Individualization of the starting dose of follitropin delta reduces the overall OHSS risk and/or the need for additional preventive interventions: cumulative data over three stimulation cycles.
RESEARCH QUESTION
Is individualization of dosing with follitropin delta in sequential ovarian stimulation cycles an effective preventive strategy for ovarian hyperstimulation syndrome risk? If so, for which patients does an individualized strategy provide the greatest OHSS risk reduction and/or the need for additional preventive interventions?


DESIGN
A secondary analysis of three ovarian stimulation cycles in IVF/intracytoplasmic sperm injection patients included in one randomized, assessor-blinded trial comparing two recombinant FSH preparations (ESTHER-1, NCT01956110), and a second trial in women undergoing up to two additional cycles (ESTHER-2, NCT01956123). Of 1326 women (aged 18-40 years) randomized and treated with follitropin delta or alfa in cycle 1, 513 continued to cycle 2 and 188 to cycle 3. Follitropin delta and alfa doses were maintained/adjusted according to ovarian response in the previous cycle.


RESULTS
Individualized dosing with follitropin delta significantly reduced moderate/severe OHSS and/or preventive interventions (P=0.018) versus conventional dosing with follitropin alfa in patients undergoing up to three ovarian stimulation cycles. The greatest benefit was observed in patients in the highest anti-Müllerian hormone (AMH) quartile (P=0.012). On evaluating separately, individualized dosing with follitropin delta significantly lowered the incidences of moderate/severe OHSS (P=0.036) and preventive interventions (P=0.044) versus follitropin alfa.


CONCLUSION
An individualized follitropin delta dosing regimen decreased the risk of moderate/severe OHSS as well as the incidence of preventive interventions versus a conventional follitropin alfa regimen. An analysis per AMH quartile indicated that these statistically significant differences are driven mainly by patients with the highest pretreatment AMH levels.
['Fernández-Sánchez|Manuel|M|', 'Visnova|Hana|H|', 'Yuzpe|Albert|A|', 'Klein|Bjarke Mirner|BM|', 'Mannaerts|Bernadette|B|', 'Arce|Joan-Carles|JC|', '|||']
D000293:Adolescent D000328:Adult D015925:Cryopreservation D003627:Data Interpretation, Statistical D005260:Female D005307:Fertilization in Vitro D043373:Follicle Stimulating Hormone, Human D006801:Humans D016471:Ovarian Hyperstimulation Syndrome D010053:Ovary D010062:Ovulation Induction D011994:Recombinant Proteins D012306:Risk D020554:Sperm Injections, Intracytoplasmic D016896:Treatment Outcome D055815:Young Adult
Follitropin delta OHSS Preventive interventions Ovarian stimulation Anti-Müllerian hormone GnRH agonist triggering