title: An upper limit of gonadotropin dose in patients undergoing ART should be advocated.
abstract: OBJECTIVE
  As no upper limit of the daily dose of gonadotropins (DD GN) used for controlled ovarian hyperstimulation (COH) in patients undergoing assisted reproductive technology (ART) has been established, we aimed to evaluate the efficacy of using different DD GN in terms of live-birth achievement.
  
  
  METHODS
  Data of patients treated at a single university medical center during the same period was analyzed retrospectively. Four groups were analyzed according to the DD GN administered: group I ("high dose"):  >225- ≤ 375 IU; Group II ("Very high dose"): 376-450 IU; group III ("extremely high dose"): 451-600 IU. Normo-responders treated with DD GN ≤250 IU served as control (C). Variables included were DD GN, total GN dose/cycle, age, FSH, BMI, gravidity, parity, cycle number, IVF/ICSI, infertility diagnosis treatment protocol and outcome parameters.
  
  
  RESULTS
  The analysis of 1394 treatment cycles of 943 patients indicated that DD and total dose of GN correlated negatively with the number of oocytes, implantation, clinical pregnancy and live-birth rate (25.9%, 14.6%, 11.4% and 4.7% in groups C, I, II and III, respectively) The logistic regression analysis indicated that the adjusted odds ratios for LBR correlated inversely with the DD administered - independently from age, baseline FSH, BMI and previous failed cycles.
  
  
  CONCLUSIONS
  Increasing the daily dose of GN to doses higher than 450 IU or a total dose of 3000 IU/cycle is at least questionable if not harmful.
authors.affiliation: a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel.
authors.forename: S
authors.initials: S
authors.lastname: Friedler
authors.affiliation: a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel.
authors.forename: S
authors.initials: S
authors.lastname: Meltzer
authors.affiliation: a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel.
authors.forename: B
authors.initials: B
authors.lastname: Saar-Ryss
authors.affiliation: a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel.
authors.forename: J
authors.initials: J
authors.lastname: Rabinson
authors.affiliation: a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel.
authors.forename: T
authors.initials: T
authors.lastname: Lazer
authors.affiliation: a Infertility and IVF Unit, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben Gurion University of the Negev , Beersheba , Israel.
authors.forename: G
authors.initials: G
authors.lastname: Liberty
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000592:standards*; D006062:Gonadotropins / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D050498:Live Birth; D010062:Ovulation Induction / Q000592:standards*; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D006062:Gonadotropins
keywords: COH; IVF; gonadotropin dose; live-birth rate; poor ovarian responder