[Results of application of high daily doses of recombinant follicle stimulating hormone in different age groups of women in IVF program]

Abstract

A prospective, randomized, comparative study has been carried out to investigate the effectiveness of administration of recombinant FSH (rFSH, Gonal-F) in doses 150 and 225 IU in different age groups of women. 63 patients started a long gonadotrophin-releasing hormone agonist protocol (GnRHa, Diphereline, 0,1 mg): 31 received rFSH 150 IU/day and 32 - 225 IU/day. The objective was to assess the impact of these dosing regimens in down-regulated women. Duration of treatment for reaching administered criteria for human chorionic gonadotropin (HCG, Profazi) showed that the results in low-dose group and high-dose group were similar (11,8+/-0,2 days versus 11,2+/-0,4 days). Though, the total dose used per cycle of stimulation for group of patients receiving 225 IU was 2493+/-56 IU and 1762+/-37 IU in the 150 IU group (p<0,001). Average number of retrieved oocytes in low-dose group was 7,4+/-0,5 and 8,9+/-0,7 in high-dose group (no significant difference). In the group of women 31-33 years of age receiving 225 IU more oocytes were retrieved (13,1+/-1,1 versus 9,3+/-0,7 in 150 IU treatment group). Thus the patients of the age 37-39 years receiving 150 IU dose a slightly higher number of oocytes were found (6,1+/-0,3 versus 5,3+/-0,4). No significant relationships were found between serum FSH concentrations as obtained in the early follicular phase and the number of oocytes collected, or the total dose. The rates of obtained transferable embryos (1 and 2 degree) were 67% in low-dose group and 54% in high-dose group. There was better quality of retrieved oocytes than in the stimulation protocol with rFSH. According to the clinical pregnancy and delivery rates per cycles (respectively 26 and 23% in 150 IU group, 19 and 16% in the 225 IU group) and embryo transfer per cycle (29 and 25% in 150 IU group, 21 and 18% in 225 IU group) no significant difference has been found. Our study has shown that in women between 31-39 years of age, the decline in number of oocytes retrieved with increasing age cannot be overcome by augmenting the daily dose of recombinant FSH from 150 to 225 IU.