Do female age and body weight modify the effect of individualized FSH dosing in IVF/ICSI treatment? A secondary analysis of the OPTIMIST trial. (21st June 2019)

• Record Type: Journal Article
• Authors: Leijdekkers, Jori A.; van Tilborg, Theodora C.; Torrance, Helen L.; Oudshoorn, Simone C.; Brinkhuis, Egbert A.; Koks, Carolien A. M.; Lambalk, Cornelis B.; de Bruin, Jan Peter; Fleischer, Kathrin; Mochtar, Monique H.; Kuchenbecker, Walter K. H.; Laven, Joop S. E.; Mol, Ben Willem J.; Broekmans, Frank J. M.; Eijkemans, Marinus J. C.
• Other Names: van Golde Ron J. T. investigator.; Verhoeve Harold R. investigator.; Nap Annemiek W. investigator.; Scheffer Gabrielle J. investigator.; Manger A. Petra investigator.; Hoek Annemieke investigator.; Schoot Bendictus C. investigator.; Oosterhuis G. Jur E. investigator.; Sluijmer Alexander V. investigator.; Friederich Jaap investigator.; Verhoeff Arie investigator.; van Hooff Marcel H. A. investigator.; van Santbrink Evert J. P. investigator.; Smeenk Jesper M. J. investigator.; Kwee Janet investigator.; de Koning Corry H. investigator.; Groen Henk investigator.; van Wely Madelon investigator.
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 98:Number 10(2019)
• Page Start: 1332
• Page End: 1340
• Publication Date: 2019-06-21
• Subjects: antral follicle count -- body weight -- effect modification -- female age -- in vitro fertilization/intracytoplasmic sperm injection -- individualized follicle‐stimulating hormone dosing -- live birth -- ovarian hyperstimulation syndrome; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.13664
• Languages: English
• ISSNs: 0001-6349

Abstract

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.