A Study Evaluating the Assisted Reproductive Technology Outcome in Patients Receiving a High Starting dose of rFSH for Controlled Ovarian Hyper-Stimulation in IVF

Aim: To evaluate the performance of a high starting dose of rFSH (≥350 IU/day) during the course of IVF in women of various age groups with high day 2 FSH (≥10 IU/L) and its correlation with the outcome of the treatment cycle. Study design: Retrospective cohort study. Materials and Methods: Sixty-seven patients undergoing IVF with high day 2 FSH (≥10 IU/L) and starting on high doses of recombinant FSH (≥350 I.U) over a 2-year period. Main outcome measures: The primary end-point was clinical pregnancy rate. Secondary variables included implan- tation rate, cycle cancellation rate, number of days of rFSH stimulation, total IUs of rFSH used, peak E2 on day of hCG administration, number of oocytes collected, number of oocytes fertilized, and total number of embryos available. Results: Patients were either stratified either according to age into groups: 38 years and ≤ 38 years; or according to the starting rFSH dose: 350 375 IU, and 400 450 IU. All groups were comparable regarding their mean age, day 2 FSH, attempt number, and cause of infertility. There was a statistically significant higher clinical pregnancy rate in patients ≤ 38 years old, but none in the dose groups. Also, there were statistically significantly more oocytes collected, and higher implantation and clinical pregnancy rates in women ≤ 38 years old. Higher doses in group 2 (400 450 IU) did not improve cycle outcome. Conclusions: Patients with elevated day 2 FSH differ in their response to high starting dose of rFSH in relation to their age. While this practice is beneficial in patients ≤ 38 years old, it seems of little value in older women. This information is useful in planning treatment, and counselling patients.