Average gonadotropin dosage per follicle as a predictor of ovarian response
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20251580Keywords:
Ovarian stimulation, Preovulatory follicle, Gonadotropin dose per follicle, Ovarian responseAbstract
Background: In ovarian stimulation, oocytes retrieved are commonly used to assess response to gonadotropins. Markers like FORT, FOI, and OSI have been proposed but show poor prediction of IVF outcomes. Each is limited by various clinical and technical factors. A novel index, average gonadotropin dosage per preovulatory follicle offers better prediction of ovarian response and clinical pregnancy rate, aiding in personalized stimulation and helping anticipate OHSS risk and cycle cancellations
Methods: This retrospective cohort study included 238 sub fertile women who underwent IVF at the Institute of Reproductive Medicine, Madras Medical Mission Hospital, from January 2019 to December 2023. It aimed to evaluate a new marker, average gonadotropin dosage per preovulatory follicle as a predictor of ovarian response and pregnancy outcomes. The index was calculated by dividing the total gonadotropin dose by the number of 16–22 mm follicles on trigger day. Patients were grouped by the 50th percentile, and stimulation parameters, MII oocyte ratio, clinical pregnancy rate, and live birth rate were compared between groups.
Results: Group A showed significantly higher oocyte yield, MII oocyte ratio, and fertilization rate (p<0.001). Clinical pregnancy and live birth rates were higher in Group A with statistical significance compared to Group B
Conclusion: Average gonadotropin dose per follicle proved to an ovarian response predictor in our study.
Metrics
References
Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011;26:1768–74. DOI: https://doi.org/10.1093/humrep/der106
Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod update. 2014;20:124–40. DOI: https://doi.org/10.1093/humupd/dmt037
Pezzuto A, Ferrari B, Coppola F, Nardelli GB. LH supplementation in downregulated women undergoing assisted reproduction with baseline low serum LH levels. Gynecol Endocrinol. 2010;26:118–24. DOI: https://doi.org/10.3109/09513590903215516
Alviggi C, Conforti A, Esteves SC, Vallone R, Venturella R, Staiano S, et al. Understanding ovarian hypo-response to exogenous gonadotropin in ovarian stimulation and its new proposed marker-the follicle-to-oocyte (FOI) index. Front Endocrinol (Lausanne). 2018;9:589. DOI: https://doi.org/10.3389/fendo.2018.00589
Conforti A, Esteves SC, Cimadomo D, Vaiarelli A, Di Rella F, Ubaldi FM, et al. Management of women with an unexpected low ovarian response to gonadotropin. Front Endocrinol (Lausanne). 2019;10:387. DOI: https://doi.org/10.3389/fendo.2019.00387
Genro VK, Grynberg M, Schefer JB, Roux I, Frydman R, Fanchin R. Serum anti-Müllerian hormone levels are negatively related to Follicular Output RaTe (FORT) in normo-cycling women undergoing controlled ovarian hyperstimulation. Hum Reprod. 2011;26:671–7. DOI: https://doi.org/10.1093/humrep/deq361
Gallot V, Berwanger da Silva AL, Genro V, Grynberg M, Frydman N, Fanchin R. Antral follicle responsiveness to follicle-stimulating hormone administration assessed by the Follicular Output RaTe (FORT) may predict in vitro fertilization-embryo transfer outcome. Hum Reprod. 2012;27:1066–72. DOI: https://doi.org/10.1093/humrep/der479
Biasoni V, Patriarca A, Dalmasso P, Bertagna A, Manieri C, Benedetto C, et al. Ovarian sensitivity index is strongly related to circulating AMH and may be used to predict ovarian response to exogenous gonadotropins in IVF. Reprod Biol Endocrinol. 2011;9:112. DOI: https://doi.org/10.1186/1477-7827-9-112
De Placido G, Alviggi C, Perino A, Strina I, Lisi F, Fasolino A, et al. Recombinant human LH supplementation versus recombinant human FSH (rFSH) step-up protocol during controlled ovarian stimulation in normogonadotrophic women with initial inadequate ovarian response to rFSH. A multicentre, prospective, randomized controlled trial. Hum Reprod. 2005;20:390–6. DOI: https://doi.org/10.1093/humrep/deh625
Ferraretti AP, Gianaroli L, Magli MC, D’Angelo A, Farfalli V, Montanaro N. Exogenous luteinizing hormone in controlled ovarian hyperstimulation for assisted reproduction techniques. Fertil Steril. 2004;82:1521–6. DOI: https://doi.org/10.1016/j.fertnstert.2004.06.041
Ruvolo G, Bosco L, Pane A, Morici G, Cittadini E, Roccheri MC. Lower apoptosis rate in human cumulus cells after administration of recombinant luteinizing hormone to women undergoing ovarian stimulation for in vitro fertilization procedures. Fertil Steril. 2007;87:542–6. DOI: https://doi.org/10.1016/j.fertnstert.2006.06.059
Carosso AR, van Eekelen R, Revelli A, Canosa S, Mercaldo N, Benedetto C, et al. Women in advanced reproductive age: are the follicular output rate, the follicle-oocyte index and the ovarian sensitivity index predictors of live birth in an IVF cycle. J Clin Med. 2022;11(3):859. DOI: https://doi.org/10.3390/jcm11030859
Hassan A, Kotb M, AwadAllah A, Wahba A, Shehata N. Follicular output rate can predict clinical pregnancy in women with unexplained infertility undergoing IVF/ICSI: a prospective cohort study. Reprod Biomed Online. 2017;34(6):598–604. DOI: https://doi.org/10.1016/j.rbmo.2017.03.004
14. Yang H, Lin J, Jin C, Meng L, Wu S, Chen Y. The predictive value of the follicular output rate on pregnancy outcome of patients with polycystic ovary syndrome undergoing in vitro fertilization and embryo transfer. Med Sci Monit. 2020;26:916175. DOI: https://doi.org/10.12659/MSM.916175
Grynberg M, Labrosse J. Understanding follicular output rate (FORT) and its implications for POSEIDON criteria. Front Endocrinol (Lausanne). 2019;10:246. DOI: https://doi.org/10.3389/fendo.2019.00246
Weghofer A, Barad DH, Darmon SK, Kushnir VA, Albertini DF, Gleicher N. The ovarian sensitivity index is predictive of live birth chances after IVF in infertile patients. Hum Reprod Open. 2020;6:49-51. DOI: https://doi.org/10.1093/hropen/hoaa049
Huber M, Hadziosmanovic N, Berglund L, Holte J. Using the ovarian sensitivity index to defne poor, normal, and high response after controlled ovarian hyperstimulation in the long gonadotropin-releasing hormone-agonist protocol: suggestions for a new principle to solve an old problem. Fertil Steril. 2013;100:1270–6. DOI: https://doi.org/10.1016/j.fertnstert.2013.06.049
Yadav V, Malhotra N, Mahey R, Singh N, Kriplani A. Ovarian Sensitivity Index (OSI): Validating the use of a marker for ovarian responsiveness in IVF. J Reprod Infertil. 2019;20(2):83–8.
Cesarano S, Pirtea P, Benammar A, De Ziegler D, Poulain M, Revelli A, et al. Are there ovarian responsive indexes that predict cumulative live birth rates in women over 39 years. J Clin Med. 2022;5:38-41. DOI: https://doi.org/10.3390/jcm11082099
Downloads
Published
How to Cite
Issue
Section
