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Clinical outcomes in relation to the daily dose of recombinant follicle-stimulating hormone for ovarian stimulation in <i>in vitro</i> fertilization in presumed normal responders younger than 39 years: a meta-analysis

By M.D. Sterrenburg, S.M. Veltman-Verhulst, M.J.C. Eijkemans, E.G. Hughes, N.S. Macklon, F.J. Broekmans and B.C.J.M. Fauser


Background: The optimal ovarian stimulation dose to obtain the best balance between the probability of pregnancy and the risk of complications, while maximizing cost-effectiveness of in vitro fertilization (IVF) treatment, is yet to be established. <br/><br/>Methods: A systematic search of the electronic databases PubMed, EMBASE and Cochrane library, from 1984 until October 2009 for randomized controlled trials comparing different doses of recombinant FSH in IVF, was performed.<br/> <br/>Results: Ten studies (totaling 1952 IVF cycles) were included in the present meta-analysis, comprising patients younger than 39 years with regular menstrual cycle, normal basal FSH levels and two normal ovaries. Comparison was made between studies using a daily dose of 100 versus 200 IU recFSH, and between 150 versus 200 IU recFSH or higher. Although oocyte yield was greater in the &gt;200 IU/day dose group, pregnancy rates were similar compared with lower dose groups. The risk of insufficient response to ovarian stimulation was greatest in the 100 IU/day dose group. The risk of developing ovarian hyperstimulation syndrome was greater in the &gt;200 IU/day dose group. The number of embryos available for cryopreservation was lowest in the 100 IU/day group, but similar comparing the 150 IU/day and the &gt;200 IU/day dose groups. <br/><br/>Conclusions: This meta-analysis suggests that the optimal daily recFSH stimulation dose is 150 IU/day in presumed normal responders younger than 39 years undergoing IVF. Compared with higher doses, this dose is associated with a slightly lower oocyte yield, but similar pregnancy and embryo cryopreservation rates. Furthermore, the wide spread adherence to this optimal dose will allow for a considerable reduction in IVF costs and complications. <br/

Topics: RG, RM
Year: 2011
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Provided by: e-Prints Soton
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