title: Individualised gonadotrophin ovulation induction in women with normogonadotrophic anovulatory infertility: A prospective, observational study.
abstract: OBJECTIVE
  The aim of this study was to evaluate an individualised gonadotrophin starting dose regimen for women with anovulatory infertility.
  
  
  METHODS
  We included 71 normogonadotrophic anovulatory infertile women in a prospective, observational study. All underwent one ovulation induction cycle in a flexible, low-dose step-up protocol. The gonadotrophin starting dose (75-150IU/day) was individualised according to a nomogram incorporating menstrual cycle pattern (oligo- or amenorrhoea), BMI, and mean ovarian volume. The number of women who fulfilled the criteria for human chorionic gonadotrophin (hCG) administration (one follicle ≥17mm or 2-3 follicles ≥15mm) was assessed.
  
  
  RESULTS
  Of the 50 women (70.4%) who fulfilled the hCG criteria and underwent intrauterine insemination, 34 (47.9%) achieved monofollicular growth and 16 (22.5%) developed 2-3 mature follicles. Seventeen (23.9%) cycles were converted to in vitro fertilisation (IVF) due to the development of >3 mature follicles, and one (1.4%) cycle was cancelled due to risk of ovarian hyperstimulation syndrome. Baseline total antral follicle count was found to be significantly associated with fulfillment of the hCG criteria (OR 0.96, 95% CI: 0.92-0.99, P=0.01).
  
  
  CONCLUSIONS
  The nomogram-based dose regimen was not considered suitable for ovulation induction due to a tendency to overestimate the gonadotrophin starting dose. However, the model may serve as a mild IVF regimen, especially in women prone to excessive follicle growth.
authors.affiliation: The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark. Electronic address: mettepetri@gmail.com.
authors.forename: Mette Petri
authors.initials: MP
authors.lastname: Lauritsen
authors.affiliation: The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Loft
authors.affiliation: The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; The Fertility Clinic, Department of Obstetrics and Gynaecology, Hvidovre Hospital, 2650 Hvidovre, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Pinborg
authors.affiliation: The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
authors.forename: Nina
authors.initials: N
authors.lastname: la Cour Freiesleben
authors.affiliation: Department of Clinical Biochemistry and Immunology, Statens Serum Institute, 2300 Copenhagen, Denmark.
authors.forename: Arieh
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Department of Biostatistics, University of Copenhagen, 1014 Copenhagen, Denmark.
authors.forename: Jørgen Holm
authors.initials: JH
authors.lastname: Petersen
authors.affiliation: The Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, 4300 Holbæk, Denmark.
authors.forename: Anne Lis
authors.initials: AL
authors.lastname: Mikkelsen
authors.affiliation: The Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, 4300 Holbæk, Denmark.
authors.forename: Marianne Rich
authors.initials: MR
authors.lastname: Bjerge
authors.affiliation: The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Nyboe Andersen
mesh_terms: D000328:Adult; D000858:Anovulation / Q000188:drug therapy*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D006801:Humans; D008596:Menotropins / Q000008:administration & dosage*; D049451:Nomograms; D006080:Ovarian Follicle / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D057285:Precision Medicine; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies
chemical_list: D005300:Fertility Agents, Female; D008596:Menotropins
keywords: Anovulatory infertility; Gonadotrophin; Individualised; Ovulation induction