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Algorithm-based individualization methodology of the starting gonadotropin dose in IVF/ICSI and the freeze-all strategy prevent OHSS equally in normal responders: a systematic review and network meta-analysis of the evidence

  • Assisted Reproduction Technologies
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Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

Ovarian hyperstimulation syndrome (OHSS) represents a rare but dangerous condition associated with controlled ovarian stimulation (COS) in IVF/ICSI. Over the last decades, many strategies have been introduced into clinical practice with the objective of preventing this potentially life-threatening condition. Among these, the freeze-all policy has gained great popularity, thanks to improvements in vitrification. Nevertheless, not all clinics have adequate skills in vitrification procedures and patients may be dissatisfied with a longer time to pregnancy.

Methods

This study is a systematic review and network meta-analysis of randomized controlled trials comparing different strategies of ovarian stimulation in IVF/ICSI cycles (freeze-all policy, algorithm-based individualization of the starting dose, experience-based individualization of the starting dose, standard dose) in terms of reduction of OHSS, in normal responders.

Results

The results indicate that only the algorithm-based individualization of the starting gonadotropin dose reduces OHSS similarly to the freeze-all strategy.

Conclusion

Albeit in the era of the freeze-all policy, the personalization of the starting gonadotropin dose obtained by the use of algorithms should be pursued as a valid and safe option for IVF.

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Authors and Affiliations

  1. Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Via Ausonia 43/45, 90144, Palermo, Italy

    Angelo Marino, Francesca Sammartano, Aldo Volpes & Adolfo Allegra

  2. Department of Psychology, Educational Science and Human Movement-Statistics Unit, University of Palermo, Palermo, Italy

    Salvatore Gullo

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  1. Angelo Marino
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Correspondence to Angelo Marino.

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Marino, A., Gullo, S., Sammartano, F. et al. Algorithm-based individualization methodology of the starting gonadotropin dose in IVF/ICSI and the freeze-all strategy prevent OHSS equally in normal responders: a systematic review and network meta-analysis of the evidence. J Assist Reprod Genet 39, 1583–1601 (2022). https://doi.org/10.1007/s10815-022-02503-2

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