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Do female age and body weight modify the effect of individualized FSH dosing in IVF/ICSI treatment? A secondary analysis of the OPTIMIST trial.
Acta Obstet Gynecol Scand. 2019 10; 98(10):1332-1340.AO

Abstract

INTRODUCTION

The OPTIMIST trial revealed that for women starting in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment, no substantial differences exist in first cycle and cumulative live birth rates between an antral follicle count (AFC)-based individualized follicle-stimulating hormone (FSH) dose and a standard dose. Female age and body weight have been suggested to cause heterogeneity in the effect of FSH dose individualization. The objective of the current study is to evaluate whether these patient characteristics modify the effect of AFC-based individualized FSH dosing in IVF/ICSI treatment.

MATERIAL AND METHODS

A secondary data-analysis of the OPTIMIST trial. Women initiating IVF/ICSI treatment were classified as predicted poor (AFC 0-7), suboptimal (AFC 8-10) or hyper responders (AFC >15), and randomly allocated to a standard FSH dose (150 IU/d) or an individualized FSH dose (450, 225 or 100 IU/d for predicted poor, suboptimal and hyper responders, respectively). In each predicted response category, logistic regression models with interaction terms were used to evaluate the presence of effect modification. The first cycle was analyzed, and the primary outcomes were first complete cycle live birth rate (including fresh plus frozen-thawed embryo transfers) and ovarian hyperstimulation syndrome (OHSS) risks.

RESULTS

No effect modification was revealed in the predicted poor (n = 234) and suboptimal (n = 277) responders. In the predicted hyper responders (n = 521), the effect of the individualized FSH dose on the first cycle live birth rate was modified by female age (P = 0.02) and the effect on OHSS risks was modified by body weight (P = 0.02). A dose reduction from 150 to 100 IU/d generally decreased the OHSS risks in predicted hyper responders, but also reduced the chance of a live birth in young women, and had no beneficial impact on OHSS risks in women with a relatively low body weight.

CONCLUSIONS

In women with a predicted hyper response undergoing IVF/ICSI treatment, female age and body weight seem to modify the effect of FSH dose individualization. Although a reduced FSH starting dose generally decreases the OHSS risks, it may also reduce the chance of a live birth, specifically for young women. Future studies could consider these findings when investigating the optimal approach to reduce OHSS risks while maintaining the probability of a live birth for predicted hyper responders in IVF/ICSI treatment.

Authors+Show Affiliations

Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.Department of Obstetrics and Gynecology, Meander Medical Center, Amersfoort, The Netherlands.Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands.Center for Reproductive Medicine, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.Center for Reproductive Medicine, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands.Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands.Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands.Department of Obstetrics and Gynecology, Monash University, Clayton, VIC, Australia.Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31127607

