Clinical application of a nomogram based on age, serum FSH and AMH to select the FSH starting dose in IVF/ICSI cycles: a retrospective two-centres study.
OBJECTIVE
To externally validate a nomogram based on ovarian reserve markers as a tool to optimize the FSH starting dose in IVF/ICSI cycles.


METHODS
A two-centres retrospective study including 398 infertile women undergoing their first IVF/ICSI cycle (June 2013-June 2014). IVF data were retrieved from two independent IVF centres in Italy (San Raffaele Hospital, Centre 1; Verona Hospital, Centre 2). A central lab for the routine measurement of AMH and FSH was used for both centres. All women were treated based on physical and hormonal characteristics according to locally adopted protocols. The nomogram was then retrospectively applied to the patients comparing the calculated starting dose to the one actually given.


RESULTS
In Centre 1, 64/131 women (48.8%) had an ovarian response below the target. While 45 of these patients were treated with a maximal FSH starting dose (≥225 IU), n=19/131 (14.5%) were treated with a submaximal dose. The vast majority of them (n=17/19) would have received a higher FSH starting dose by using the nomogram. Seventeen patients (n=17/131) had hyper response and about half of them would have been treated with a reduced FSH starting dose according to the nomogram. In Centre 2, 142/267 patients (53.2%) had an ovarian response below the target. While 136 of these were treated with a maximal FSH starting dose (≥225 IU), n=6/267 were treated with a submaximal dose. The majority of them (n=5/6) would have received a higher FSH starting dose. Thirty-two (n=32/267) patients had hyper response and more than half of them would have been treated with a reduced FSH dose.


CONCLUSIONS
In both Centres, applying the nomogram would have resulted in more appropriate FSH starting doses compared to the the ones actually given based on clinicians choices. The use of an objective algorithm based on patient's age, serum FSH and AMH levels may thus be an effective advice on the selection of the tailored FSH starting dose. Hence, the use of this easily available nomogram could increase the proportion of patients achieving the optimal ovarian response.
IRCCS San Raffaele Hospital, Centro Scienze della Natalità, Department of Obstetrics and Gynaecology, 20132 Milan, Italy. Electronic address: papaleo.enrico@hsr.it.
Enrico
E
Papaleo
Department of Obstetrics and Gynaecology, University of Verona, 37129 Verona, Italy.
Stefano
S
Zaffagnini
IRCCS San Raffaele Hospital, Centro Scienze della Natalità, Department of Obstetrics and Gynaecology, 20132 Milan, Italy.
Maria
M
Munaretto
IRCCS San Raffaele Hospital, Centro Scienze della Natalità, Department of Obstetrics and Gynaecology, 20132 Milan, Italy.
Valeria Stella
VS
Vanni
IRCCS San Raffaele Hospital, Centro Scienze della Natalità, Department of Obstetrics and Gynaecology, 20132 Milan, Italy.
Giorgia
G
Rebonato
Mother-Infant Department, University of Modena and Reggio Emilia and Clinica Eugin Modena, 41100 Modena, Italy.
Valentina
V
Grisendi
Department of Obstetrics and Gynaecology, University of Verona, 37129 Verona, Italy.
Rossana
R
Di Paola
Mother-Infant Department, University of Modena and Reggio Emilia and Clinica Eugin Modena, 41100 Modena, Italy.
Antonio
A
La Marca
D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D054796:Drug Dosage Calculations; 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 / Q000097:blood*; D006773:Hospitals, Municipal; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000628:therapy*; D007558:Italy / Q000453:epidemiology; D049451:Nomograms; D010044:Outpatient Clinics, Hospital; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010062:Ovulation Induction / Q000009:adverse effects; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D020554:Sperm Injections, Intracytoplasmic
D015415:Biomarkers; D005300:Fertility Agents, Female; D011994:Recombinant Proteins; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone
AMH; FSH starting dose; IVF; Nomogram; Ovarian reserve