Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency.
OBJECTIVE
To predict the FSH response (threshold) dose in normogonadotropic, anovulatory infertile women undergoing gonadotropin induction of ovulation.


METHODS
Prospective longitudinal clinical study.


METHODS
Specialist academic fertility unit.


METHODS
Normogonadotropic, oligoamenorrheic, infertile women who were resistant to clomiphene citrate or in whom clomiphene citrate therapy had failed.


METHODS
Daily exogenous FSH administration in a low-dose, step-up regimen.


METHODS
The FSH dose on the day of ovarian response (follicle growth > 10 mm in diameter).


RESULTS
Multivariate analysis was used to devise the following equation to predict the individual FSH response dose (75 to >187 IU/d) before initiation of therapy: [4 body mass index (in kg/m(2))] + [32 clomiphene citrate resistance (yes = 1 or no = 0)] + [7 initial free insulin-like growth factor-I (in ng/mL)] + [6 initial serum FSH level (in IU/L)] - 51. The SE of the predicted dose is 35 IU.


CONCLUSIONS
The individual FSH response dose for gonadotropin induction of ovulation in anovulatory infertile women can be predicted on the basis of initial screening characteristics. The prediction model developed in this study may increase the safety and efficiency of low-dose gonadotropin protocols (step-up and step-down) by correctly determining the appropriate starting dose for a given patient.
Imani
Babak
B
Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Eijkemans
Marinus J C
MJ
Faessen
Gerry H
GH
Bouchard
Philippe
P
Giudice
Linda C
LC
Fauser
Bart C J M
BC
D000328:Adult; D000568:Amenorrhea / Q000097:blood / Q000188:drug therapy; D000704:Analysis of Variance; D000858:Anovulation / Q000097:blood* / Q000503:physiopathology; D002996:Clomiphene / Q000627:therapeutic use; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood* / Q000627:therapeutic use*; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000150:complications*; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood; D008137:Longitudinal Studies; D009839:Oligomenorrhea / Q000097:blood / Q000188:drug therapy; D006080:Ovarian Follicle / Q000187:drug effects / Q000502:physiology; D010062:Ovulation Induction; D011388:Prolactin / Q000097:blood; D012044:Regression Analysis; D013972:Thyrotropin / Q000097:blood; D017211:Treatment Failure
D012739:Gonadal Steroid Hormones; D018970:Insulin-Like Growth Factor Binding Protein 1; D002996:Clomiphene; D011388:Prolactin; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin