Development of a nomogram based on markers of ovarian reserve for the individualisation of the follicle-stimulating hormone starting dose in in vitro fertilisation cycles.

OBJECTIVE

To elaborate a nomogram based on markers of ovarian reserve for the calculation of the appropriate starting dose of follicle-stimulating hormone (FSH).

DESIGN

Cohort study of infertile women.

SETTING

In vitro fertilisation (IVF) unit, University Hospital of Modena, Italy.

POPULATION

Women aged 18-40 years (n = 346) and undergoing their first IVF cycle.

METHODS

Serum FSH and anti-Müllerian hormone (AMH) measurement.

MAIN OUTCOME MEASURES

Development of a model for the prediction of ovarian response to FSH.

RESULTS

A model based on age, AMH and FSH was able to accurately predict the ovarian sensitivity and accounted for 30% of the variability of ovarian response to FSH. An FSH dosage nomogram was constructed and overall it predicts a starting FSH dose <225 IU in 55.1 and 25.9% of women younger and older than 35 years, respectively.

CONCLUSIONS

In the present study we clearly demonstrated that the daily FSH dose may be calculated on the basis of a woman's age and two markers of ovarian reserve, namely AMH and FSH, with the first two vari;s (age and AMH) being the most significant predictors. The nomogram we developed seems easily applicable for clinicians during their daily clinical practice.