Effect of follicle-stimulating hormone dose on the risk of being classified as suboptimal responders according to the POSEIDON criteria.

IF 3.2 3区医学 Q2 GENETICS & HEREDITY

Journal of Assisted Reproduction and Genetics Pub Date : 2024-10-18 DOI:10.1007/s10815-024-03296-2

Alyssa Hochberg, Michael H Dahan, Hakan Yarali, Lan N Vuong, Sandro C Esteves

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Abstract

Purpose: The purpose of this study is to investigate the impact of daily follicle-stimulating-hormone (FSH) dose on the likelihood of suboptimal response to ovarian stimulation (OS) for in vitro fertilization (IVF) according to POSEIDON's criteria.

Methods: A tri-center retrospective cohort study (2015-2017) including women with normal anti-Müllerian hormone (AMH ≥ 1.2 ng/mL) and antral follicle count (AFC ≥ 5) values per POSEIDON's criteria, undergoing their first IVF/ICSI cycle using conventional OS (FSH ≥ 150 IU/day). Suboptimal response was the retrieval of 4-9 oocytes. In previous research, we detected an AMH ≤ 2.97 ng/mL and AFC ≤ 12 as the optimal cut-offs predicting suboptimal response. Therefore, we examined the effect of daily FSH dose (≤ 300 IU versus > 300 IU) on suboptimal response risk for each AMH and AFC value within these thresholds (AMH between 1.20 and 2.97 ng/mL, by 0.01 ng/mL increments; and an AFC between 5 and 12, by unit increments). Analysis involved contingency tables and multivariable logistic regression.

Results: Included were 4005 patients with AMH and AFC values in the specific range, among whom 2131 (53.2%) were suboptimal responders. Among 177 AMH groups analyzed, apart from three distributed irregularly, daily FSH doses > 300 IU versus lower doses (≤ 300 IU) did not decrease suboptimal response risk; similarly, higher doses did not decrease risk at the eight AFC values examined (p > 0.05 for all). Using multivariable logistic regression, FSH doses were not associated with suboptimal response risk. Conversely, female age, AMH, AFC, and gonadotropin type were associated with suboptimal response.

Conclusions: In women with AMH values between 1.20 and 2.97 ng/mL and/or AFC between 5 and 12, FSH dose increase did not decrease suboptimal response risk. Individualizing the gonadotropin regimen and considering LH activity supplementation to FSH may mitigate risks.

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卵泡刺激素剂量对根据 POSEIDON 标准被列为次优应答者风险的影响。

目的：本研究旨在根据POSEIDON标准，探讨每日卵泡刺激素（FSH）剂量对体外受精（IVF）卵巢刺激（OS）次优反应可能性的影响：三中心回顾性队列研究（2015-2017年），包括根据POSEIDON标准抗缪勒氏管激素（AMH≥1.2纳克/毫升）和前卵泡计数（AFC≥5）值正常的女性，使用常规OS（FSH≥150 IU/天）进行首次IVF/ICSI周期。次优反应是取回 4-9 个卵母细胞。在之前的研究中，我们发现 AMH ≤ 2.97 纳克/毫升和 AFC ≤ 12 是预测次优反应的最佳临界值。因此，我们研究了在这些临界值（AMH 在 1.20 和 2.97 纳克/毫升之间，以 0.01 纳克/毫升为增量；AFC 在 5 和 12 之间，以单位为增量）范围内，每日 FSH 剂量（≤ 300 IU 与 > 300 IU）对每种 AMH 和 AFC 值的次优反应风险的影响。分析包括或然率表和多变量逻辑回归：结果：共纳入 4005 名 AMH 和 AFC 值在特定范围内的患者，其中 2131 人（53.2%）为次优反应者。在分析的 177 个 AMH 组别中，除了三个分布不规则的组别外，每日 FSH 剂量大于 300 IU 与较小剂量（≤ 300 IU）相比，并没有降低次优反应风险；同样，在检查的 8 个 AFC 值中，较高剂量也没有降低风险（P 均大于 0.05）。通过多变量逻辑回归，FSH 剂量与次优反应风险无关。相反，女性年龄、AMH、AFC和促性腺激素类型与次优反应相关：结论：对于AMH值介于1.20至2.97纳克/毫升和/或AFC值介于5至12之间的女性，增加FSH剂量并不会降低次优反应风险。个性化的促性腺激素方案和考虑在FSH基础上补充LH活性可降低风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Assisted Reproduction and Genetics 医学-妇产科学

CiteScore

5.70

自引率

9.70%

发文量

286

审稿时长

1 months

期刊介绍： The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species. The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.