Journal
REPRODUCTIVE BIOMEDICINE ONLINE
Volume 43, Issue 6, Pages 1019-1026Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.rbmo.2021.08.0241472-6483
Keywords
Anti-Mullerian hormone (AMH); Individualized FSH dosing; Ovarian response; Risk of OHSS
Categories
Funding
- Ferring Pharmaceuticals
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Individualized follitropin delta dosing provides an improved efficacy-safety balance in women with high ovarian reserve, reducing the risk of ovarian hyperstimulation syndrome (OHSS) without compromising the chance of pregnancy.
Research question: How does the efficacy and safety of individualized follitropin delta dosing compare with conventional dosing for ovarian stimulation in potential high responders? Design: Retrospective analysis of 153 potential high responders identified on the basis of baseline serum anti-Mullerian hormone (AMH) levels above 35 pmol/l, who were originally randomized to an individualized fixed dose of follitropin delta based on AMH and body weight (n = 78) or to a daily starting dose of 150 IU follitropin alfa (n = 75). Results: At the end of stimulation, patients treated with individualized follitropin delta or conventional follitropin alfa had 12.1 +/- 7.0 and 18.3 +/- 7.0 (P < 0.001) follicles measuring 12 mm or wider, and 27.3% and 62.7% had serum progesterone levels higher than 3.18 nmol/l (P < 0.001), respectively. Overall number of oocytes in these two respective arms was 9.3 +/- 6.7 and 17.9 +/- 8.7 (P < 0.001), and the ongoing pregnancy rate per started cycle after fresh blastocyst transfer was 28.2% and 24.0%. The risk of ovarian hyperstimulation syndrome (OHSS) for all cases was three times higher in the conventional follitropin alfa arm at 16.0% versus 5.1% with individualized follitropin delta treatment (P = 0.025) and 26.7% versus 7.7% (P = 0.001) for early moderate or severe OHSS, preventive interventions for early OHSS, or both. Conclusions: Treatment with individualized follitropin delta provides an improved efficacy-safety balance in women with high ovarian reserve, as it normalizes the ovarian response and decreases the risk of OHSS without compromising the chance of pregnancy.
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