TY - JOUR
T1 - Low dose HP-hMG in an antagonist protocol for IVF in ovulatory and anovulatory patients with high AMH
AU - Sopa, Negjyp
AU - Larsen, Elisabeth Clare
AU - Nyboe Andersen, Anders
PY - 2018/7
Y1 - 2018/7
N2 - Women with high-AMH levels have an increased risk of ovarian hyperstimulation syndrome (OHSS). Studies have suggested that highly purified menotropin (HP-hMG) Menopur® reduces the risk. We, therefore, studied use of low-dose (112.5 IU/day) HP-hMG in ovulatory and anovulatory patients with high AMH (>32 pmol/L). The primary endpoint was the distribution of patients with appropriate, excessive, and inadequate response (5-14, ≥15, and ≤4 oocytes). Another endpoint was frequency of OHSS. Totally 115 women were included and 78 (67.8%) had an appropriate, 8 (7.0%) an excessive, and 29 (25.2%) an inadequate response. The number of oocytes was independent on AMH levels and ovulatory status but declined significantly with increasing bodyweight (R2 = 0.07, p < .01). The ongoing pregnancy rate per started cycle was 47.0%. Three (2.6%) developed OHSS, two had cancelation of the cycle and seven patients had GnRH agonist triggering to prevent OHSS. Selective use of a low dose of HP-hMG in patients with high levels of AMH provides 5-14 oocytes in more than two-thirds of the patients and is safe with low risk of OHSS. The number of aspirated oocytes was independent of AMH levels and ovulatory status, but inversely related to body weight.
AB - Women with high-AMH levels have an increased risk of ovarian hyperstimulation syndrome (OHSS). Studies have suggested that highly purified menotropin (HP-hMG) Menopur® reduces the risk. We, therefore, studied use of low-dose (112.5 IU/day) HP-hMG in ovulatory and anovulatory patients with high AMH (>32 pmol/L). The primary endpoint was the distribution of patients with appropriate, excessive, and inadequate response (5-14, ≥15, and ≤4 oocytes). Another endpoint was frequency of OHSS. Totally 115 women were included and 78 (67.8%) had an appropriate, 8 (7.0%) an excessive, and 29 (25.2%) an inadequate response. The number of oocytes was independent on AMH levels and ovulatory status but declined significantly with increasing bodyweight (R2 = 0.07, p < .01). The ongoing pregnancy rate per started cycle was 47.0%. Three (2.6%) developed OHSS, two had cancelation of the cycle and seven patients had GnRH agonist triggering to prevent OHSS. Selective use of a low dose of HP-hMG in patients with high levels of AMH provides 5-14 oocytes in more than two-thirds of the patients and is safe with low risk of OHSS. The number of aspirated oocytes was independent of AMH levels and ovulatory status, but inversely related to body weight.
KW - Adult
KW - Anovulation/blood
KW - Anti-Mullerian Hormone/blood
KW - Dose-Response Relationship, Drug
KW - Female
KW - Fertilization in Vitro/methods
KW - Gonadotropin-Releasing Hormone/antagonists & inhibitors
KW - Hormone Antagonists/administration & dosage
KW - Humans
KW - Menotropins/administration & dosage
KW - Ovarian Hyperstimulation Syndrome/prevention & control
KW - Ovulation/blood
KW - Ovulation Induction/methods
KW - Pregnancy
KW - Pregnancy Rate
U2 - 10.1080/09513590.2018.1428302
DO - 10.1080/09513590.2018.1428302
M3 - Journal article
C2 - 29345163
SN - 0951-3590
VL - 34
SP - 623
EP - 626
JO - Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
JF - Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
IS - 7
ER -