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    Too much of a good thing could be hampering IVF success

    COG-SpecialDelivery-Issue_2641.jpg

    A new study from Michigan State University, the largest of its kind, seems to indicate that there may be such a thing as too much of a good thing when it comes to hormones, in particular follicle stimulating hormone (FSH) and fertility.

    Researchers looked at a total of 658,519 fresh autologous cycles of in vitro fertilization (IVF) that had been reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS) from 2004 to 2012. Logistic regression models were fitted to live birth rates with the use of values for total FSH dose and the number of oocytes retrieved. To reduce the potential significant confounders, additional analyses were restricted to patients with a good prognosis (<35 years of age, body mass index <30 kg/m2, and no diagnosis of diminished ovarian reserve, endometriosis, or ovulatory disorder) and duration of gonadotropin treatment was included.

    Related: Use of ICSI is on the rise, but are the outcomes better?

    Regardless of the number of oocytes retrieved, the live birth rate significantly decreased as the FSH dose increased, reaching as much as 15% to 20%. The significant decrease in live birth was seen even in patients with a good prognosis, regardless of age, except for women aged ≥35 years with 1–5 oocytes retrieved.

    The investigators noted that some of the cycles studied may have been in women with diminished ovarian reserve even though the diagnosis was not reported by the IVF program. SART CORS also does not contain information on antral follicle count. Therefore, this analysis does not reflect some of the predictors of ovarian sensitivity that physicians may use to determine FSH dosage.

    Nevertheless, the authors concluded that physicians may want to avoid prescribing high doses of FSH. They said, however, that the study results should in no way be read as justification for minimal-stimulation or natural-cycle IVF.

    NEXT: Progesterone and recurrent pregnancy loss

    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

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