Individualizing gonadotropin dose in IVF treatment: the role of AMH and BMI in prediction models

Details

Supervisors

Wyns, Christine

Faculty

Faculté de médecine et médecine dentaire

Degree label

Master [180] en médecine

Abstract

Objective Previous studies concerning individualized versus standard IVF treatment protocols show controversial results. The objective of this study is to apply a new drug dosing algorithm for ovarian stimulation based on anti-müllerian hormone serum concentration, small antral follicle count (2-5mm) and body mass index to a population of women undergoing IVF/ICSI treatments. The algorithm would help us to determine if there is a benefit in terms of the number of oocytes retrieved as the primary endpoint compared to a standard protocol of ovarian stimulation. Secondary outcomes include recombinant FSH dose, dose adjustment rate, duration of stimulation, ovarian hyperstimulation syndrome (OHSS), clinical pregnancies and live birth rate per transfer. Methods In this prospective multicenter trial patient recruitment started in September 2016, and so far 150 patients have been randomized including women aged 18 - 43 years undergoing a GnRH antagonist IVF/ICSI treatment protocol. Women were assigned to the study group where human recombinant FSH was administered using the dosing algorithm for the starting dose or the control group where recombinant FSH was given at a dose as currently applied in the ART center. Gonadotropin dose adjustment was allowed as of day six in case of insufficient or excessive ovarian response. Results A halfway study analysis showed that the primary outcome, total percentage of patients with recovered mature oocytes (5-15) were similar between study (57.5%) and control group (56.3%) (p = 0.88). Dose increase after day 6 was significantly higher in study group (p = 0.04). The dose was increased in 43% of patients receiving <=150 IU/day in study group and 14% in controls (p = 0.01), even though total duration of stimulation as well as total dose of FSH consumed were similar between groups. In patients receiving > 150-< 300 IU/day and >= 300 IU/day, no difference was observed in the proportion of patients with a dose adjustment between groups. No cases of severe OHSS were observed in this trial. Live birth rate per transfer was 18.2% and 28.1% in study and control group, respectively (p = 0.18). Limitation Currently, less than half of the number needed to treat has been included in the trial; which is insufficient for proper statistical analysis and interpretation. It is indisputable that other questions will arise once total study population will be analysed. Conclusion To this day, there is no evidence of a superiority with regard to efficacy and safety in an individualized protocol based on an algorithm compared with a dose as applied without algorithm based on current practice in an ART center.