Is there a recommended maximum starting dose of FSH in IVF?

Abstract

This report reviews and discusses the existing evidence on recommended FSH doses in IVF cycles. A comprehensive search for relevant data was performed in the Cochrane Library, MEDLINE, EMBASE and NICE clinical guidelines database, and the reference lists of manuscripts. A good body of evidence exists looking at starting doses of FSH for first IVF attempts. Only one randomised controlled trial was identified looking at the efficacy of increasing doses during an IVF cycle. Some observational studies dealt with the question whether a suboptimal ovarian response should be managed by an increased FSH dose in a subsequent cycle, but no randomised trials addressed this issue.

Fig. 1

Clinical pregnancy rates at Monash IVF grouped per starting dose for nafarelin down-regulated cycles (with or without pill-scheduling) between 1997–2006

Fig. 2

Odds ratio (OR) for clinical pregnancy rates for RCTs comparing 100 vs. 200 IU recFSH. Circles represent point estimates of OR. Circle size is proportionate to number of patients. The 95%CI are illustrated by error bars. The overall OR was calculated using the Peto method. There was no statistically significant heterogeneity between the studies (χ² = 1.97; P = 0.74)