Ovarian hyperstimulation syndrome prevention strategies: individualizing gonadotropin dose

Abstract

The choice of the gonadotropin starting dose is an important parameter to prevent the onset of ovarian hyperstimulation syndrome (OHSS). The vast majority of studies available propose decreasing the gonadotropin starting dose, but conflicting results confirm that simply reducing the dose is not sufficient to prevent OHSS. True and dependable individualization of the gonadotropin starting dose is not yet possible. Attempts have been made to select parameters that predict ovarian response and to model them in a scoring system or algorithm that would result in a recommended gonadotropin starting dose. The CONSORT (CONsistency in r-FSH Starting dOses for individualized tReatmenT) dosing algorithm individualizes recombinant human follicle-stimulating hormone doses for assisted reproduction technologies, assigning 37.5-IU increments according to easily available patient characteristics (basal follicle-stimulating hormone, body mass index, age, and antral follicle count) that have been proven to accurately predict ovarian response to ovarian stimulation. The use of the CONSORT algorithm achieved an adequate oocyte yield and good pregnancy rates in a preliminary study. Results of a prospective randomized study are awaited to see if this tool would allow individualization of the gonadotropin starting dose.