title: A randomized controlled trial investigating the use of a predictive nomogram for the selection of the FSH starting dose in IVF/ICSI cycles.
abstract: The number of oocytes retrieved is a relevant intermediate outcome in women undergoing IVF/intracytoplasmic sperm injection (ICSI). This trial compared the efficiency of the selection of the FSH starting dose according to a nomogram based on multiple biomarkers (age, day 3 FSH, anti-Müllerian hormone) versus an age-based strategy. The primary outcome measure was the proportion of women with an optimal number of retrieved oocytes defined as 8-14. At their first IVF/ICSI cycle, 191 patients underwent a long gonadotrophin-releasing hormone agonist protocol and were randomized to receive a starting dose of recombinant (human) FSH, based on their age (150 IU if ≤35 years, 225 IU if >35 years) or based on the nomogram. Optimal response was observed in 58/92 patients (63%) in the nomogram group and in 42/99 (42%) in the control group (+21%, 95% CI = 0.07 to 0.35, P = 0.0037). No significant differences were found in the clinical pregnancy rate or the number of embryos cryopreserved per patient. The study showed that the FSH starting dose selected according to ovarian reserve is associated with an increase in the proportion of patients with an optimal response: large trials are recommended to investigate any possible effect on the live-birth rate.
authors.affiliation: Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy. Electronic address: adolfo.allegra@clinicaandros.it.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Allegra
authors.affiliation: Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Marino
authors.affiliation: Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Volpes
authors.affiliation: Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Coffaro
authors.affiliation: Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Scaglione
authors.affiliation: Medical Statistics Unit, ANDROS Day Surgery Clinic, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gullo
authors.affiliation: University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: La Marca
mesh_terms: D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage* / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000494:pharmacology; D006801:Humans; D008423:Maternal Age; D049451:Nomograms; D054315:Oocyte Retrieval; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic
chemical_list: D007987:Gonadotropin-Releasing Hormone; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone
keywords: Anti-Müllerian hormone; IVF/ICSI; ovarian reserve; ovarian response; predictive nomogram