title: Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles.
abstract: OBJECTIVE
  To evaluate the correlation between total gonadotropin dose and live birth rate.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  A total of 658,519 fresh autologous cycles of in vitro fertilization (IVF) reported to the Society for Assisted Reproductive Technology from 2004 to 2012.
  
  
  METHODS
  None.
  
  
  METHODS
  Logistic regression models were fitted to live birth rates with the use of categorized values for total FSH dose and number of oocytes retrieved as the primary predictor variables. To reduce the effect of the most significant confounders that may lead physicians to prescribe higher doses of FSH, additional analyses were performed limited to good-prognosis patients (<35 years of age, body mass index <30 kg/m(2), and no diagnosis of diminished ovarian reserve, endometriosis, or ovulatory disorder) and including duration of gonadotropin treatment.
  
  
  RESULTS
  Live birth rate significantly decreased with increasing FSH dose, regardless of the number of oocytes retrieved. The statistically significant decrease in live birth rate with increasing FSH dose remained in patients with good prognosis, and regardless of female age, except for women aged ≥ 35 years with 1-5 oocytes retrieved.
  
  
  CONCLUSIONS
  This analysis suggests that physicians may wish to avoid prescribing a high dose of FSH. However, the results of this study do not justify the use of minimal-stimulation or natural-cycle IVF.
authors: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California. Electronic address: vlbaker@stanford.edu.
authors: Valerie L
authors: VL
authors: Baker
authors: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors: Morton B
authors: MB
authors: Brown
authors: Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan.
authors: Barbara
authors: B
authors: Luke
authors: Laboratory of Mammalian Reproductive Biology and Genomics, Department of Animal Science, Michigan State University, East Lansing, Michigan.
authors: George W
authors: GW
authors: Smith
authors: Molecular Reproductive Endocrinology Laboratory, Department of Animal Science, Michigan State University, East Lansing, Michigan.
authors: James J
authors: JJ
authors: Ireland
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D016015:Logistic Models; D054315:Oocyte Retrieval; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D005640:Follicle Stimulating Hormone
keywords: In vitro fertilization; gonadotropin dose; live birth rate