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Hum. Reprod. Advance Access originally published online on July 27, 2006
Human Reproduction 2006 21(11):2941-2947; doi:10.1093/humrep/del259
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Timing of FSH administration for ovarian stimulation in normo-ovulatory women: comparison of an early or a mid follicular phase initiation of a short-term treatment

I. Cedrin-Durnerin1,3, N. Massin1, J. Galey-Fontaine1, H. Bry-Gauillard1, M. Roger2, N. Lahlou2 and J.N. Hugues2

1 Centre for Reproductive Medicine—Jean Verdier Hospital, Bondy Cedex, AP-HP, University Paris XIII and 2 Hormonal Biology, Saint Vincent de Paul Hospital, AP-HP, University Paris VI, Paris, France

3 To whom correspondence should be addressed at: Service de Médecine de la Reproduction, Hôpital Jean Verdier, Avenue du 14 Juillet, 93 143 Bondy Cedex, Bondy, France. E-mail: isabelle.cedrin-durnerin{at}jvr.ap-hop-paris.fr

BACKGROUND: In normo-ovulatory infertile women undergoing mild ovarian stimulation out of IVF, FSH stimulation regimen must be carefully adjusted to control the number of recruited follicles and to prevent multiple pregnancies. The aim of this prospective study was to assess the effect of the timing of FSH administration (fixed dose and duration) on the number of large follicles. METHODS: Women were prospectively randomized by means of sealed envelopes to receive daily 112.5 IU recombinant FSH (rFSH), either from cycle day (CD) 2–6 (Group A) or from CD 7–11 (Group B). Hormonal measurements and follicular ultrasound assessments were performed on CD 2, 7 and 12. RESULTS: On CD 12, the development rate of exactly two follicles ≥14 mm in diameter was significantly lower in Group A than in Group B (4% of women versus 42%, P = 0.002). Although the pattern of serum estradiol (E2) concentrations in Group A displayed a plateau from CD 7, the cancellation rate for overstimulation (more than three follicles ≥14 mm in diameter) was significantly increased (P = 0.009). CONCLUSIONS: Preventing the closure of the FSH window by mid to late follicular phase FSH administration better fulfils the objective of obtaining a limited number of large follicles than surpassing the FSH threshold by an early administration.

Key words: follicle development/FSH administration/ovarian stimulation/ovulatory women


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