title: Timing of FSH administration for ovarian stimulation in normo-ovulatory women: comparison of an early or a mid follicular phase initiation of a short-term treatment.
abstract: BACKGROUND
  In normo-ovulatory infertile women undergoing mild ovarian stimulation out of IVF, FSH stimulation regimen must be carefully adjusted to control the number of recruited follicles and to prevent multiple pregnancies. The aim of this prospective study was to assess the effect of the timing of FSH administration (fixed dose and duration) on the number of large follicles.
  
  
  METHODS
  Women were prospectively randomized by means of sealed envelopes to receive daily 112.5 IU recombinant FSH (rFSH), either from cycle day (CD) 2-6 (Group A) or from CD 7-11 (Group B). Hormonal measurements and follicular ultrasound assessments were performed on CD 2, 7 and 12.
  
  
  RESULTS
  On CD 12, the development rate of exactly two follicles >or=14 mm in diameter was significantly lower in Group A than in Group B (4% of women versus 42%, P = 0.002). Although the pattern of serum estradiol (E(2)) concentrations in Group A displayed a plateau from CD 7, the cancellation rate for overstimulation (more than three follicles >or=14 mm in diameter) was significantly increased (P = 0.009).
  
  
  CONCLUSIONS
  Preventing the closure of the FSH window by mid to late follicular phase FSH administration better fulfils the objective of obtaining a limited number of large follicles than surpassing the FSH threshold by an early administration.
authors.affiliation: Centre for Reproductive Medicine--Jean Verdier Hospital, Bondy Cedex, AP-HP, University Paris XIII, France. isabelle.cedrin-durnerin@jvr.ap-hop-paris.fr
authors.forename: I
authors.initials: I
authors.lastname: Cedrin-Durnerin
authors.forename: N
authors.initials: N
authors.lastname: Massin
authors.forename: J
authors.initials: J
authors.lastname: Galey-Fontaine
authors.forename: H
authors.initials: H
authors.lastname: Bry-Gauillard
authors.forename: M
authors.initials: M
authors.lastname: Roger
authors.forename: N
authors.initials: N
authors.lastname: Lahlou
authors.forename: J N
authors.initials: JN
authors.lastname: Hugues
mesh_terms: D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000494:pharmacology*; D005498:Follicular Phase / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008597:Menstrual Cycle / Q000187:drug effects / Q000502:physiology; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000502:physiology; D010060:Ovulation / Q000187:drug effects / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods*; D011994:Recombinant Proteins / Q000494:pharmacology; D012016:Reference Values; D014463:Ultrasonography
chemical_list: D011994:Recombinant Proteins; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone