What is the optimum maximal gonadotropin dosage used in microdose flare-up cycles in poor responders?

Fertility and Sterility

Volumn 94, Issue 2, 2010, Pages 662-665

  Berkkanoglu, Murat ^a   Ozgur, Kemal ^a  

^a Antalya IVF   (Turkey)

Author keywords

microdose cycle; poor responders; pregnancy rate; Recombinant FSH

Indexed keywords

CHORIONIC GONADOTROPIN; ESTRADIOL; GONADORELIN AGONIST; GONADOTROPIN; GONADOTROPIN DERIVATIVE; LEUPRORELIN; MYRALON; ORAL CONTRACEPTIVE AGENT; RECOMBINANT FOLLITROPIN; UNCLASSIFIED DRUG;

ADULT; ARTICLE; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; COST BENEFIT ANALYSIS; EMBRYO TRANSFER; ESTRADIOL BLOOD LEVEL; FEMALE; FEMALE INFERTILITY; HUMAN; MAJOR CLINICAL STUDY; OOCYTE RETRIEVAL; OPTIMAL DRUG DOSE; PREGNANCY RATE; PRIORITY JOURNAL; PROSPECTIVE STUDY; RANDOMIZED CONTROLLED TRIAL;

ADULT; DOSE-RESPONSE RELATIONSHIP, DRUG; DRUG RESISTANCE; EMBRYO TRANSFER; FEMALE; FOLLICLE STIMULATING HORMONE; GONADOTROPIN-RELEASING HORMONE; HUMANS; INFERTILITY, FEMALE; OOCYTE RETRIEVAL; OVULATION INDUCTION; PREGNANCY; PREGNANCY RATE; PROSPECTIVE STUDIES; RECOMBINANT PROTEINS;

EID: 77953724372     PISSN: 00150282     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.fertnstert.2009.03.027     Document Type: Article

References (36)

