Research

Journal of Ovarian Research

, 6:11

Open Access This content is freely available online to anyone, anywhere at any time.

Individualization of the FSH starting dose in IVF/ICSI cycles using the antral follicle count

  • Antonio La MarcaAffiliated withMother-Infant Department, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia Email author 
  • , Valentina GrisendiAffiliated withMother-Infant Department, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia
  • , Simone GiuliniAffiliated withMother-Infant Department, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia
  • , Cindy ArgentoAffiliated withMother-Infant Department, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia
  • , Alessandra TirelliAffiliated withMother-Infant Department, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia
  • , Giulia DondiAffiliated withMother-Infant Department, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia
  • , Enrico PapaleoAffiliated withCentro Natalità, Gynecological-Obstetrics Department, San Raffaele Hospital
  • , Annibale VolpeAffiliated withMother-Infant Department, Institute of Obstetrics and Gynecology, University of Modena and Reggio Emilia

Abstract

Background

The FSH starting dose is usually chosen according to women’s age, anamnesis, clinical criteria and markers of ovarian reserve. Currently used markers include antral follicle count (AFC), which is considered to have a very high performance in predicting ovarian response to FSH. The objective of the present study to elaborate a nomogram based on AFC for the calculation of the appropriate FSH starting dose in IVF cycles.

Methods

This is a retrospective study performed at the Mother-Infant Department of Modena University Hospital. IVF patients (n=505) were subjected to blood sampling and transvaginal ultrasound for measurement of serum day3 FSH, estradiol and AFC. The variables predictive of the number of retrieved oocytes were assessed by backwards stepwise multiple regression. The variables reaching the statistical significance were then used in the calculation for the final predictive model.

Results

A model based on age, AFC and FSH was able to accurately predict the ovarian sensitivity and accounted for 30% of the variability of ovarian response to FSH. An FSH dosage nomogram was constructed and overall it predicts a starting dose lower than 225 IU in 50.2% and 18.1% of patients younger and older than 35 years, respectively.

Conclusions

The daily FSH dose may be calculated on the basis of age and two markers of ovarian reserve, namely AFC and FSH, with the last two variables being the most significant predictors. The nomogram seems easily applicable during the daily clinical practice.

Keywords

Starting FSH dose ART AFC FSH Ovarian reserve