Choosing the optimal dose of human menopausal gonadotropins for ovarian stimulation in ICSI cycles

ObjectiveTo identify the most important predictive variables for ovarian response and establishing a model that could predict the most suitable starting gonadotropin (Gn) dose to optimize ovarian stimulation thus avoiding the undesirable side effects of ovarian hyperstimulation and minimizing cancelation rates.Study designRetrospective observational multicenter study.Materials and methodsData of 233 normo ovulatory females below the age of 39 undergoing their first intracytoplasmic sperm injection (ICSI) trial were collected. All patients were on long protocol and human menopausal gonadotropin (HMG) was used for ovulation induction. Patients with at least 5 oocytes retrieved and good quality embryos transferred were included in the analysis.ResultsMultivariate analysis revealed that predictive variables of statistical significance on Gn dose were age, body mass index (BMI), follicle stimulating hormone (FSH) and estradiol after downregulation (E2-DR). Fitting these factors in a model to calculate the starting Gn dose revealed this equation:Dose = 1.035 Age + 2.355 FSH + 0.340 BMI + 0.241 E2--DR – 15.266.The concordance probability index for this model is 60%.ConclusionAge, basal FSH, BMI and E2 after downregulation are important predictors of ovarian response when considering a long protocol of ovarian stimulation and could help in selecting the appropriate starting dose of GN.