1. Toner J.P., Philput C., Jones G.S., and Muasher S.J. Basal follicle-stimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril 55 (1991) 784-791
2. De Koning C.H., Popp-Snijders C., Schoemaker J., and Lambalk C.B. Elevated FSH concentrations in imminent ovarian failure are associated with higher FSH and LH pulse amplitude and response to GnRH. Hum Reprod 15 (2000) 1452-1456
3. Smotrich D.B., Widra E.A., Gindoff P.R., Levy M.J., Hall J.L., and Stillman R.J. Prognostic value of day 3 estradiol on in vitro fertilization outcome. Fertil Steril 64 (1995) 1136-1140
4. Seifer D.B., Scott Jr. R.T., Bergh P.A., Abrogast L.K., Friedman C.I., Mack C.K., et al. Women with declining ovarian reserve may demonstrate a decrease in day 3 serum inhibin B before a rise in day 3 follicle-stimulating hormone. Fertil Steril 72 (1999) 63-65
5. Van Rooij I.A., Broekmans F.J., Te Velde E.R., Fauser B.C., Bancsi L.F., de Jong F.H., et al. Serum anti-Mullerian hormone levels: a novel measure of ovarian reserve. Hum Reprod 17 (2002) 3065-3071
6. Kwee J., Schats R., McDonnell J., Schoemaker J., and Lambalk C.B. The clomiphene citrate challenge test versus the exogenous follicle-stimulating hormone ovarian reserve test as a single test for identification of low responders and hyperresponders to in vitro fertilization. Fertil Steril 85 (2006) 1714-1722
7. Ravhon A., Aurell R., Lawrie H., Margara R., and Winston R.M. The significance of delayed suppression using buserelin acetate and recombinant follicle-stimulating hormone in a long protocol in vitro fertilization program. Fertil Steril 73 (2000) 325-329
8. Bancsi L.F., Broekmans F.J., Eijkemans M.J., de Jong F.H., Habbema J.D., and te Velde E.R. Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve. Fertil Steril 77 (2002) 328-336
9. Loverro G., Nappi L., Mei L., Giaccomoantonio L., Carriero C., and Tartagni M. Evaluation of functional ovarian reserve in 60 patients. RBM Online 7 (2003) 200-204
10. Garcia J., Padilla S., Bayati J., and Baramki T. Follicular phase gonadotropin-releasing hormone agonist and human menopausal gonadotropins: a better alternative for ovulation induction in in vitro fertilization. Fertil Steril 53 (1990) 302-305
11. Padilla S.L., Dugan K., Maruschak V., Shalika S., and Smith R.D. Use of the flare-up protocol with high dose human follicle-stimulating hormone and human menopausal gonadotropins for in vitro fertilization in poor responders. Fertil Steril 65 (1996) 796-799
12. Leondires M.P., Escalpes M., Segars J.H., Scott R.T., and Miller B.T. Microdose follicular phase gonadotropin-releasing hormone agonists (GnRH-a) compared with luteal phase GnRH-a for ovarian stimulation at in vitro fertilization. Fertil Steril 72 (1999) 1018-1023
13. Berkkanoglu M., Isikoglu M., Aydin D., and Ozgur K. Clinical effects of ovulation induction with recombinant follicle-stimulating hormone supplemented with recombinant luteinizing hormone or low-dose recombinant human chorionic gonadotropin in the midfollicular phase in microdose cycles in poor responders. Fertil Steril 88 (2007) 665-669
14. Filicori M. Clinical review 81: gonadotropin-releasing hormone analogs in ovulation induction: current status and perspectives. J Clin Endocrinol Metab 81 (1996) 2413-2416
15. Ben Rafael Z., Benadiva C., Ausmanas M., Barber B., Blasco L., Flickinger G., et al. Dose of human menopausal gonadotropin influences the outcome of an in vitro fertilization program. Fertil Steril 48 (1987) 964-968
16. Hofmann G., Toner J., Muasher S., and Jones G. High-dose follicle stimulating hormone (FSH) ovarian stimulation in low responder patients for in vitro fertilization. J In Vitro Fertil Embryo Transfer 6 (1993) 285-289
17. Surrey E.S., Boer J., Hill D.M., Ramsey J., and Surey M.W. Clinical and endocrine effects of a microdose GnRH agonist flare regimen administered to poor responders who are undergoing in vitro fertilization. Fertil Steril 69 (1998) 419-424
18. Out H.J., Braat D.D.M., Lintsen B.M.E., Gurgan T., Bukulmez O., Gokmen O., et al. Increasing the daily dose of recombinant follicle stimulating hormone (Puregon) does not compensate for the age-related decline in retrievable oocytes after ovarian stimulation. Hum Reprod 15 (2000) 29-35
19. Klinkert E.R., Broekmans F.J., Looman C.W., Habbema J.D., and te Velde E.R. Expected poor responders on the basis of an antral follicle count do not benefit from a higher starting dose of gonadotrophins in IVF treatment: a randomized controlled trial. Hum Reprod 20 (2005) 611-615
20. Tarlatzis B.C., Zepiridis L., Grimbizis G., and Bontis J. Clinical management of low ovarian response to stimulation for IVF: a systematic review. Hum Reprod Update 9 (2003) 61-76
21. Hofmann G.E., Toner J.P., Muasher S.J., and Jones G.S. 1989. High-dose follicle-stimulating hormone (FSH) ovarian stimulation in low responder patients for in vitro fertilization. J In Vitro Fertil Embryo Transfer 6 (1989) 285-289
22. Raga F., Bonilla-Musoles F., Casan E.M., and Bonilla F. Recombinant follicle stimulating hormone stimulation in poor responders with normal basal concentrations of follicle stimulating hormone and oestradiol: improved reproductive outcome. Hum Reprod 14 (1999) 1431-1434
23. Faber B.M., Mayer J., Cox B., Jones D., Toner J.P., Oehninger S., et al. Cessation of gonadotropin-releasing hormone agonist therapy combined with high-dose gonadotropin stimulation yields favorable pregnancy results in low responders. Fertil Steril 69 (1998) 826-830
24. Wang P.T., Lee R.K., Su J.T., Hou J.W., Lin M.H., and Hu Y.M. Cessation of low-dose gonadotropin releasing hormone agonist therapy followed by high-dose gonadotropin stimulation yields a favorable ovarian response in poor responders. J Assist Reprod Genet 1 (2002) 1-6
25. Karande V., Morris R., Rinehart J., Miller C., Rao R., and Gleicher N. Limited success using the "flare" protocol in poor responders in cycles with low basal follicle-stimulating hormone levels during in vitro fertilization. Fertil Steril 67 (1997) 900-903
26. Surrey E.S., Bower J.A., Hill D.M., Ramsey J., and Surrey M.W. Clinical and endocrine effects of a microdose GnRH agonist flare regimen administered to poor responders who are undergoing in vitro fertilization. Fertil Steril 69 (1998) 419-424
27. Land J.A., Yarmolinskaya M.I., Dumoulin J.C., and Evers J.L.H. High-dose human menopausal gonadotropin stimulation in poor responders does not improve in vitro fertilization outcome. Fertil Steril 65 (1996) 961-965
28. Shulman A., Ghetler Y., Fejgin M., Kaneti H., Weinstein S., Byeth Y., et al. Relationship between the threshold of ovarian sensitivity to human menopausal gonadotropin stimulation and in-vitro fertilization treatment outcome. Hum Reprod 10 (1995) 3198-3201
29. Karande V., Jones G., Veeck L., and Muasher S. High-dose follicle stimulating hormone stimulation at the onset of the menstrual cycle does not improve the in vitro fertilization outcome in low responder patients. Fertil Steril 53 (1990) 486-489
30. Confino E., Zhang X., and Kazer R.R. GnRHa flare and IVF pregnancy rates. Int J Gynaecol Obstet 85 (2004) 36-39
31. Kailasam C., Keay S.D., Wilson P., Ford W.C., and Jenkins J.M. Defining poor ovarian response during IVF cycles, in women aged <40 years, and its relationship with treatment outcome. Hum Reprod 19 (2004) 1544-1547
32. Borini A., and Dal Prato L. Tailoring FSH and LH administration to individual patients. Reprod Biomed Online 11 (2005) 283-293
33. Dorn C. FSH: what is the highest dose for ovarian stimulation that makes sense on an evidence-based level?. Reprod Biomed Online 11 (2005) 555-561
34. Karande V., and Gleicher N. A rational approach to the management of low responders in IVF. Hum Reprod 14 (1999) 1744-1749
35. Karande V. Managing and predicting low response to standard in vitro fertilization therapy: a review of the options. Treat Endocrinol 2 (2003) 257-272
36. Centre for Clinical Effectiveness. In women labelled as poor responders to ovulation stimulation in an assisted reproduction program, is there evidence for the effectiveness of increasing the total dose of FSH above 3000 IU?. Cochrane Database (2000) HTA:20030660