Impact of recombinant FSH dose adjustments on ovarian response in the second treatment cycle with IVF or ICSI in "standard" patients treated with 150 IU/day during the first cycle.

BACKGROUND: A dose of 150 IU/day of recombinant follicle stimulating hormone (rFSH) is commonly used as a "standard" dose for "standard" patients in the first in vitro fertilization (IVF) treatment cycle. In the second cycle, the starting dose is adjusted in those patients who had an inappropriate response during the first cycle. The purpose of the study was to assess the impact of dose adjustments on ovarian response.

MATERIALS AND METHODS: Retrospective study including 567 first IVF/intracytoplasmic sperm injection (ICSI) cycles using the long agonist protocol in "standard" patients. In the second cycle 385 patients who had failed to achieve an ongoing pregnancy were included. The starting dose in the second cycle was adjusted according to the response in the first cycle.

RESULTS: A total of 215 patients (55.8%) had altered starting dose in the second cycle: 193 (50.1%) received >150 IU/day, whereas 22 (5.7%) had <150 IU/day. In the group given >150 IU/day, significantly more follicles (9.8 vs. 8.3, p = 0.002) and oocytes (8.4 vs. 6.7, p <0.0001) were obtained in the second cycle. In the group given <150 IU/day, there were significantly fewer follicles (20.4 vs. 13.5, p <0.0001) and oocytes (16.4 vs. 11.4, p = 0.005) in the second cycle. In the group given <150 IU/day in the second cycle, six (27.3%) had an appropriate ovarian response (5-14 oocytes) in the first cycle compared to 14 (63.6%) women in the second cycle (p = 0.01). The ongoing pregnancy rates in all of the first (32.1%) and second cycles (27%) were similar (p = NS).

CONCLUSION: In a "standard" patient population, 55.8% needed an altered starting dose in the second cycle and rFSH dose adjustments had a significant impact on the ovarian response.