Lekamge Dharmawijaya N, Lane Michelle, Gilchrist Robert B, Tremellen Kelton P
School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.
J Assist Reprod Genet. 2008 Nov-Dec;25(11-12):515-21. doi: 10.1007/s10815-008-9266-6. Epub 2008 Oct 30.
This retrospective study was carried out to evaluate whether increasing the starting dose of FSH stimulation above the standard dose of 150 IU/day in patients with low predicted ovarian reserve can improve IVF outcomes.
A total of 122 women aged less than 36 years in their first cycle of IVF were identified as having likely low ovarian reserve based on a serum AMH measurement below 14 pmol/l. Thirty five women were administered the standard dose of 150 IU/day FSH, while the remaining 87 received a higher starting dose (200-300 IU/day FSH). There were no significant differences in age, BMI, antral follicle count, serum AMH, FSH or aetiology of infertility between the two dose groups.
No significant improvement in oocyte and embryo yield or pregnancy rates was observed following an upward adjustment of FSH starting dose. While increasing the dose of FSH above 150 IU/day did not produce any adverse events such as OHSS, it did consume an extra 1,100 IU of FSH per IVF cycle.
The upward FSH dose adjustment in anticipation of low ovarian reserve can not be advocated as it is both expensive and of no proven clinical value.
本回顾性研究旨在评估对于预测卵巢储备功能低下的患者，将促卵泡激素（FSH）刺激的起始剂量提高至标准剂量150 IU/天以上是否能改善体外受精（IVF）结局。
根据血清抗缪勒管激素（AMH）测量值低于14 pmol/l，确定122名年龄小于36岁且处于首次IVF周期的女性可能存在卵巢储备功能低下。35名女性接受150 IU/天的标准FSH剂量，其余87名接受更高的起始剂量（200 - 300 IU/天FSH）。两个剂量组在年龄、体重指数、窦卵泡计数、血清AMH、FSH或不孕病因方面无显著差异。
FSH起始剂量上调后，卵母细胞和胚胎产量或妊娠率未见显著改善。虽然将FSH剂量增加至150 IU/天以上未产生诸如卵巢过度刺激综合征（OHSS）等不良事件，但每个IVF周期确实额外消耗了1100 IU的FSH。
对于预测卵巢储备功能低下而向上调整FSH剂量的做法不能被提倡，因为这既昂贵又无已证实的临床价值。
