Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, No. 49 North Huayuan Road, Haidian District, Beijing, 100191, China.
National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
Adv Ther. 2023 Sep;40(9):3971-3985. doi: 10.1007/s12325-023-02582-2. Epub 2023 Jul 3.
For high responders with polycystic ovary syndrome (PCOS), there is no clear recommendation for the initial follicle-stimulating hormone (FSH) dosage to ensure an optimal number of retrieved oocytes and avoid ovarian hyperstimulation syndrome (OHSS). The aim of this study was to determine the ideal initial FSH dosage of in patients with PCOS undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) using the gonadotropin-releasing hormone antagonist (GnRH-ant) protocol to obtain the optimal number of retrieved oocytes and minimize the risk of OHSS.
The data of 1898 patients with PCOS aged 20-40 years from January 2017 to December 2020 were retrospectively analyzed to explore the factors related to the number of retrieved oocytes. Statistically significant variables were used to construct a dose nomogram and it was then validated using an independent cohort of patients with PCOS from January 2021 to December 2021.
Multivariate analyses demonstrated that body mass index (BMI) was the most significant factor to predict the number of retrieved oocytes compared to body weight (BW) and body surface area (BSA). Among patients with PCOS aged 20-40 years undergoing their first IVF cycles with the GnRH-ant protocol, age was not a significant predictor of the initial FSH dosage. We developed a nomogram based on BMI, basal FSH, basal luteinizing hormone (bLH), anti-Müllerian hormone (AMH), and antral follicle count (AFC) to calculate the ideal initial FSH dosage for patients with PCOS undergoing IVF/ICSI using the GnRH-ant protocol. In addition, low BMI and high bLH and AMH levels and AFC appear to be risk factors for OHSS.
We clearly demonstrated that the initial FSH dosage for patients with PCOS undergoing IVF/ICSI with the GnRH-ant protocol may be calculated on the basis of the woman's BMI and ovarian reserve markers. The nomogram will help guide clinicians in the selection of the most appropriate initial FSH dose in the future.
对于多囊卵巢综合征（PCOS）的高反应者，尚无明确的推荐初始促卵泡激素（FSH）剂量，以确保获得最佳数量的可回收卵母细胞并避免卵巢过度刺激综合征（OHSS）。本研究旨在确定采用促性腺激素释放激素拮抗剂（GnRH-ant）方案进行体外受精（IVF）/胞浆内精子注射（ICSI）的 PCOS 患者的理想初始 FSH 剂量，以获得最佳数量的可回收卵母细胞并最大程度降低 OHSS 的风险。
回顾性分析了 2017 年 1 月至 2020 年 12 月期间 1898 名年龄在 20-40 岁的 PCOS 患者的数据，以探讨与可回收卵母细胞数量相关的因素。对有统计学意义的变量进行分析，构建剂量nomogram，并使用 2021 年 1 月至 2021 年 12 月期间接受 PCOS 治疗的独立队列患者进行验证。
多变量分析表明，与体重（BW）和体表面积（BSA）相比，体重指数（BMI）是预测可回收卵母细胞数量的最重要因素。在年龄在 20-40 岁之间的接受 GnRH-ant 方案进行首次 IVF 周期的 PCOS 患者中，年龄不是初始 FSH 剂量的显著预测因素。我们基于 BMI、基础 FSH、基础黄体生成素（bLH）、抗苗勒管激素（AMH）和窦卵泡计数（AFC），制定了一个 nomogram，以计算接受 GnRH-ant 方案的 PCOS 患者进行 IVF/ICSI 的理想初始 FSH 剂量。此外，低 BMI 和高 bLH 和 AMH 水平以及 AFC 似乎是 OHSS 的危险因素。
我们明确表明，采用 GnRH-ant 方案进行 IVF/ICSI 的 PCOS 患者的初始 FSH 剂量可根据女性的 BMI 和卵巢储备标志物来计算。该 nomogram 将有助于指导临床医生在未来选择最合适的初始 FSH 剂量。
