450 IU versus 600 IU gonadotropin for controlled ovarian stimulation in poor responders A randomized controlled trial

Capsule:
Our randomized controlled trial showed poor ovarian response, a microdose GnRH-a flare-up protocol with a daily dose of 600 IU gonadotropin does not significantly increase the number of mature (MII) oocytes compared with 450 IU/d.

Authors:
Jessica Lefebvre, M.D., Roland Antaki, M.D., Jacques I. Kadoch, M.D., Nicola L. Dean, Ph.D., Camille Sylvestre, M.D., François Bissonnette, M.D., Joanne Benoit, M.D., Sylvain Ménard, M.D., Louise Lapensée, M.D.

Volume 104, Issue 6, Pages 1419-1425

Abstract:

Objective:
To compare the outcomes of controlled ovarian stimulation/in vitro fertilization cycles using 450 IU and 600 IU gonadotropin per day in women at risk of poor ovarian response.

Design:
Prospective randomized controlled nonblinded study.

Setting:
University-affiliated private IVF center.

Patient(s):
Women considered to be at risk of poor ovarian response: aged <41 years with basal FSH >10 IU/L, antimüllerian hormone <1 ng/mL, antral follicle count ≤8, or a previous IVF cycle with ≥300 IU/d gonadotropin that resulted in a cancellation, <8 follicles, or <5 oocytes. Intervention(s):
A total of 356 patients underwent a microdose GnRH agonist flare-up IVF/intracytoplasmic sperm injection protocol with a fixed daily dose of either 450 IU FSH (n = 176) or 600 IU FSH (n = 180) equally divided between Menopur and Bravelle.

Main Outcome Measure(s):
Number of mature oocytes retrieved.

Result(s):
The two groups were similar in terms of age, ovarian reserve, cause of infertility, duration of stimulation, and cycle cancellation rate. There were no significant differences in the number of metaphase II oocytes retrieved (4 [range 0–6] vs. 4 [range 2–7]), fertilization rate (62.4% vs. 57.0%), biochemical pregnancy rate (20.5% vs. 22.9%), clinical pregnancy rate (16.4% vs. 18.3%), and implantation rate (29.8% vs. 30.4%) between the 450 IU and 600 IU groups, respectively.

Conclusion(s):
Gonadotropin of 600 IU/d does not improve outcome of IVF cycles compared with 450 IU/d in women at risk of poor ovarian response.

Clinical Trial Registration Number:
NCT00971152.

  • Jason M. Franasiak

    A randomized controlled trial of 450 vs 600 IU of gonadotropins in women at risk for poor response. Very interesting to see that progesterone levels at final ultrasound was different between the two groups. Further evidence that control over stimulation protocol may allow for progesterone manipulation and thus management of endometrial synchrony in fresh cycles.

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