Citation

Leijdekkers, Jori A., et al. "Do Female Age and Body Weight Modify the Effect of Individualized FSH Dosing in IVF/ICSI Treatment? a Secondary Analysis of the OPTIMIST Trial." Acta Obstetricia Et Gynecologica Scandinavica, vol. 98, no. 10, 2019, pp. 1332-1340.
Leijdekkers JA, van Tilborg TC, Torrance HL, et al. Do female age and body weight modify the effect of individualized FSH dosing in IVF/ICSI treatment? A secondary analysis of the OPTIMIST trial. Acta Obstet Gynecol Scand. 2019;98(10):1332-1340.
Leijdekkers, J. A., van Tilborg, T. C., Torrance, H. L., Oudshoorn, S. C., Brinkhuis, E. A., Koks, C. A. M., Lambalk, C. B., de Bruin, J. P., Fleischer, K., Mochtar, M. H., Kuchenbecker, W. K. H., Laven, J. S. E., Mol, B. W. J., Broekmans, F. J. M., & Eijkemans, M. J. C. (2019). Do female age and body weight modify the effect of individualized FSH dosing in IVF/ICSI treatment? A secondary analysis of the OPTIMIST trial. Acta Obstetricia Et Gynecologica Scandinavica, 98(10), 1332-1340. https://doi.org/10.1111/aogs.13664
Leijdekkers JA, et al. Do Female Age and Body Weight Modify the Effect of Individualized FSH Dosing in IVF/ICSI Treatment? a Secondary Analysis of the OPTIMIST Trial. Acta Obstet Gynecol Scand. 2019;98(10):1332-1340. PubMed PMID: 31127607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do female age and body weight modify the effect of individualized FSH dosing in IVF/ICSI treatment? A secondary analysis of the OPTIMIST trial. AU - Leijdekkers,Jori A, AU - van Tilborg,Theodora C, AU - Torrance,Helen L, AU - Oudshoorn,Simone C, AU - Brinkhuis,Egbert A, AU - Koks,Carolien A M, AU - Lambalk,Cornelis B, AU - de Bruin,Jan Peter, AU - Fleischer,Kathrin, AU - Mochtar,Monique H, AU - Kuchenbecker,Walter K H, AU - Laven,Joop S E, AU - Mol,Ben Willem J, AU - Broekmans,Frank J M, AU - Eijkemans,Marinus J C, AU - ,, Y1 - 2019/06/21/ PY - 2018/12/10/received PY - 2019/03/05/revised PY - 2019/05/21/accepted PY - 2019/5/28/pubmed PY - 2020/3/14/medline PY - 2019/5/26/entrez KW - antral follicle count KW - body weight KW - effect modification KW - female age KW - in vitro fertilization/intracytoplasmic sperm injection KW - individualized follicle-stimulating hormone dosing KW - live birth KW - ovarian hyperstimulation syndrome SP - 1332 EP - 1340 JF - Acta obstetricia et gynecologica Scandinavica JO - Acta Obstet Gynecol Scand VL - 98 IS - 10 N2 - INTRODUCTION: The OPTIMIST trial revealed that for women starting in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment, no substantial differences exist in first cycle and cumulative live birth rates between an antral follicle count (AFC)-based individualized follicle-stimulating hormone (FSH) dose and a standard dose. Female age and body weight have been suggested to cause heterogeneity in the effect of FSH dose individualization. The objective of the current study is to evaluate whether these patient characteristics modify the effect of AFC-based individualized FSH dosing in IVF/ICSI treatment. MATERIAL AND METHODS: A secondary data-analysis of the OPTIMIST trial. Women initiating IVF/ICSI treatment were classified as predicted poor (AFC 0-7), suboptimal (AFC 8-10) or hyper responders (AFC >15), and randomly allocated to a standard FSH dose (150 IU/d) or an individualized FSH dose (450, 225 or 100 IU/d for predicted poor, suboptimal and hyper responders, respectively). In each predicted response category, logistic regression models with interaction terms were used to evaluate the presence of effect modification. The first cycle was analyzed, and the primary outcomes were first complete cycle live birth rate (including fresh plus frozen-thawed embryo transfers) and ovarian hyperstimulation syndrome (OHSS) risks. RESULTS: No effect modification was revealed in the predicted poor (n = 234) and suboptimal (n = 277) responders. In the predicted hyper responders (n = 521), the effect of the individualized FSH dose on the first cycle live birth rate was modified by female age (P = 0.02) and the effect on OHSS risks was modified by body weight (P = 0.02). A dose reduction from 150 to 100 IU/d generally decreased the OHSS risks in predicted hyper responders, but also reduced the chance of a live birth in young women, and had no beneficial impact on OHSS risks in women with a relatively low body weight. CONCLUSIONS: In women with a predicted hyper response undergoing IVF/ICSI treatment, female age and body weight seem to modify the effect of FSH dose individualization. Although a reduced FSH starting dose generally decreases the OHSS risks, it may also reduce the chance of a live birth, specifically for young women. Future studies could consider these findings when investigating the optimal approach to reduce OHSS risks while maintaining the probability of a live birth for predicted hyper responders in IVF/ICSI treatment. SN - 1600-0412 UR - https://www.unboundmedicine.com/medline/citation/31127607/Do_female_age_and_body_weight_modify_the_effect_of_individualized_FSH_dosing_in_IVF/ICSI_treatment_A_secondary_analysis_of_the_OPTIMIST_trial_ L2 - https://doi.org/10.1111/aogs.13664 DB - PRIME DP - Unbound Medicine ER -