Aims and Background:In vitro fertilization (IVF) is a method of assisted reproductive technology (ART) in which the ovary is stimulated using gonadotropins. The purpose of this study is to decide the optimum gonadotropin dose that would adequately stimulate the ovaries without leading to hyperstimulation syndrome or cycle cancelation due to understimulation. In this study along with the age and body mass index (BMI) of the patient, various ultrasound parameters have been used for tailoring the appropriate gonadotropin dose for every individual based on a baseline scoring system.
Materials and methods: It was a retrospective study of 61 patients. All consenting patients between the age of 22 and 40 years and BMI between 18 and 34 who were taken for IVF/intracytoplasmic sperm injection (ICSI) cycles by virtue of tubal factor infertility, male factor infertility, dysovulatory infertility (including polycystic ovarian syndrome (PCOS)] and unexplained infertility were included in the study. The baseline scoring system parameters were assessed in relation to the dose of recombinant follicle- stimulating hormone (rFSH) given, luteinizing hormone (LH) supplementation dose added at different times in the cycle, the need to change the dose of gonadotropins, various size ranges of follicles on the day of trigger and their ultimate relation with M2 oocytes retrieved.
Results: Only one patient required a change of dose of gonadotropins. There was no ovarian hyperstimulation or cycle cancelation. There was a significantly higher number of M2 oocytes retrieved in patients where LH supplementation was not done, irrespective of dose or day of addition of LH. There was also a strong positive correlation between follicles 10–15 mm on the day of trigger and the number of prophase oocytes retrieved.
Conclusion: The baseline scoring system is an accurate and reliable method for deciding the dose of gonadotropins in IVF stimulation protocols. The addition of human menopausal gonadotropin (HMG) to rFSH anytime in the cycle at any dose does not show improvement in the number of M2 oocytes retrieved and its use should be judicial. Retrieval of follicles <15 mm may not result in M2 oocytes and so may not be beneficial.
Clinical significance: To individualize the stimulation dose in IVF cycles, other than age and BMI, other ultrasound parameters like antral follicle count (AFC), ovarian volume, and ovarian stromal Doppler studies should be used. This can avoid hyperresponse and cycle cancelation.
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