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Hum. Reprod. Advance Access published online on December 9, 2004
Human Reproduction, doi:10.1093/humrep/deh663
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Human Reproduction © European Society of Human Reproduction and Embryology 2004; all rights reserved
Received January 5, 2004
Revised September 7, 2004
Accepted November 19, 2004

Article

Expected poor responders on the basis of an antral follicle count do not benefit from a higher starting dose of gonadotrophins in IVF treatment: a randomized controlled trial*

E.R. Klinkert 1*, F.J.M. Broekmans 1, C.W.N. Looman 2, J.D.F. Habbema 2, and E.R. te Velde 1

1 Department of Reproductive Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
2 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

* To whom correspondence should be addressed.
E.R. Klinkert, E-mail: e.r.klinkert{at}azu.nl


  Abstract

BACKGROUND: The aim of this study was to evaluate the effect of doubling the starting dose of gonadotrophins on the ovarian response in IVF patients with a low antral follicle count (AFC). METHODS: Fifty-two patients with an AFC of <5 follicles of 2-5 mm diameter before starting their first IVF cycle participated in this randomized controlled trial. They were randomized by opening a sealed envelope, receiving either 150 IU (group I, n=26) or 300 IU (group II, n=26) of rFSH as a starting dose. The main outcome measures of the study were number of oocytes, poor response (<4 oocytes at retrieval or cancellation due to insufficient follicle growth) and ongoing pregnancy (12 weeks of gestation). RESULTS: The groups were comparable regarding patient characteristics and outcome of the IVF treatment. The median number of oocytes collected was 3 for both groups (P=0.79). The difference in the mean number of oocytes was 0.3 oocytes in favour of group I (P=0.69). Sixty-five per cent of the patients in group I experienced a poor response and 62% in group II. The ongoing pregnancy rate was 8% in group I and 4% in group II (P=0.55). CONCLUSIONS: Expected poor response patients, defined as patients with an AFC <5, are not likely not to benefit from a higher starting dose of gonadotrophins in IVF.

Keywords: antral follicles; gonadotrophin dose; IVF; poor response; randomized study.

*Presented in part as an oral presentation at the 19th annual meeting of the ESHRE in Madrid, July 1, 2003.


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