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Hum. Reprod. Advance Access published online on March 26, 2008
Human Reproduction, doi:10.1093/humrep/den089
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© The Author 2008. 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
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed: the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given: if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative word this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Predicting the FSH threshold dose in women with WHO Group II anovulatory infertility failing to ovulate or conceive on clomiphene citrate

Anders Nyboe Andersen1,5, Adam Balen2, Peter Platteau3, Paul Devroey3, Lisbeth Helmgaard4, Joan-Carles Arce for the Bravelle Ovulation Induction (BOI) Study Group4

1 Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark 2 Department of Obstetrics and Gynaecology, Leeds General Infirmary, Leeds, UK 3 Center for Reproductive Medicine, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium 4 Ferring Pharmaceuticals A/S, Obstetrics and Gynaecology, Clinical Research and Development, Copenhagen, Denmark

5 Correspondence address. E-mail: anyboea{at}rh.dk

BACKGROUND: The objective of this investigation was to establish independent predictors of follicle-stimulating hormone (FSH) threshold dose in anovulatory women undergoing ovulation induction with FSH preparations.

METHODS: One hundred and fifty-one patients with WHO Group II anovulatory infertility failing to ovulate or conceive on clomiphene citrate underwent ovarian stimulation with FSH-only preparations following a low-dose step-up protocol. The individual FSH threshold dose was defined as the FSH dose when meeting the human chorionic gonadotrophin criteria (one follicle ≥17 mm, or 2–3 follicles ≥15 mm). The influence of demographics, physical characteristics, obstetric and infertility and menstrual cycle history, ovarian ultrasonography, endocrine parameters and type of gonadotrophin preparation on the FSH threshold dose was assessed through multiple regression analysis.

RESULTS: In the univariate analysis, age, body mass index (BMI), failure to ovulate with clomiphene citrate, menstrual cycle history (amenorrhea, oligomenorrhea or anovulatory cycles of 21–35 days), mean ovarian volume, LH/FSH ratio, testosterone and free androgen index were significant (P < 0.05) predictors of FSH threshold dose. In the multivariate analysis, menstrual cycle history, mean ovarian volume and BMI remained significant (P < 0.001).

CONCLUSIONS: The individual FSH threshold dose for ovulation induction in anovulatory women can be predicted based on three variables easily determined in clinical practice: menstrual cycle history, mean ovarian volume and BMI. A FSH dosage nomogram was constructed based on these parameters.

Key words: anovulation/follicle-stimulating hormone/threshold dose/predictors/efficiency

Submitted on November 15, 2007; resubmitted on February 13, 2008; accepted on February 28, 2008.


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