A low-dose stimulation protocol using highly purified follicle-stimulating hormone can lead to high pregnancy rates in in vitro fertilization patients with polycystic ovaries who are at risk of a high ovarian response to gonadotropins.
OBJECTIVE
To study the benefits of a low-dose stimulation (LDS) protocol with purified urinary follicle-stimulating hormone in patients with polycystic ovaries who have presented previously with a very high ovarian response to a standard hMG stimulation.


METHODS
Cohort study.


METHODS
Fertility center in a university hospital.


METHODS
Sixty-one patients involved in an IVF/ICSI program from January 1995 to December 1996.


METHODS
The patients were first stimulated with a standard protocol using hMG and presented with a very high ovarian response. These patients were then stimulated a second time using a low-dose protocol. Cryopreserved embryos were transferred in later artificial or natural cycles until to December 1999.


METHODS
Number of gonadotropin ampules; estradiol level on the day of ovulation induction; follicles, oocytes, and cryopreserved zygotes; fertilization, implantation, and pregnancy rates; and number of ovarian hyperstimulation syndromes (OHSS).


RESULTS
The number of ampules used, the estradiol level reached, and the number of oocytes obtained were significantly lower under the LDS than the standard protocol. High implantation (21.8%) and clinical pregnancy (38.4%) rates were obtained after LDS. The cumulated deliveries per cycle started and per patient were, respectively, 41.6% and 52.5%. Five patients suffered OHSS with the standard protocol, and none with the LDS.


CONCLUSIONS
The LDS protocol offers a safe and efficient treatment for patients who present with echographic polycystic ovaries and are at risk of an excessive ovarian response to standard IVF stimulation protocols.
Marci
R
R
Reproductive Medicine Unit, Department of Gynecology and Obstetrics, CHUV, Lausanne, Switzerland.
Senn
A
A
Dessole
S
S
Chanson
A
A
Loumaye
E
E
De Grandi
P
P
Germond
M
M
D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric; D004305:Dose-Response Relationship, Drug; D010064:Embryo Implantation; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008596:Menotropins / Q000009:adverse effects* / Q000627:therapeutic use; D009865:Oocytes; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced; D010053:Ovary / Q000187:drug effects*; D011085:Polycystic Ovary Syndrome / Q000503:physiopathology*; D011247:Pregnancy; D018873:Pregnancy Rate; D012307:Risk Factors; D013048:Specimen Handling; D020554:Sperm Injections, Intracytoplasmic
D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone