The value of increasing the dose of human menopausal gonadotropins in women who initially demonstrate a poor response.

OBJECTIVE

To evaluate the benefit of increasing the hMG dose in subsequent superovulation cycles for those individuals who demonstrate a poor response on up to three ampules of hMG daily.

DESIGN AND SETTING

Retrospective analysis of all superovulation cycles at the University of Connecticut Health Center.

PATIENTS

All women undergoing hMG therapy with IUI from January 1990 until December 1992.

INTERVENTIONS

All patients were initially stimulated with up to three ampules of hMG daily. All patients who did not conceive on their first hMG cycle and demonstrated a poor response to hMG therapy were started on higher doses of hMG in an effort to obtain a good response. A maximum of eight ampules of hMG per day were used.

MAIN OUTCOME MEASURES

Peak serum E2, the number of mature preovulatory follicles, and cycle fecundity were compared.

RESULTS

The poor responders using up to three ampules daily had a peak E2 of 384 +/- 26 pg/mL (1,421 +/- 96 pmol/L), 1.4 +/- 0.1 mature follicles, and a cycle fecundity of 3.1% compared with an E2 of 900 +/- 83 pg/mL (3,330 +/- 307 pmol/L), 2.7 +/- 0.2 mature follicles, and a cycle fecundity of 4.3% when these poor responders had their dose increased to five or more ampules daily. Those individuals demonstrating a good response on less than or equal to three ampules of hMG daily had an average peak E2 of 1,159 +/- 41 pg/mL (4,288 +/- 151 pmol/L), 3.4 +/- 0.2 mature follicles, and a cycle fecundity of 16.5%.

CONCLUSIONS

Despite significant improvement in peak E2 and the number of mature preovulatory follicles when the hMG dose was increased in poor responders, no significant increase in cycle fecundity was noted.