Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan North Road 53, Nanjing, 210008, Jiangsu, People's Republic of China.
Reproductive Medical Center of Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, People's Republic of China.
Arch Gynecol Obstet. 2019 Aug;300(2):441-446. doi: 10.1007/s00404-019-05156-2. Epub 2019 Apr 11.
Although exogenous follicle-stimulating hormone (FSH) has been used for decades and millions of cycles have been performed worldwide until now, criteria for selecting the proper FSH starting dose have not been clearly identified. The aim of this study was to elaborate a formula based on markers of ovarian reserve for the calculation of the appropriate starting dose of FSH.
A total of 931 patients underwent in vitro fertilization (IVF) treatment using long GnRH agonist protocol was retrospectively identified and reviewed. 673 cases of them with a normal ovarian response (4-14 retrieved oocytes) were used to analysis the predictive formula. All follicles 4-7 mm in diameter were counted in the same day of blood sample in both ovaries using transvaginal ultrasound scan. The modified protocol of each patient was recorded and analyzed in the same center. In another center were the numbers of retrieved oocytes of 750 validated patients recorded and analyzed.
A formula model based on age, AMH, and antral follicle count (AFC) was able to accurately predict the ovarian sensitivity and accounted for 57.2% of the variability of ovarian response to FSH. When tested in the same total population used to elaborate the model it predicts a high 46.88% rate of step-down protocol in higher-starting FSH dose group and about 57.92% of patients had their dose step-up modified in lower-starting FSH dose group during their treatment, respectively. And when tested in different population from another center used to elaborate the model it predicts a high 64.40% rate of ≥ 15 retrieved oocytes in higher-starting FSH dose group and about 22.50% of patients had ≤ 7 retrieved oocytes in lower-starting FSH dose group during their treatment, respectively.
In the present study we demonstrated that the individualized FSH starting dose may be calculated on the basis of a woman's age, AMH and AFC. The formula model might be a useful, immediate, and easily applicable tool for clinicians to predict the tailored starting dose of FSH during their daily clinical practice.
虽然外源性促卵泡激素（FSH）已经使用了几十年，并且到目前为止已经在全球范围内进行了数百万个周期，但选择合适的 FSH 起始剂量的标准尚未明确确定。本研究的目的是制定一个基于卵巢储备标志物的公式，用于计算 FSH 的适当起始剂量。
回顾性确定并分析了 931 名接受长 GnRH 激动剂方案体外受精（IVF）治疗的患者。其中 673 例卵巢反应正常（4-14 个获卵），用于分析预测公式。使用经阴道超声扫描在同一天计数双侧卵巢中 4-7mm 的所有卵泡。记录并分析每位患者的改良方案，均在同一中心进行。在另一个中心记录并分析了 750 名经验证患者的获卵数。
基于年龄、AMH 和窦卵泡计数（AFC）的公式模型能够准确预测卵巢敏感性，占 FSH 卵巢反应变异性的 57.2%。在用于构建模型的相同总体人群中进行测试时，它预测在较高起始 FSH 剂量组中，下调方案的比例高达 46.88%，约 57.92%的患者在治疗期间修改了较低起始 FSH 剂量组的剂量上调。在用于构建模型的不同人群中进行测试时，它预测在较高起始 FSH 剂量组中，获得≥15 个获卵的比例高达 64.40%，在较低起始 FSH 剂量组中，获得≤7 个获卵的比例约为 22.50%。
在本研究中，我们证明可以根据女性的年龄、AMH 和 AFC 计算个体化的 FSH 起始剂量。该公式模型可能是临床医生在日常临床实践中预测 FSH 起始剂量的有用、即时且易于应用的工具。
