlation between total gonadotropin dose and live birth rate.

Design:
Retrospective analysis.

Setting:
Not applicable.

Patient(s):
A total of 658,519 fresh autologous cycles of in vitro fertilization (IVF) reported to the Society for Assisted Reproductive Technology from 2004 to 2012.

Intervention(s):
None.

Main Outcome Measure(s):
Logistic regression models were fitted to live birth rates with the use of categorized values for total FSH dose and number of oocytes retrieved as the primary predictor variables. To reduce the effect of the most significant confounders that may lead physicians to prescribe higher doses of FSH, additional analyses were performed limited to good-prognosis patients (<35 years of age, body mass index <30 kg/m2, and no diagnosis of diminished ovarian reserve, endometriosis, or ovulatory disorder) and including duration of gonadotropin treatment. Result(s):
Live birth rate significantly decreased with increasing FSH dose, regardless of the number of oocytes retrieved. The statistically significant decrease in live birth rate with increasing FSH dose remained in patients with good prognosis, and regardless of female age, except for women aged ≥35 years with 1–5 oocytes retrieved.

Conclusion(s):
This analysis suggests that physicians may wish to avoid prescribing a high dose of FSH. However, the results of this study do not justify the use of minimal-stimulation or natural-cycle IVF.

  • Daniel J. Kaser, MD

    Dear Dr. Baker and colleagues,
    Thanks very much for this important contribution, which quite nicely shows an inverse relationship between both total gonadotropin dose and average daily gonadotropin dose with live birth rates following fresh transfer, independent of patient age and the number of oocytes retrieved. It would be interesting to do a similar analysis with the donor population included to help tease out the effect of gonadotropin dosing on oocyte competence/embryo development vs. endometrial effects. Congratulations–a great paper with a clinically important message.

    • Valerie Baker

      Thank you for your kind comment. We agree that a similar analysis examining the dose of gonadotropin for oocyte donors would be of value.

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